Protecting Rural Healthcare: Advocating to Keep Our Nation’s Heartland Healthy


Health care reform is currently sweeping the nation but many don’t stop to take rural America into consideration when talking about healthcare policy issues facing our country. Rural communities face an entirely unique set of factors and healthcare in these areas is drastically different than healthcare in urban or suburban cities.

What are the top issues affecting rural healthcare in America right now? Let’s break them down below.

Workforce Shortages

Did you know that even though 17 percent of Americans live in rural or remote parts, only 9 percent of physicians practice in rural areas? Ease of access to healthcare in urban areas is typically not an issue; however, in rural America it continues to become harder and harder every day as more health professionals prefer urban lifestyles and amenities over rural landscapes and communities. In fact, the patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians to 100,000 in urban areas. These shortages and uneven distribution are similar for dentists, pharmacists, nurse practitioners and emergency medical services. 

Another startling statistic shows if you have a health emergency but are more than 30 minutes from the nearest hospital, you have a 46 percent mortality rate compared to 21 percent if you live less than 30 minutes from a hospital. Couple these statistics with the reality that rural hospitals and healthcare providers simply cannot afford to hire the amount of needed doctors for their communities, and it’s a complete recipe for poor health outcomes.

Therefore, how do we convince doctors and health professionals to stay, live and work in rural communities? While there are multiple solutions being debated in the industry, a couple of solutions include:

  • Physician Loan-Forgiveness Programs- these programs allow for new residents and doctors to work in a Health Professional Shortage Area (HPSA) after graduation in exchange for tuition and stipend reimbursement from the federal government. One goal of these programs is to encourage physicians to stay working in the HPSAs even after the program is completed. Some of these include the Students to Service Program and the NHSC Scholarships.
  • Skills/Training Programs and Centers- there are various programs that recruit, train and provide financial assistance to health professionals looking to work in underserved communities. Some of these include the National AHEC Organization and HRSA Health Workforce grants.
  • Telehealth/Telemedicine- with the use of telemedicine and telehealth technologies, rural communities can increase access to care for their patients by bringing in specialty physicians remotely. From Tele-ICU to telemental health, telemedicine has already been proven to lead to better health outcomes and is highly beneficial to the patients often decreasing driving time and time away from work for health-related appointments.
  • Recruitment Reimbursement- one policy rural healthcare organizations are pushing for to help keep physicians in rural areas makes recruitment costs for hiring and retaining physicians reimbursable by the government. If these costs were eligible for reimbursement, it would help remote, rural hospitals and providers be able to afford the costs of hiring the healthcare workers they need most.

Rural Hospital Closures

One of the most frightening, negative impacts from the rural health care crisis has been the recent closures of dozens of rural hospitals across the country. In fact, the North Carolina Rural Health Research Program (NCRHRP) tracked 80 rural hospitals closures between January 2010 and November 2016, finding most of them occurring throughout the South. Texas saw 13 hospital closures in that time period, the most of any state. A 2016 study identified over 650 rural hospitals vulnerable to closure in 42 states with 38 percent of 1,332 Critical Access Hospitals (CAH) operating at a financial loss.

Hospital closures can wreck rural communities forcing residents to seek care further away or move away from an area that can no longer provide for their medical needs.

There are numerous factors into why rural hospitals are shutting down, from decreased Medicaid reimbursements and certain Affordable Care Act (ACA) regulations to large uninsured and under-insured patient populations. But, what can the industry do to prevent hospital closures? Some argue that freestanding emergency centers (FECs) present a practical solution to the crisis while others believe telemedicine technology is the answer, and national organizations such as the National Rural Health Association (NRHA) are pushing for comprehensive policy reform with the Save Rural Hospitals Act.

Electronic Health Record Implementation & HIT

While electronic health records (EHR) provide numerous benefits to traditional paper records, the transition to digitize healthcare has been especially hard on rural healthcare providers. The American Recovery and Reinvestment Act of 2009 was truly the catalyst for wide-spread EHR adoption, providing $25 billion in funding from Health and Human Services (HHS) to promote and incentivize the use of EHR software. This established extensive Meaningful Use standards that required rural healthcare compliance in order to receive Medicare and Medicaid reimbursements.

In addition, with the rise of health IT came the demand for health IT workers to manage, monitor and secure their IT networks and environments. Long gone are the days of simple “PC technicians” to fix simple computer problems. Healthcare organizations need highly skilled, qualified and trained health IT professionals to ensure the safety and protection of the patient data living on their networks. As with healthcare workers, there is a significant health IT workforce shortage that isn’t going to be easily solved. Many organizations are training current employees to fill IT roles or outsourcing IT needs to 3rd party professional vendors, but the same factors are hindering this workforce shortage as rural HCPs have low budget and resources to recruit top talent.

Broadband Access

With the rise of EHR technology and federal mandates for its adoption came the increased need for robust, high-speed broadband networks to support digitized healthcare systems. EHRs, patient portals, telehealth technologies and scanning systems such as MRI and CAT scans produce large volumes of data that need enough bandwidth for proper transmission. The digitalization of healthcare has been revolutionary and ground-breaking for urban populations; whose broadband networking costs are significantly cheaper than rural network rates. This has created an urban-rural digital divide that is currently crushing rural providers who can’t cover the costs of necessary upgrades and networking requirements.

According to the FCC, fifty-three percent of rural Americans lack access to 25 Mbps/3 Mbps of bandwidth, the benchmark for internet speed. High-speed broadband has evolved into a basic infrastructure that everyone deserves, no matter how urban or rural. Bringing high-speed broadband to rural areas not only helps healthcare providers but the community as a whole. Broadband has the power to create local jobs, encourage rural innovation and help build investment in rural communities.

While there are numerous government programs designed to help fund general broadband access to rural and underserved communities, the Universal Service Fund’s (USF) Rural Health Care Program provides funding exclusively for rural healthcare provider broadband networks. The fund allows qualifying HCPs to receive broadband networks at the same cost as urban networks through funding reimbursements.

Do you want to take action and help support our rural healthcare providers and in turn, our rural communities that are the backbone of our nation? Here are a couple of fantastic organizations dedicated to advocating for rural healthcare policy, legislative and regulatory issues. They are on the frontlines fighting every day for American’s rural hospitals, behavioral centers, community health centers, and more.

Rural Health Care:

Telehealth Policy Resources: