Role of Rural Health Clinics in a Changing Rural Primary Care Landscape
This project builds upon our past work with Rural Health Clinics (RHCs) to examine the challenges faced by RHCs in serving uninsured and underinsured rural residents by implementing sliding fee scales and seeing all patients regardless of ability to pay; expanding service capacity to include mental health, dental, and obstetrical care; competing for a declining supply of primary care providers and other health care workers; implementing health information technology, and preparing to cope with proposed changes in conditions of participation requirements and payment provisions. The RHC Program is one of the oldest and largest rural health programs with approximately 3,800 clinics serving rural residents living in designated health professions shortage areas. Our past work indicates that RHCs serve as safety net providers in rural communities by providing free and discounted care to those unable to pay, serving vulnerable populations, and by their location in disadvantaged rural communities. Despite this fact, RHCs are not eligible for Section 330 funding to provide care to underserved populations or to participate in the 340B discount drug pricing program as they are not recognized as “official” safety net providers. This project will examine the extent to which they perform similar functions and provide similar services as “official” safety net providers and explore ways in which this role can be supported and strengthened. We will also examine the potential impact of proposed changes in conditions of participation requirements and the extent to which RHCs at risk for loss of designation status may fail to qualify for exemption from loss of designation based on exception criteria contained in the proposed changes.
This study will examine these issues using data to be collected from a national telephone survey of a random sample of RHCs in the fall of 2009, data from past surveys of RHCs to identify and analyze trends related to the above issues; and cost reports for independent and provider-based RHCs available from the Centers for Medicare and Medicaid Services. Anticipated products include a web-based chart book, a briefing paper, and a policy brief. We will submit proposals to present at relevant meetings including annual meetings of the National Association of Rural Health Clinics and the National Rural Health Association.
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