Treating Rural America
According to the National Rural Health Association, there are only 30 specialists for every 100,000 residents in rural areas, compared to 263 per 100,000 in urban communities.
These shortages mean that many patients must routinely drive long distances to see their doctors, or simply go without care. This leaves rural populations more vulnerable to developing more serious illnesses.
More than 15% of Americans — about 46 million — live in rural areas, but only 10% of doctors practice in these communities, many of whom are primary care and family physicians.
Rural hospitals and those with a big share of poor patients are already struggling due to insufficient Medicaid reimbursements, having to care for a high mix of uninsured patients and increasing costs.
Rural communities face big challenges
There are many reasons rural hospitals have had difficulty weathering these particular economic conditions. Many of these institutions face new challenges they have not yet been able to solve.
Hospitals cannot dictate prices to Medicare or Medicaid. They receive payments based on rates set by government entities.
Hospitals cannot control what it costs to protect electronic medical records from cyberattacks or purchase IV fluid after a natural disaster.
Hospital labor increases in 2023 alone were more than 10%.
Drug prices incurred by hospitals have increased dramatically, with one recent study showing that prices for nearly 2,000 drugs had an average increase of 15.2% from 2022 to 2023. Additionally, in 2023 there was an average of more than 300 drugs in shortage at any one time, further increasing costs to hospitals trying to navigate those shortages.
The hospital workforce was upended by the pandemic. To keep beds open and accessible to our communities, hospitals throughout Ohio have been forced to utilize contract labor at unprecedented levels. This shift has been devastating for hospital finances:
Though the reliance on contract labor has started to come down, it remains well above pre-pandemic levels and continues to strain hospitals’ budgets in service to their communities. This is especially true for rural hospitals, where the workforce pool is smaller, and it is more difficult to recruit staff.
As a result of the continuing economic pressures, credit rating agencies have a generally bleak outlook for the hospital community in recent years with downgrades outpacing credit ratings or upgrades by almost 2:1.
Ohio follows the trend
Ohio is a perfect example of a place where rural hospitals seem particularly vulnerable.
For many Ohioans, the local hospital they once knew operated at a loss in 2024. In fact, the generational economic challenges facing our hospitals have culminated in more than 50% of Ohio hospitals (and 72% of rural hospitals) reporting negative operating margins over the past few years. The median hospital operating margin was 0.0% in 2024, -0.7% in 2023 and -2.8% in 2022. The reasons for this poor economic performance are due to factors largely outside our members’ control.
Factors outside of Ohio Hospitals’ control:
On average, 17% of patients treated by Ohio hospitals are Medicaid patients and 49% are Medicare patients, which means reimbursement for a large proportion of care provided in Ohio hospitals is set at rates below the cost of providing those services.
In 2019, Ohio hospitals spent $280 million collectively on contract labor. In the five years since then, Ohio hospitals have spent nearly $6 billion on contract labor – equivalent to more than 21 years’ worth of pre-pandemic spending – to sustain operations and keep inpatient beds open and available to the public.
Understanding the Cause
Because a single hospital may serve a large and loosely connected area, providers find it difficult to manage resources efficiently among the population. At the same time, patients may lack convenient or affordable access to the care they need. Due to distance from a facility, rural patients may often miss routine appointments or, when they do need immediate care, have few options other than the emergency department (ED). In these communities, alternate forms of access are key to saving resources and ensuring viable patient options.
Those mismatches and circumstances out of control forces every rural doctor to tackle all sorts of cases and make the best use of their limited resources. In this short documentary, STAT explores why the shortage exists and shows what life is like for a doctor in Kansas who wears many hats and a physician in Illinois pondering retirement. This is the first video in a series that delves into rural medicine.
Rural Health is National Health
Rural Americans represent about 65 million people in the United States who have disproportionate incidents of heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Those living in rural communities face greater challenges accessing the care they need, which is why attention and resources continue to be dedicated to the critical issues surrounding rural medicine.
For some care episodes, in-person interaction is essential. In rural settings, patients may have problems getting to routine doctor visits, and simply not go to scheduled appointments, if they do not need immediate care. In urgent care situations, regardless of severity, these patients may have no choice but to use their closest ED.
Doctors are trained to treat all sorts of patients — whether they’re at the clinic, the hospital or a nursing home — and respond to the unique needs of rural patients.
Training with a Purpose
These rural training programs provide a much-needed supply of doctors to critically underserved rural communities. Multiple studies show that physicians who train in a rural area are much more likely to stay and practice in a rural community. There are now over 160 accredited rural training programs according to The RTT Collaborative, a cooperative of rural residency programs.
The second installment of STAT’s rural health series explores why these programs are so effective at training rural doctors and the barriers that prevent rural medical education from growing.
Digital access and telehealth
Access to high-speed internet is vital for a diverse set of industries, including modern communications between rural American households, schools, and healthcare centers as well as markets and customers around the world.
Unfortunately, 22.3% of Americans in rural areas and 27.7% of Americans in Tribal lands lack coverage from fixed terrestrial 25/3 Mbps broadband, as compared to only 1.5% of Americans in urban areas, according to a recent report by the Federal Communications Commission.
Improving this disparity would help close the gap in care for rural and urban communities. Access to high-speed internet means access to information, video appointments, and communications across the board.
Tracking Digital Equity
Who in the United States has internet access, suitable devices and digital skills — and who doesn’t — is at the heart of digital equity.
The Digital Equity Act Population Viewer, an interactive map that shows broadband availability and use alongside demographics in every state.
The map shows the number of people who are members of the “covered populations” in the United States as defined by the Digital Equity Act, as well as the percentage of the population that lives in places where fixed broadband is unavailable, lives in households that lack a computer or broadband, and the percentage not using the internet, a PC or tablet.
This map and the underlying data are the product of a collaboration between the Census Bureau and the National Telecommunications and Information Administration (NTIA).
Telehealth
Many telehealth services entail manageable costs supplemented by public and private payers, though providers and patients may need to identify those services. For example, remote patient monitoring can help allocate and prioritize resources more effectively than not. Remote video visits or artificial intelligence chat functions that act as triage can be effective ways to assess the issue.
While telehealth offerings are growing in both scope and capacity, rural patients may not be positioned to take advantage of them. They may not know these alternatives exist, have the reliable and capable internet access they need to use them or be able to determine what the best solution is for them.
Many medical locations have ramped up their telehealth offerings in an effort to bridge this gap. With hundreds of miles between them and their patients, they’re using virtual appointments and remote monitoring technologies to make sure everyone is able to access care.
Part three of our short documentary series on rural health focuses on how Newman and his colleague, OB-GYN Johnna Nynas, are using technology to offset major obstacles to health care access in their region.
ClaimLinx Solution
ClaimLinx started with a simple mission: help companies save on their health insurance. Hear directly from the person that pioneered the Solution that has saved small business owners millions.
Rural businesses often face particular challenges for their health insurance needs. Costly care equates to costly premiums and services. The ClaimLinx Solution was designed for rural businesses — operations that often run on the slimmest margins while employing people with the greatest need. Savings on the health plan create an opportunity for better care, including adding telehealth services to the plan offerings.
The ClaimLinx Solution combines traditional group insurance with a self-funded plan. It allows owners to take advantage of the assets inherent in a plan with a major medical carrier, without throwing money away on medial services employees aren’t using.
How This Strategy Saves Money
A high-deductible health plan lowers the monthly premiums for each employer. Instead of paying $1,000 per month for a family’s coverage, an employer might pay $700.
The MERP continues the savings because it’s a tax deduction. Every time an employer reimburses an employee’s medical expenses, it lowers the amount of money the IRS figures into business taxes. Business owners not only pay lower income taxes, but also they lower onboarding costs by retaining employees for longer periods of time.
Employees who remain healthier are more productive and miss less work. ClaimLinx shows you how we deliver for both business owners and employees with our full-service insurance strategy.
The ClaimLinx Solution Fits You
The ClaimLinx Simple Option Solution plan is different for each client. The self-funded plan is customized for each company. ClaimLinx chooses each high-deductible to fit each clients specific needs. It’s a way to provide great benefits without paying high premiums to a health insurance company for services employees are not using.
ClaimLinx offers the ClaimLinx Solution to help lower your health insurance rates. Our experienced health benefits consultants can find you the best possible rates on employer-paid benefits while also educating your workers on how to save money on healthcare costs. Schedule a Meeting or call toll-free 1-800-858-1772 to see what we can do.
