Preserving Rural Healthcare is Preserving America

By Dr. Richard Watson, co-founder of Motient

Much has been said about the current status of rural America. Stories of declining populations, diminished quality of life, and the effects of the COVID-19 pandemic continue to lead the news coverage of rural life. 

In the midst of an existential crisis, large private corporations have been slow to invest and migrate into these areas. When they do, it’s not without significant concessions by rural communities which lead to a constant battle to maintain the relationship with those entities. 

As I look at the fabric of rural America, there is a realization that a significant amount of effort and investment will be needed to facilitate any change in the landscape. This obviously would mean that tax dollars will be pulled from urban areas to supplement the rural lifestyle of fewer and fewer Americans. At some point, the question will be asked, ‘Is there value in preserving the rural lifestyle?’

The contrarian view would say that so much about the rural lifestyle has changed over the past few decades. Once a predominantly agrarian nation, America’s needs can be met by elaborate supply chains and sourcing mechanisms outside of our geographical borders. 

In this context, the rural lifestyle is a luxury; an archaic construct that can only be afforded by the few that are content with not having the opportunities and amenities available to urbanites. Most of these residents are typically multi-generational, people who have had their land passed down through families and aim to retain their rural status for as long as possible.

At the heart of this discussion on rural life is the healthcare complication. It is common knowledge that healthcare is at the core of rural life. Communities not only depend on healthcare for the treatment they receive but oftentimes for the employment opportunities offered.  Hospitals are often the largest employers in these rural communities and the quality of available healthcare is one of the first things evaluated by someone when choosing to live in a rural area.  

Due to the vast technological and scientific advances over the past century, it is obvious that the current rural healthcare system is in need of revamping. Change is slow to happen in these areas because of how many stakeholders there are as well as how much money comes in through different streams in the system. 

With fewer people dependent on the healthcare decisions made by the federal government or private companies, rural residents become less of a priority for those in decision-making positions. 

But I would contend that as our economy and way of life become more global and interconnected, we should rededicate our efforts to internal investment. Now more than ever, we are in a precarious position for disruption of the global supply chain, as we saw during the rush for PPE during the spring of 2020. One thing the coronavirus pandemic has taught us is that these supply chain mechanisms are dependent on forces outside of our control. 

Even the Texas power loss that occurred earlier this year proves that isolationism is not without its cost. We need to develop the infrastructure of rural America to buffer against catastrophic changes that can happen within a global economy. 

We understand that at the heart of rural healthcare are values of quality, compassion, and comprehensiveness. Still, we also know that the current rural healthcare system needs to adapt and evolve for modern times. Additionally, we recognize that the metrics used to measure performance in larger ecosystems do not translate to evaluating outcomes at the rural level.

In our ongoing effort to rebuild a life in rural America, we must start with healthcare, and there are several factors to examine in the effort to create a more resilient system. 

First is evolving the traditional bricks-and-mortar approach to healthcare delivery. Currently, we have a system based largely on county healthcare facilities that are large and intended for the  population seeking treatment. We need to move away from that antiquated approach and invest our resources in preventative care, such as at-home management. 

Resource matching is also a key to increasing the role of rural healthcare in the economy. Being abler to tailor the actual facilities and services to the patient and community needs has a great advantage. While there have been worthwhile discussions exploring concepts like health outposts or rural emergency hospitals, these conversations are happening at a snail’s pace. 

A second factor is an investment in technology. As we saw during the heights of the pandemic surges, technology becomes a bridge between healthcare in small communities and the medical resources that are typically only available in larger urban areas. While the technology itself is a relatively easy lift, the difficult part is fixing the reimbursement situation to be aligned with the care needs and sustainable for the long haul. 

The third and final factor to consider is the redefinition of reimbursement. Without a change in the ways healthcare is reimbursed in rural areas, there will be no way that change can move forward. A comprehensive modification in rural healthcare reimbursement could vastly improve the ability of these hospitals to maintain basic levels of care for their population. 

This would require that decisions be made at a different level than where they are now. The one-size-fits-all central decision-makers are so far away and removed from the actual realities of the rural residents and the healthcare system that treats them that they cannot adequately begin to assess what will be the correct incentives for change. I think this would require more regional decision-making and that those with ready access to patient care have the best vantage point for making these decisions.

The preservation of rural healthcare is essential to the preservation of rural America, an inherently necessary move for the stability of our country. Without a vibrant and effective rural economy, our country cannot function in the broader global ecosystem. Without quality, comprehensive, and compassionate healthcare in rural areas, America cannot be preserved. 

This task will require intentional, deliberate, and rapid steps to truly affect the change that needs to happen. I do believe there’s a growing realization that without these actions, we place ourselves in ever-increasing instability in a global environment.