Following nearly two years of pandemic life and the awkwardness of virtual gatherings, it’s been a busy spring for in-person conferences. After traveling to Chicago for the American College of Healthcare Executives annual congress, South Carolina for the Healthcare Finance Institute and then Sin City for the Asembia Specialty Pharmacy Summit, I capped the spring conference calendar with a visit to Albuquerque, N.M. to network with rural healthcare leaders, government officials, association leaders and vendors with a passion for rural healthcare.
We were pleased to engage with attendees and speakers at the National Rural Health Association annual meeting on issues related to both 340B and revenue cycle, at both the state and federal levels.
Some of the hot topics discussed:
- Protecting the 340B Drug Pricing Program, including efforts like the PROTECT 340B Act of 2021
- Manufacturer exclusions on 340B contract pharmacies and removal of orphan drug voluntary 340B pricing
- The prevalence of social determinants of health in rural communities
- The need for increased federal funding and reforms to improve quality and health outcomes
While rural healthcare challenges are similar across all states in many ways, there are also unique challenges related to local funding and other state-specific programs that make it so important to be engaged at the state level. Rural hospitals have a huge need for the 340B program, something we continue to acknowledge through our advocacy efforts.
As inflation continues to wreak havoc on the economy, rural hospitals are seeking alternative funding sources due to the loss of 340B savings from manufacturers restricting contract pharmacy access.
For rural facilities to remain open and care for the most vulnerable, the strategy for 340B must change. A hospital closing due to losses from the contract pharmacy exclusions or lack of 340B eligibility is unacceptable. Our rural communities deserve better.
Federal and state challenges
Rural communities know the importance of federal and state engagement. Rural hospitals are fortunate to have a federal agency, HRSA’s Office of Rural Health Policy, that works closely with the community to discuss policy challenges prior to actual implementation. It is well known that rural communities face challenges that are distinct from those in urban areas; rural America is fraught with provider shortages, hospital wage index disparities, poor maternal health and access to maternity care, the ongoing opioid epidemic, and unique social risk factors that impact health. Social determinants of health are highly prevalent, with many migrant workers in farming communities as well as significant poverty.
The NRHA conference addressed these challenges, with input from state leaders 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.
Improving access to needed prescription drugs at 340B contract pharmacies is key, as most rural hospitals do not have an in-house retail pharmacy. Limitations placed by certain manufacturers on rural hospitals to designate a single pharmacy impact the entire community, since patients must choose from what may be a very small number of retail pharmacies in the area.
Finding success through transformation
While rural providers face unique challenges, there are successes to celebrate.
Tom Morris, HRSA’s associate administrator of rural health policy, shared some new ideas and recent successes of the flex programs. Having served as judge for the NRHA Rural Recognition program last year, it was great to celebrate the top 100 rural hospitals, with an emphasis on quality and operational indicators for success, and the individual accomplishments of educators, providers, and longstanding leaders from all over the U.S. who are paving the way for the future generations. I met with several public health interns who have a passion for rural health policy, and I can say with confidence we are in good hands.
NRHA’s new Chief Policy Officer, Carrie Cochran, explained the continued need for transformation, reminding us that there are new opportunities that must be considered, which include having a rural office within CMS, getting technical assistance from the USDA, and funding rural residency training programs to fill the provider gap. We remain aligned with NRHA on preventing further attacks on 340B by manufacturers, pharmacy benefit managers, and focusing on reforms that protect the program.
The Washington Update provided perspective on the future of rural healthcare from a funding standpoint and discussed 2022 appropriations for federal agencies. NRHA shared its support for the following legislation in Congress:
- HR4390, the Protect 340B Act
- HR7666 to address mental health in rural communities
- A 2023 farm bill to address infrastructure and workforce
- HR6400, the Save America’s Rural Hospitals Act
Clearly, 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 our rural hospital customers, and with The Craneware Group focused on transforming the business of healthcare, we are positioned to support rural providers through the next evolution.
We encourage our rural customers to utilize resources provided by organizations such as NRHA, network with other rural hospitals to share ideas, and reach out to Craneware with any concerns you may have. Whether your needs are 340B-focused or you need a technology solution to support transparency, we know that rural health systems’ resources are limited, so having an expert like The Craneware Group on hand can make all the difference in keeping your doors open another day to support your community.