A chronic health workforce challenge facing nations throughout the world is a maldistribution of personnel. Approximately 60 million inhabitants of the United States, roughly one of every five individuals, live in rural areas. Significant obstacles face patients and providers in rural communities where rates for the five leading causes of death are higher, poverty is more common, higher rates of uninsurance or underinsurance prevail, greater transportation difficulties exist in going to a hospital or to the offices of health professionals, and residents lack access to high-speed Internet, which limits their access to information. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 individuals, compared to 53.3 physicians per 100,000 in urban areas, to cite just one example of a health professions workforce shortage. A worrisome trend according to the Centers for Medicare & Medicaid Services (CMS) is that since 2010, more than 100 rural hospitals have closed and nearly 40% of rural hospitals currently running are operating with negative margins, limiting the ability of providers to compete based on high value care and leading to fewer choices for beneficiaries.

Similar to other U.S. presidential administrations, the Trump administration has launched initiatives aimed at ensuring improved access to health care services in rural areas. A Rural Health Strategy has been undertaken to increase access to telehealth and other virtual services across the Medicare program. One way of doing so is to pay for virtual check-ins that allow a patient to check in with his or her clinician by telephone or other telecommunication system, along with remote evaluations of recorded videos or images that a patient submits to a clinician to help in making a joint decision whether a trip needs to be made by this individual to be seen in-person. An example of coping with the threat of hospital closures is a proposal to enhance their stability by transforming the way CMS pays certain rural hospitals and facilities in other low wage areas. A related action is a proposed change in the way Medicare factors local labor costs into hospital payments by increasing the wage index of rural and other low wage index hospitals to address payment disparities.

Provision Of Health Coverage For The Uninsured: Medicare For All

The Affordable Care Act of 2010 has been instrumental in reducing the proportion of the U.S. population lacking health insurance coverage. Despite many impressive gains that have been made, an estimated 9.4% of U.S. residents, or 30.4 million individuals, lacked health insurance when surveyed in 2018, according to a report released by the Centers for Disease Control and Prevention (CDC) on May 9 of this year, a rate not significantly different from the survey’s uninsured rate in 2017, but 18.2 million persons fewer than in 2010. The uninsured rate for adults under age 65 was 9.9% in Medicaid expansion states, compared with 18.7% in non-expansion states.

An effort gaining momentum in Congress is a proposal by Democrats called Medicare for All legislation. Generally, this universal health care program would include coverage of primary care, hospital stays, mental health treatment, prescription drugs, along with dental, vision, hearing, and home and community-based long-term care services. Meanwhile, an annual report from the Medicare Board of Trustees that was released last month indicates that the Hospital Insurance (HI) Trust Fund is expected to be depleted in 2026. Also, a report from the RAND Corporation on May 19, 2019 states that the prices paid to hospitals by private health plans averaged 241% of what Medicare would have paid. Since Medicare for All has the prospect of terminating private health plans, an interesting question is what rate will an expanded Medicare program pay and how will these costs be financed?

Predictive Analytics And Social Determinants Of Health (SDoH)

A report from Deloitte on April 30, 2019 discusses how addressing the housing, nutrition, and other social needs of Medicaid members could result in fewer ambulance rides, fewer emergency room visits, and fewer hospitalizations. Predictive analytics could help Medicaid departments and managed care organizations more accurately target these services by using a state’s resources more efficiently and effectively. Officials of SDoH programs also might want to determine how to ensure that spending is aimed at individuals who are most at risk of a decline in health status so that they can leverage the lessons learned from the experience of Medicaid home and community-based service programs.

More Articles from TRENDS May 2019


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