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Question: How do you spell “rural regulatory relief?”

Answer: By providing a permanent extension of the enforcement instruction on unreasonable supervision requirements for outpatient therapeutic services in critical access and small rural hospitals. 

In what some are seeing as a wrong being addressed – if not finally righted – and at perhaps one of the most vulnerable times for healthcare in rural America in history, with nearly 30 percent of the country’s rural hospitals being at risk of closing in the next two years, the U.S. House of Representatives Ways and Means Committee advanced a measure to provide regulatory relief to rural hospitals in a markup on Thursday, July 7.

The bill (H.R. 5613, Continuing Access to Hospitals Act), first sponsored by rural champions Reps. Lynn Jenkins (R-Kan.) and Dave Loebsack (D-Iowa) on May 3, 2016, would preserve and protect patient access to healthcare in rural communities by temporarily delaying enforcement through 2017 of a regulation that would require physicians to directly supervise outpatient procedures. The measure was approved on a bipartisan basis through a voice vote.

Rural Highlights

  1. This bill addresses a regulation that isn’t realistic for rural access points such as critical access hospitals and rural hospitals, many of which are strapped for resources.
  2. It reinforces the importance for patients in rural areas to receive healthcare services in their own communities.
  3. It eliminates regulatory burdens on rural facilities.
  4. It lessens the stress already placed on physicians and non-physician practitioners in rural environments and sites that are already short-staffed.
  5. It keeps quality of care intact at rural facilities.
  6. It keeps cost of care in balance.

Next Action 

An amendment by Rep. Xavier Becerra (D-Calif.), which was adopted by voice vote, called for the Medicare Payment Advisory Commission/MEDPAC to submit a report analyzing the effect of the delay.

Third Time’s a Charm

Born from need, Congresswoman Jenkins first introduced the bill to protect access to healthcare in rural Kansas. Her recognition that Medicare’s cumbersome and nearly impossible enforcement of the direct supervision rule would debilitate the fabric of the rural healthcare network has been longstanding, and it led to a third introduction of legislation (H.R. 5164).

What’s Next:

Rural healthcare challenges persist, and as the Sheps Center for Health Services Research at the University of North Carolina has noted, 75 rural hospitals have closed since 2010 and one-quarter of the 673 such hospitals nationwide are at risk of closing in less than a decade. Not addressing “direct supervision,” whether temporary or permanently, would escalate the closings and continue to chisel away at theviability and lean margins of the small, rural hospitals, simply because increased healthcare delivery costs for care and the lack of available medical professionals to provide the direct supervision of outpatient care don’t equate to rural healthcare sustainability.   

If this bill passes, it would be a small victory for rural healthcare organizations, providers, patients, and communities, and for the organizations such as the National Rural Health Association (NRHA) and the American Hospital Association (AHA), which have been deliberate and continuous in advocating for what’s right for rural healthcare and for the rarity of bipartisanship agreement. These groups have urged lawmakers on both sides of the aisle to come together knowing that support of this bill is the right thing to do for the pockets of rural America that exist in every state.

We can’t hit the snooze button now, though; the next seven weeks is a time for an immediate call to action to optimize our time with members of Congress who have come back home to their respective constituencies for the congressional summer recess. Just as we round with patients in our rural hospitals, we must round with our Washington, D.C. representatives via meetings, letters, and on-site rural hospital invitations/visits to let them know up close and personal the lifeline this bill is to for rural hospitals.  

But remember, this is just a tourniquet.  And we can’t afford any more scars.  

About the Author

Janelle Ali-Dinar, PhD is a rural healthcare expert and advocate with more than 15 years of healthcare executive experience in many key areas addressing critical access hospitals (CAHs), rural health clinics (RHCs), physicians, and patients. Dr. Ali-Dinar is also a sought-after speaker on Capitol Hill.  A former hospital CEO and regional rural strategy executive, Janelle is a past National Rural Health Association Rural Fellow, Rural Congress member, and Nebraska Rural Health Association president. She is currently the Nebraska DHHS Chair of The Office of Minority Health Statewide Council, addressing needs of rural, public, minority, tribal, and refugee health, and she serves on the Regional Health Equity Region VII council as co-chair of rural health and partnerships. Janelle holds a master’s degree and doctorate in communications and recent graduate in public health leadership. Janelle is currently the vice president of rural health for MyGenetx.  

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