Sentry Data Systems recently sponsored and attended two spring conferences with a focus on rural healthcare – the Texas Organization of Rural and Community Hospitals (TORCH) Annual Conference and Trade Show held in April in Dallas, and the National Rural Health Association (NRHA) Annual Conference held in May in Atlanta.
Sentry was pleased to engage with attendees and speakers at both events, on issues related to both 340B and healthcare analytics, at both the state and federal levels. While rural challenges are similar across all states in some ways, there are also unique events related to local funding and other state-specific programs that make it to important to be engaged at the state level as well.
State challenges – TORCH
The TORCH conference saw record-breaking attendance this year, with just over 700 participants, making it the largest state-based rural meeting in the US.
Social media engagement
We know that 20% of the US population lives in rural America, yet only 10% of US physicians practice in these underserved areas, which leads to challenges in providing needed services. As patient experience increasingly encompasses various types of digital engagement, rural hospitals have had to turn to social media to engage with patients, showcasing their involvement in the wellbeing of the community and their ability to be resourceful.
Employee participation in social media is a must, from the CEO to ancillary staff. Rural hospitals must monitor and actively poll their communities online, while still honoring their brand. As a rural hospital, while your organization may be small, your voice must be mighty. If you don’t control the message on social media, it will control you. 340B hospitals have heeded this advice by sharing the faces of 340B and its success stories with their community in ways that demonstrate the program’s necessity.
Texas hospitals have been challenged by several issues, including state funding, reduced disproportionate share hospital (DSH) payment strategies, and payers introducing new agreements that change/reduce reimbursement rates.
The DSH payments, while federal, have state-specific funding that will also be cut over the next several years. Finance matters were, therefore, a focus of the event, with particular attention paid to S-10 reporting.
Presumptive reporting approaches were also discussed, with a focus on how to identify patients up-front for cost reporting requirements. The conversation also addressed uninsured columns and rising instances of “insured charity,” in which patients are insured but still cannot afford to pay and the costs end up being written off as charity care. Charity policy discussions reminded hospitals to review and follow their policies,-including catastrophic language. Conference speakers emphasized the need to adhere to the low-income utilization rate (LIUR) of 20%.
While the Texas rural leaders gathered to discuss policy impacts, they also took time to build their leadership skills, focusing on who they were as decision makers. Leadership development company On-Demand Leadership reviewed seven things great leaders do differently. Leaders were challenged to ask the right questions, know the best times to NOT make decisions, identify high-growth versus low-growth needs staff, and help others see context.
Federal challenges – NRHA
Moving from the state impact of rural America to the federal impact at the recent NRHA conference, we see that there are many similarities. Rural hospitals are fortunate to have a federal agency, HRSA’s Office of Rural Health Policy, which works closely with the rural community to discuss policy challenges prior to actual implementation. It is well known that rural communities are unique in comparison to urban communities; rural America is fraught with provider shortages, hospital wage index disparities, maternal health decline, opioid epidemic effects and greater social risk factors that impact health.
The NRHA conference addressed these challenges, with input from leaders of the state offices of rural health policy, federal agencies including HRSA, CMS, and the CDC, and research organizations that focus on rural projects related to quality and finance strategies.
The CDC addressed opioid misuse/overuse and the increased incidence of death in preventable diseases in rural communities. In areas including cardiovascular, oncology, and HIV, rural communities have a staggering difference in health outcomes, resulting from unique challenges related to distance and availability of services and providers.
CMS administrator Seema Verma discussed drug pricing and the latest initiative to increase transparency, through the recently implemented requirement that television advertisements must include the price of drugs for any prescription medication that costs more than $35/month. Verma also emphasized the need for payment reform through avenues such as the innovations center, and more specifically, the need for rural healthcare transformation. Maggie Elehwany, NRHA’s VP Government Relations, explained this need for transformation, reminding us that there have been “over 100 hospital closures, in addition to 388 rural health clinic closures in rural America since 2012, with 46% of rural hospitals operating at a loss in 2019.”
CMS staff also held a session on health policy to discuss site-neutral payments, geographic reclassification, and the impact of Medicare Part B cuts to 340B. While 340B could not be addressed specifically, CMS did note that they had filed for an appeal of the latest ruling by Judge Contreras for the 2019 payment cuts that was announced that week.
The Washington Update provided a perspective on the future of rural healthcare from a funding standpoint, including additional closures to future legislation to address dental reform as a Medicare benefit. The panel also discussed appropriations for 2020 agencies, with focus on a partisan Congress that will concentrate on oversight hearings in the House and investigations in the Senate. It is clear that the rural communities and stakeholders have their sights set on a vision for improving quality, health outcomes, and the financial viability of rural providers.
Closing thoughts – rural voices matter
Sentry continues to support its rural hospital customers. We encourage our rural customers to utilize resources provided by organizations such as TORCH and NRHA, network with other rural hospitals to share ideas and reach out to Sentry with any concerns you may have. Whether your needs are 340B focused or you need a technology solution to support your cost accounting—we know that rural health systems’ resources are limited and having an expert like Sentry on hand can make all the difference in keeping your doors open another day to support your community.