Legislation Proposes Steps to Improve Rural Health Care, Omits Major Coverage Solution

State lawmakers introduced several bills this year aiming to improve access to health care in rural Georgia. Six rural Georgia hospitals closed since 2013 and the state’s high rate of uninsured means many people in rural communities lack health coverage. The House Rural Development Council, created in 2017 to study the problem, traveled across the state last year find out how rural communities are coping with insufficient broadband connectivity, economic development, health care and other deficiencies. The council’s findings conspicuously omit one big obvious solution, accepting billions of dollars through Medicaid expansion to close the state’s health insurance coverage gap. Still, House Bill 769 includes several of the council’s recommendations worth trying to get a handle on Georgia’s health care. The wide-ranging bill proposes a mix of tactics designed to ease the rural health system crisis.

Support for Remote Pharmacy Services

Some rural hospitals might not have a pharmacist on site at all hours, especially late at night and weekends. The proposal allows more hospitals to use remote order entry services that allow an offsite licensed pharmacist to approve a medication order. This allows orders to be approved around the clock, which means hospitals can reduce the costs of staffing a pharmacist in off-peak hours. After drug orders are approved by a pharmacist, a nurse can get the medication from the hospital’s automated dispensing cabinets.

Examine Options to Streamline the Billing Process

The Department of Community Health will work to streamline and expedite the billing process for Medicaid, PeachCare for Kids and the State Health Benefit Plan, if the bill passes. Streamlined billing can help ease the accounting burden on rural hospitals and allow hospitals to receive payments in less time.

Training for Rural Hospital Leadership

The bill creates the Rural Center for Health Care Innovation and Sustainability within the State Office of Rural Health. This center is planned to be at a Georgia postsecondary institution with a program or college focused on rural areas of the state. The center is supposed to develop curriculum standards and approve education programs for rural hospital board members and executives and hospital authority members. The proposal calls for hospital leaders to complete an education program by a deadline or the facility loses eligibility to receive rural hospital tax credit donations or money from state grant programs. They would also face a $10,000 fine per violation. The 2018 amended state budget includes $100,000 for the State Office of Rural Health to identify a host institution. The plan also calls for that office to distribute $1 million to health systems for data analysis tools to find ways to improve rural health outcomes.

Define micro-hospitals

Georgia’s hospital certification is complex and is a barrier to opening facilities tailored to rural communities. The bill defines a micro-hospital as a rural facility with two to seven beds that provides 24-hour emergency services. The bill defines a rural county as one with fewer than 50,000 people instead of today’s 35,000 benchmark. These small hospitals can operate in Georgia now, but the certification process is lengthy and expensive. An example of an existing micro-hospital is the state’s first freestanding emergency room in Ellijay that replaced a 50-bed hospital that closed.

Grants for Physician Malpractice Insurance

The proposal authorizes the Georgia Board for Physician Workforce to establish a grant program to help physicians in rural areas pay malpractice insurance premiums. Eligible physicians will need to accept Medicaid patients, provide weekend and extended hours and agree to an extended practice in a rural area. The House proposes $130,000 for these grants in the 2019 budget, pending final approval of the state spending plan.

Rural hospital tax credit

State lawmakers created the rural hospital tax credit program in 2016 to give individuals and businesses a tax credit worth 70 percent of their donation to a rural hospital.  Last year lawmakers bumped that amount to 90 percent of the donation. Last year’s legislation set aside $180 million in state dollars, with a tax credit purchase cap of $60 million a year for three years. Up to $4 million in credits is allowed for each hospital. This year lawmakers propose an increase to make the tax credit worth 100 percent of the donation. The credit only raised $10 million of the $60 million allotted last year. The rural hospital tax credit increase is also proposed in a standalone bill, House Bill 827.

This effort to get more dollars to rural hospitals can help them improve their facility and pay off debt related to uncompensated care. Although the Department of Community Health produces a list of hospitals ranked by greatest need, donors decide how the money is distributed. Hospitals more experienced in fundraising can have an advantage attracting donations and most of the hospitals are hiring a consultant to market and manage the program.

Overarching Solution Conspicuous by its Absence

The tax credit and other tactics in HB 769 are not likely enough to fix Georgia’s much larger health care problems, especially its high uninsured rate and the resulting reduced payments to hospitals. Georgia is turning away $3 billion in federal dollars this year that could provide health care coverage to about 460,000 Georgians. While steps to streamline processes and marginal tactics to bring more money to rural hospitals can help rural communities, the proposed legislation falls short of what’s needed to handle the expected increase in the rural uninsured rate to 25 percent by 2026. Lawmakers need to seize the opportunity to put an insurance card in the pockets of more rural Georgians. Tinkering around the edges of the problem won’t solve the rural health crisis.

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