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Rural America, Front and Center

December 1, 2016

National Rural Health Day: Celebrating the Power of Rural
Hard-pressed on many fronts -- but helping to lead innovation in health care -- Rural America held the spotlight through most of Fall 2016, leading up to National Rural Health Day.

Continuing a decades-long trend, rural Americans have shorter life expectancies than urban dwellers – even as life spans have increased markedly in the nation as a whole, federal authorities said at a recent conference hosted by the Centers for Medicare and Medicaid Services (CMS) ahead of National Rural Health Day.

"There is clear evidence that we're making progress," said Acting CMS Administrator Andy Slavitt, pointing to a sharp decline in the number of uninsured rural Americans. "But the big black mark on our health care system are the vast disparities in the care people receive.

"Access to specialists is one of the biggest challenges, and that becomes more important as the health needs of the population become more complex."​

Acting HRSA Administrator Jim Macrae
Jim Macrae told CMS staff that health centers are often the only source of care in rural communities -- adding last week that several small, struggling "critical access" hospitals in remote areas have closed their doors in re​cent years.

More than six out of 10 health professions shortage areas are in rural areas, noted Acting HRSA Administrator Jim Macrae, and an estimated 46 million people – or 15 percent of the nation's population -- live in rural communities. But only nine percent of all physicians practice there.

Similarly, at a time when rural communities are facing an addiction crisis, behavioral health counselors are hard to find across large parts of the country. One in eight rural counties have none at all.

"With prescription drug abuse, increasing suicide rates, and the opioid epidemic taking its toll," Slavitt said, "our shortages of psychiatrists and psychologists – a problem everywhere – are deeper in rural counties.​"

Their remarks came at a "Rural Health Solutions Summit" before an audience of some 600 CMS staff and stakeholders.

The gap in life expectancy is but "one eye-opening piece about health in rural America," said Acting Assistant HHS Secretary Dr. Karen DeSalvo. "There's no doubt that the burden of disease is exacerbated by the geographic challenges of transportation, and access in today's world to broadband and … specialists."

HHS Assistant Secretary Dr. Karen DeSalvo
HHS Assistant Secretary Dr. Karen DeSalvo

The elderly, in particular, can quickly become isolated when they fall ill in remote towns and "frontier" enclaves​​.

DeSalvo called for "a broader set of players at the table," both public and private, to reinforce rural America's long-recognized strengths: community cohesion and innovation.

She recalled a 2015 visit to western Nebraska, where she met with hospital and university health system officials to discuss a range of public health issues -- particularly telehealth, and how to bring specialty care to hard-to-reach populations via teleconsulting, closed-circuit television and digital records transfer.

HRSA Rural Health Policy chief Tom Morris
HRSA Rural Health Policy chief Tom Morris hosted a national telehealth demonstration on Rural Health Day, showing how broadband video feeds can be used by specialists at a distance to guide first-responders and other caregivers on the ground in isolated areas.

The Nebraska visit, DeSalvo said, brought home to her how rural providers "were really attuned to the fact that they all had a responsibility and accountability for their population … the community was working together to create the conditions in which everyone can be healthy," even as they deal daily with issues of access, scarcity and delivery.

Maintaining the rural health workforce and infrastructure are particular priorities at HRSA, which houses the Federal Office of Rural Health Policy, the National Health Service Corps and a range of other programs with major rural components.  

"With more than 9,800 service sites around the county," Macrae said of the community health center program, "47 percent are either located in or serve rural communities. For health centers that offer oral or mental health services, they're often the only source of care in a rural community." The centers operate in large part on CMS reimbursements for services.

Acting CMS Administrator Andy Slavitt
Andy Slavitt announced a new CMS rural health initiative on Oct. 19.

​HRSA's Federal Home Visiting Program consulted and helped guide new mothers and infants into care in more than 400 rural counties last year, Macrae added.​

Said Tom Morris in a national webcast with State Offices of Rural Health last week: The gap in life expectancy between rural and urban dwellers is "one of the most compelling disparities we've seen emerge in the last 20 years ... we started seeing a gap around the late-1980s, and it became more pronounced as we went into the early-2000s."

"What we haven't seen is a high level of national attention to this, which I think it's deserving of."

​Watch the CMS summit:

Get the latest news and information on Rural America.

Date Last Reviewed:  April 2017