The Rural Health Transformation Program
States will soon submit applications to the Centers for Medicare & Medicaid Services (CMS) to receive their share of the $50 billion available under the Rural Health Transformation Program (RHTP). Unlike targeted Provider Relief Fund payments intended to cover COVID-19-related lost revenue and expenses, RHTP is meant to drive innovative solutions to transform rural health. As the single largest investment in rural health in over two decades, RHTP encourages out-of-the-box solutions to sustain access to quality healthcare and improve health outcomes in rural communities.
In its application, a state will need to present its rural health transformation plan, detailing the specific initiatives the state intends to pursue with RHTP funds. Several states now are soliciting stakeholder feedback as they develop their plans in anticipation of CMS’ release of the formal request for applications, and we anticipate several more will soon follow suit.
Potential Rural Health Transformation Plan Initiatives
Drawing on our decades of experience working with rural providers, PYA has compiled the following list of potential initiatives for which rural providers may want to advocate with their state officials. Any such initiative would need to be more fully developed based on existing relationships and resources in the state including, for example, a comprehensive description of the initiative, a five-year work plan, staffing plan, estimated budget, sustainability plan, and evaluative measures.
Revolving Loan Funds
Create one or more revolving loan funds to provide rural facilities with long-term access to capital. The state or its appointee (e.g., a not-for-profit organization) would make loans on favorable terms to rural facilities to fund capital projects. The funds would be replenished as providers make loan payments over time, extending the availability of funds after RHTP ends.
Multiple funds could be created to encourage a wider range of investments, such as technology acquisition [e.g., artificial intelligence (AI) tools, remote monitoring equipment, EHR upgrades, patient safety solutions]; equipment purchases to expand local services (e.g., MRI scanner, surgical suite implements and monitors); physical plant repairs and renovations; and transportation-related purchases (e.g., ambulance rigs).
Leadership Training Programs
Develop curriculum and present content in accessible manner. Given high turnover rates for key positions (e.g., CFO, quality director) and challenges hiring individuals with relevant experience and expertise, many rural hospitals would benefit significantly from easily accessible specialized training programs funded by RHTP to quickly and thoroughly onboard new team members. Similar training for new board members would improve rural hospital governance.
Rural Health Extension Programs
Provide hands-on outreach, education, and support services to connect rural providers. Modeled on USDA’s successful agriculture extension agent program, rural health extension agents would support rural providers by disseminating and supporting the implementation of evidence-based guidelines for treatment of specific conditions and prevention and wellness programs, including nutrition and exercise. RHTP funds would be used to recruit, train, deploy, and support health extension agents throughout the state.
Centralized Care Management Programs
Leverage care management resources across multiple rural communities. Many rural providers lack resources to operate effective care management programs for recently hospitalized patients and/or patients with chronic conditions. The state would use RHTP funds to stand up centralized care management teams supporting providers across multiple communities. These programs would be sustained over the long term through reimbursement for the services they provide to individual patients.
Rural Clinically Integrated Networks
Support network formation, launch, and ongoing network operations. Through CIN participation, independent rural providers can access a wide range of support services focused on clinical performance improvement and population health. CINs also provide an opportunity for these providers to engage in alternative payment models and joint contract negotiations. RHTP funds would provide critical resources to support CINs in which rural providers participate, including staff and supportive technology.
Simulation Training
Fund staff and equipment for mobile simulation training. The state, in partnership with provider organizations, would develop a mobile simulation training program for rural EMS and hospital emergency room staff. Employing computerized mannequins, standardized curricula, and skilled facilitators, the program would allow trainees to encounter crisis situations of illness or injury multiple times with focused feedback. Providers would not incur travel costs, and all staff would be able to participate in local training sessions.
Patient Safety Organization
Support PSO formation, launch, and ongoing quality improvement initiatives. Organized under the federal Patient Safety Act, PSOs provide confidentiality protections for patient safety information, encouraging voluntary reporting of errors and near misses to improve patient care. A PSO also supports providers in complying with quality improvement and reporting requirements. A statewide PSO for rural providers can address the unique challenges these providers face. RHTP funds would be used for PSO formation and ongoing operations.
Regional Collaboration
Facilitate regional initiatives to coordinate care delivery. The state would make available “honest brokers,” relevant data, and other resources to facilitate discussions and decision-making among providers in a region regarding shared services and care coordination to maximize limited resources.
Rural Surgical Centers of Excellence
Enhance access to specialty surgical services by expanding the scope of services at facilities serving rural communities. Funds would be used to provide access to the latest surgical equipment (including equipment to enhance safety and improve outcomes) and to group purchasing arrangements to reduce spending on supplies. Technical support would assist RSCEs to establish close working relationships with primary care and post-acute providers in surrounding communities to strengthen regional partnerships and ensure a seamless continuum of care, as well as supportive relationships with quaternary care providers to maintain current evidence-based practices.
Service Line Optimization
Provide rural hospitals with resources to address under-performing service lines and to pursue opportunities for service line expansion. The state would arrange for technical assistance for rural hospitals to evaluate existing service line performance, assess current and future market supply and demand for services, and develop and execute on specific strategies and tactics.
Telehealth Specialty Care
Develop statewide capacity to furnish specialty services to rural residents via telehealth. The state would provide funding to recruit a dedicated team of specialists to provide telehealth services to rural residents in coordination with local primary care providers. The funding also would support the development of protocols, policies, and procedures for telehealth services and the hiring of support staff to facilitate the scheduling and delivery of telehealth services.
Electronic Health Records
Assist rural hospitals with under-performing EHRs. The state would coordinate and fund efforts to make interoperable systems (e.g., Epic Community Connect, Oracle Health CommunityWorks) available to rural hospitals.
Coordination of Hospital Transfers
Fund technology to provide real-time bed availability data for patient transfers. The state would facilitate necessary patient transfers by funding the creation and operation of an electronic notification showing available beds and facilitating transfer arrangements between hospitals.
Other Technology Support Services
Support rural providers in deploying technology solutions. Such support may include, for example, implementation of digital front doors, evaluation and deployment of AI solutions for clinical care and revenue cycle operations, assistance with cybersecurity-related issues, and acquisition of remote monitoring technologies (including monitoring command centers serving multiple communities).
Access to Data
Furnish providers with relevant claims data and analytical tools to identify healthcare cost drivers and support population health initiatives and to make available training and ongoing support regarding appropriate use of such data.
Broadband Initiatives
Target rural communities lacking broadband access for delivery of healthcare services.
Hospital-at-Home
Support development of rural provider programs to deliver acute care services in patients’ homes. RHTP funds would be used to develop tools and templates for rural hospitals to implement hospital-at-home programs to expand local capacity.
Barriers to Access
Understand barriers and identify and implement solutions. The state would fund research to identify gaps in local transportation systems and other barriers that prevent rural residents from accessing care or adhering to prescribed treatment plans. With a thorough understanding of these barriers, the state would partner with local communities to identify and implement appropriate solutions.
Prevention and Wellness Programs
Provide technical assistance and funding for program implementation and ongoing operations. RHTP funds would be used to support local Implementation of promising programs like Food is Medicine and the Diabetes Prevention Program, as well as community engagement initiatives.
Rural Residency Programs
Provide opportunities for physician training in rural communities. Using HRSA’s Rural Residency Planning and Development Program as a model, states would make available funds to support planning for and implementation of rural residency programs to expand the physician workforce in rural areas.
Nursing and Other Health Professional Scholarship Programs
Provide incentives to increase student enrollment in training programs by individuals committed to working in rural communities.
Supply Chain
Help rural hospitals reduce operating expenses by securing favorable pricing. Unlike their urban counterparts, many rural hospitals have not benefited fully from participation in group purchasing organizations or similar arrangements. RHTP funds would be used to secure opportunities for participation.
Provider Reimbursement for Specific Services
Payments to cover providers’ costs of furnishing identified services. While CMS officials have cautioned that RHTP funds are not intended to increase provider reimbursement, a state plan may identify expanded access to specific types of services not presently reimbursed by some payers (e.g., community health worker services) as critical to transforming care. For these services, the state would use RHTP funds to cover providers’ costs associated with providing these services, as opposed to the state furnishing the services directly.
Innovation Models
Fund pilot projects to evaluate the impact of new reimbursement models. The state would use RHTP funds to test the impact of new models on total cost of care and health outcomes by covering the cost of services not presently reimbursed due to regulatory restrictions (e.g., the three-day stay requirement for skilled nursing services).
How PYA Supports Rural Health Transformation
Undoubtedly, many additional initiatives could have significant potential for transforming rural health, in both small and big ways. With deep experience in launching rural initiatives and a keen understanding of the financial, logistical, regulatory, and political challenges facing rural providers, PYA can help your organization fully develop a comprehensive initiative to propose as part of your state’s rural health transformation plan.
Learn about PYA’s Center for Rural Health Advancement, and read our recent Washington Updates.
