This analysis was prepared by McDermott+ Consulting, on behalf of AACOM.

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PURPOSE 

The purpose of this hearing was to examine the current state of rural healthcare in the U.S., specifically addressing the challenges faced by healthcare organizations and physicians serving rural areas. The hearing emphasized the importance of improving healthcare access in rural areas and explored potential solutions to bridge the healthcare coverage gap. The discussion included provider shortages, infrastructure decline, the impact of rural hospital closures, the significance of telehealth access, the role of value-based care models, and the necessity for policy strategies that consider the unique challenges and assets of rural America.

MEMBERS PRESENT

Chairman Cardin, Ranking Member Daines, Senators Stabenow, Carper, Casey, Whitehouse, Cortez Masto, Grassley, Lankford, Barrasso, Thune, and Blackburn

WITNESSES

• Erin Aune, MBA, CRHCP, Vice President of Strategic Programs, Frances Mahon Deaconess Hospital, Glasgow, MT
• Sara Rich, President And CEO, Choptank Community Health System, Denton, MD
• David Herman, MD, CEO, Essentia Health, Duluth, MN
• Mark Holmes, Director, Cecil G. Sheps Center or Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, NC

KEY TAKEAWAYS

• Rural areas make up a sizable portion of the population, and access to healthcare providers is limited, especially for specialty and behavioral health services. 
• Rural communities face significant challenges in accessing healthcare, including limited access to providers, long travel distances, and the closure of rural hospitals. These challenges contribute to disparities in health outcomes and access to care between rural and urban areas.
• Rural healthcare providers have created and implemented various innovative solutions to address healthcare gaps in rural communities. Examples include the use of telehealth services, school-based health centers, mobile facilities, and community partnerships. These solutions aim to improve access, overcome workforce shortages, and provide comprehensive care closer to patients' homes.
• Telehealth is a vital aspect of rural healthcare, and infrastructure support, including broadband connectivity, is necessary to expand telehealth services in rural communities.
• Financial stability and reimbursement issues pose challenges for rural health clinics and hospitals, impacting their ability to provide comprehensive care.

RELEVANT DISCUSSION

• Ranking Member Daines (R-MT) explained shortages of healthcare providers have a significant impact on rural communities, where the pool of potential hires is much smaller compared to urban areas. 
• Senator Stabenow (D-MI) shared her efforts to advance legislative initiatives aimed at expanding the behavioral health workforce. She mentioned successfully creating Graduate Medical Education (GME) slots for psychiatrists. She then asked whether a physician bonus payment for rural areas could help attract and retain more providers in rural clinics. Ms. Rich expressed that any incentive to encourage providers to work in rural communities is beneficial. However, she also emphasized the importance of fostering a strong connection between providers and the communities they serve, which has proven to be successful in their efforts.
• Sen. Lankford (R-OK) explained that the costs of medical supplies cost the same everywhere, and that the current system financially punishes physicians and care facilities for serving in rural communities. He asked if partnerships with educational institutions have been successful in recruiting workforce long term. Ms. Rich explained that Choptank has found success with these types of initiatives but the challenges of this is that they take time, but there is still a critical shortage of providers in rural areas and long-term programs are not solving the problems they are having now but it is a long-term solution.
• Senator Carper inquired about the success demonstrated by expanding provider training at rural health facilities in addressing workforce needs. Dr. Holmes highlighted the Rural Residency Planning and Development Program implemented by the Health Resources and Services Administration (HRSA). This program has led to the creation of more residency slots in rural areas, increasing the likelihood of providers staying in those regions after completing their residencies. Dr. Herman further explained that to treat patients effectively and efficiently, the workforce will require innovative approaches and solutions.
• Senator Barrasso (R-WY) inquired about the potential impact of legislation focused on rural healthcare workforce development on health outcomes in rural America. Dr. Holmes responded by discussing two significant factors that strongly influence rural practices: being from a rural area and receiving training in a rural setting. He suggested that an initiative to expand rural practice would result in more trainees providing care, leading to a workforce that is more attuned to rural needs and more likely to practice in rural areas. Continuing the discussion, Senator Barrasso asked about the necessary federal policies to safeguard critical healthcare facilities from closure in rural areas. Dr. Herman shared their success in involving communities in the recruitment process, which helps providers feel valued and more inclined to remain in the area. Senator Barrasso inquired about any barriers posed by local and state legislation to expanding the healthcare workforce. Dr. Herman explained that sometimes regulations hinder health systems from utilizing available resources effectively. Dr. Holmes further emphasized the importance of team-based healthcare as the direction in which the workforce needs to progress.
• Senator Blackburn (R-TN) asked about the closures of rural hospitals and how health centers are addressing the resulting gap in healthcare provision within those communities. Dr. Herman explained that health systems are striving to support rural hospitals by offering integrated care and utilizing the financial and technical infrastructure of the entire health system. This approach has significantly increased the sustainability of rural hospitals within the Essentia system. Dr. Herman also acknowledged that while there have been instances of fraud related to telehealth, regulations that restrict the use of telehealth in rural communities hinder citizens' ability to access necessary care.