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‘Value versus volume’ necessary for vast gaps in rural health care

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(The Center Square) – Rural communities continue to struggle with the changing health care landscape across Pennsylvania’s vast and sparsely populated regions.

It’s an issue that leaves residents hours from medical facilities, sometimes at the risk of life or death.

The House Subcommittee on Health Facilities met this week to hear testimony that could provide insight on ways the state could keep hospitals and clinics open where they are needed most.

“We’re facing a real crisis of access in our rural communities as we see the continuation of the kind of forces that are bringing on the rapid consolidation that doesn’t always mean we’re improving access to health care,” said Majority Chairman Rep. Dan Frankel, D-Pittsburgh.

Rural Pennsylvanians suffer from higher rates of several preventable diseases, like obesity and tobacco use, though the opioid epidemic still claims the most lives in the region.

These communities also have older populations and a higher percentage of people living with disabilities.

Basic needs like maternity care, good nutrition and dental care are often out of reach, eroding the foundations of community health.

Recent years have seen massive networks like UPMC and Penn State Health gobble up local providers. Meanwhile, independent hospitals have shuttered their doors, unable to provide the staffing and infrastructure required to operate.

Michael Makosky, President and CEO of Fulton County Medical Center, highlighted some of the pressures specific to independent hospitals. Major pain points include recruitment and retention as well as the need for efficient and secure systems of electronic recordkeeping and telehealth access to specialists in other locations.

“The most important aspect for us to remain independent is to keep the decision-making within our local community,” said Makosky. “We are, however, realists, living real-life struggles to survive in this challenging healthcare environment and my board understands that affiliation is inevitable at some point in the future.”

Some hospitals have seen great success joining forces with their larger counterparts, though testifiers emphasized that positive outcomes are most likely when the local hospital comes to the table before there is an imminent threat of closure.

One success story is Punxsutawney Area Hospital, which began partnering with neighboring Indiana Regional Medical Center over a decade ago. Since formally affiliating in 2020, President Jack Sisk has noted increased revenue and services.

One major advantage to cooperation between hospitals is tackling the ever-changing, costly tangle of billing and payment. Denials from insurance companies create exorbitant back-end administrative costs for financial departments navigating the demands of private and government-based insurance systems.

That’s where the work of programs like the Rural Health Redesign Center can fill the gap. The center was created in 2020 and oversees the Pennsylvania Rural Health Model, a partnership with the federal government to create rural health sustainability.

Janice Walters, the center’s executive director, described a global budget model that emphasized value over volume. This ensures that rural hospitals aren’t penalized when fewer people are sick and incentivize preventative care measures that keep people out of the emergency room.

“Innovating new payment models is key to solving the rural health crisis. Medical insurance companies and payers really serve as the judge, jury, and the executioner when it comes to payments to hospitals,” said Makosky. “If payers would simply pay hospitals fairly and eliminate the denial and certification games and regulations were updated and streamlined, all hospitals, not just rural hospitals, would have a fighting chance.”

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