Trends in Rural Health Clinics and needs during U.S. health care reform

Abstract

Aim Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.S. health care reform. Methods Using a panel of RHCs continuously in existence from 2006 through 2007, we calculated and compared statistics with corresponding statistics from the literature. We describe the geographic distribution of RHCs, demographics of their counties of location, and characteristics of RHC structure and staffing. We also explore the implications of the recently enacted health reform law (the Patient Protection and Affordable Care Act or ACA) for RHCs, and the improvements that RHCs need as it is implemented. Findings By the end of the study period the highest percentages of RHCs were in the South and Midwest, the percentage of RHCs in the West had grown, and that in the South had declined. RHCs served counties with increasing proportions of individuals below poverty and Hispanics/Latinos. The percentage of independent clinics had grown, as had the percentage of for-profit clinics. Finally, the percentage of nurse practitioner full-time equivalents had grown as a proportion of the total for three providers. Conclusions In investigating the performance of RHCs, many managerial and operational factors are not well understood. It is imperative that RHCs gather the information that could help them maximize the elements of their performance that would keep them financially stable. In addition, a broader awareness of the unique challenges that RHCs face in this era of health care reform is needed.

Disparities in Primary Care EHR Adoption Rates

“…However, CHCs receive federal grant funding to provide care to the uninsured, while RHCs only receive enhanced Medicare reimbursement rates for expanding the available primary care workforce in the rural community by adding nurse practitioners or physician assistants to the practice. 14 In addition, over the past four years various federal programs have provided FQHCs with additional funds to assist with EHR implementation and other HIT infrastructure, which may help account for their higher rate of EHR adoption despite their high-Medicaid / high-uninsured patient mix. While CHCs were still 1.6 times more likely than large private group practices not to have achieved EHR go-live status, RHCs were more than 5.5 times more likely not to have implemented an EHR.…”

Effectiveness of primary health care services in one municipality in the Province of Batangas

“…The difference in responses on the effectiveness of primary health care services when grouped according to age was also evident. These finding was supported by the study of Ortiz et al (2016) where higher ratings of primary health care services were associated with an increase in age. In terms of sex, it was observed that there was no significant difference on all selected primary health care programs when grouped according to sex.…”

Implementing Enhanced Primary Care Registered Nurse Reimbursement in Rural Health Clinics: A Policy Analysis

“…RHCs are increasing in number, with 314 in 1990 to more than 4,400 as of 2018, and half are in states without Medicaid expansion (Hutchinson et al., 2018; National Association of Rural Health Clinics, 2018; Ortiz et al., 2013). Since 2012, at least 388 RHCs have closed, often because of disparate Medicare reimbursement rates (Hutchinson et al., 2018).…”