Change is coming to rural health care, whatever the Supreme Court decides

DULUTH -- Whether the U.S. Supreme Court confirms or strikes down portions of the federal Affordable Care Act later this week, change is coming to rural health providers, Bill Finerfrock, executive director of the National Association of Rural Health Clinics, said here this morning. He was speaking to a packed house and kicking off the annual Minnesota Rural Health Conference, which runs through tomorrow.

His advice to rural health care providers: Don't sit back waiting for the system to sort itself out after the high court rules.

The conference will cover a wide range of topics, from meeting electronic health records standards to the challenges inherent in providing obstetrical services to counties with few physicians and sparse populations. But the overarching theme is change, much of it related to federal health care reform.

Finerfrock called the anticipated Supreme Court ruling, "the most anticipated judicial decision since the O.J. Simpson trial."

He was willing to make some predictions, suggesting that the individual mandate, that is the requirement that everyone have insurance or face penalties, would be struck down. But, he thought a provision that expands Medicaid to more people would stand. Striking down the mandate would set off a flurry of activity in Congress, he said, but the flurry would largely be put off until next year, after the election. "Nobody wants to make decisions right now," he said.

Many of the pieces that make rural health care work are in play, he suggested, including how physicians are reimbursed by the federal government for some services. If these fees are reduced, as has been proposed, he said it will be harder for doctors to make ends meet.

It all comes down to money, Finerfrock said. How does a rural hospital or clinic ensure it has enough dollars to keep the doors open, especially with costs increasing and so much funding going to urban areas? How do you make sure a primary care provider on the Iron Range can continue to do her job? "The status quo is not sustainable as a business model," he said.

The ground is shifting so fast in the health care realm, it's hard to know the exact way forward. But he said some of the provisions of reform, such as the emphasis on collaborative care and various attempts at cost control, will be pushed by the private market no matter what. Things will not go back to the way they've been.

Even if the Supreme Court rules some part of the law unconstitutional, he said, "I don't think it will derail the move forward toward change. It's not prudent for health organizations to sit back and wait. Reform will continue to move and evolve. The push toward more integrated models will continue to occur. The notion that individual hospitals [and other providers] will exist as islands is probably not realistic."

He did note that rural providers, because of sparse local populations and distances between communities, will have a hard time fitting into these new, more collaborative models. This could lead to the "Walmartization" of health care, where services are provided more efficiently, presumably by larger and larger organizations, but where people have to travel farther for services because very local providers cease to exist. "If health care isn't accessible," he said, "it's not a good system."

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