AHA urges more funding and fewer limitations for Rural Health Care Program

The American Hospital Association is pushing for changes it said will both streamline and further incentivize the Rural Health Care Program, notably making remote patient monitoring an eligible expense, revising the definition of rural, and removing limitations on telehealth.

The AHA testified before the Energy and Commerce Subcommittee on Communications and Technology this week asking for a systematic review of pending needs and calling for funding amid increasing implementation of health IT.

That testimony came just days after the Center for Medicare and Medicaid Services proposed a new rule that would pay doctors for more virtual care performed via audio or video and otherwise relieve some administrative burdens. What's more, rural hospitals are once again in the spotlight this week for common struggles, including an abundance of uninsured patients, Medicaid populations and their lower reimbursement rates, as well as other patients seeking care outside the rural areas they call home.

To that end, AHA made several recommendations, the first being to allow remote patient monitoring to be deemed an eligible expense, saying they enable providers to better manage care for patients with chronic illness by allowing greater oversight over treatment plan compliance, possibly preventing acute episodes and cutting down on unnecessary readmissions.

They are also calling for cost control within the program, asking that healthcare providers are able to get services that meet their connectivity demands at affordable rates. 

"Congress should ensure that the FCC takes steps to identify any unjustified increases in pricing that drive up program costs; however, the FCC's policy response cannot be to increase the out-of-pocket expenses for health care providers," the AHA said.

AHA is also asking for a revision of the term "rural" as it is used by the FCC within the program to define whether a provider is eligible for program participation and support. The AHA called the current definition "quite restrictive" and argued that other agencies have adopted more inclusive and equitable definitions. The AHA urged Congress to revise their own definition to be more inclusive and aligned with program objectives. 

"The goal of the program should be to support all health care providers that provide essential health care services to individuals who reside in rural areas, notwithstanding their status according to the census," the AHA said.

AHA praised the FCC's potential creation of a $100 million Connected Care Pilot Program to support telehealth for low-income Americans, especially those in rural areas and veterans, but suggested that be separately funded and not run in competition with the Rural Health Care Program. 

Much like other legislation that has come into effect in the last couple years, the AHA also urged Congress to make sure that the level of administrative burden that comes with participation in the RHCP does not become prohibitive, dissuading providers from involvement because they are already buried in paperwork through the course of routine care delivery operations. 

According to AHA survey data, more than three-fourths of U.S. hospitals are using or implementing solutions to connect with patients and consulting practitioners at a distance through video and other technology. But barriers persist to further widening the use of telehealth. Insurance coverage for such services varies, as do reimbursement rates. 

The AHA expressed appreciation that the FCC has voted to increase the program's annual cap to $571 million, after stagnating at $400 million for more than two decades. The cap was established in 1997, so the increase represents what it would be had there been an inflation adjustment. There will now be annual adjustments for inflation, and unused funds from one year will carry over to the future. 

"These changes will enable rural health care providers to expand broadband connections in their communities," the AHA said.

But the revenue needed to invest in such technologies can be elusive, especially for strained rural providers who are short on resources. Also, cross-state licensure is a major issue. Despite recently expanded Medicare coverage for telehealth services for stroke patients, Medicare still limits coverage and payment for many telehealth services. Often, public payers dominate payer mixes for rural facilities and systems. 

The AHA wants to see Medicare's limitations on telehealth including: eliminating geographic and setting requirements so patients outside of rural areas can benefit from telehealth; expanding the types of technology that can be used, including remote monitoring; covering all services that are safe to provide, rather than a small list of approved services; and  including telehealth in new payment models. 

"Electronic health records, technology-based patient engagement strategies, health information sharing for coordinated care, and remote-monitoring technologies all require robust broadband connections," AHA explained. "According to the FCC, tens of millions of Americans still lack access to adequate broadband, and rural communities are more likely to be in need."

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Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com