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Rural Health Pain Points - Part 1

This is the first in a three-part series that highlights some of the top reimbursement pain points being experienced by rural providers.

Rural health providers continue to face a vulnerability related to their operations and revenue flow that can have a negative impact on their ability to serve their community. This vulnerability was present prior to the pandemic and continues on even more so today. Included in the challenges are a number of reimbursement related issues that can have a direct impact on the overall cash flow. This series will highlight a number of top points of contention that providers need to consider with suggestions on addressing each.

Continued Cost Pressures

Rural providers, in general, are more efficient than other providers. This efficiency may be the result of lower volumes and revenue constraints. Due to this, cutting costs further can be challenging.

Cutting too much could create issues on the overall quality of care and services being provided. The limitation on services being provided creates a risk of impacting the facility’s overall volume. Providers need to assess the services being offered to ensure optimal efficiencies and review the full net cost benefit of cutting costs due to the reduction in cost-based reimbursement.

Patient Volumes

The aging of the largest generation comes with multiple consequences. Not only does that include the aging workforce and increasing rates of retirement, but it also comes with increasing Medicare utilization and greater medical needs. Rural Health providers can use this to their advantage by ensuring optimal Medicare and Medicare HMO reimbursement.

Fees for Value vs. Volume

This is a common challenge for rural health providers since they see lower volume on average. It is important to understand the reimbursement impact and thresholds needed for fee for value contracts.. Initial steps should include a review of all insurance contracts for reimbursement methodology – value vs. volume.

Staffing / Scarce Resources

Resource shortages are something the world became familiar with during the pandemic. The same has been and continues to be true for rural health providers. Since practices are rurally located, finding trained staff and necessary supplies can sometimes be difficult. One tidbit for seeking new staff; consider the offering for candidate as well as their family.. Highlight those opportunities and benefits for the candidate’ spouse/significant other and/or children and be sure they are part of the recruitment process.

 While these pain points can present their own unique reimbursement challenges, there are solutions and strategic actions to be taken that will work in favor of your facility or practice. If you have any questions or would like further information, please reach out to our Rural Healthcare Reimbursement Manager, Caren Puvalowski.

Stay tuned for part 2 of Rural Health Reimbursement Pain Points, coming to you next month.

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