The COVID-19 pandemic has brought rural healthcare systems to the brink. In 2020, at least 20 rural hospitals closed—a new annual record since 2005.
Even before the pandemic, rural healthcare systems have been fighting for their lives. A recent report from the U.S. Government Accountability Office (GAO) found that 101 rural hospitals closed from January 2013 through February 2020. The report found people in the closed hospitals’ service areas would have to travel substantially farther to access certain healthcare services—the median distance to access some of the more common healthcare services increased about 20 miles from 2012 to 2018.
In addition to putting patients at risk of losing access to healthcare, hospital closures strike at the heart of a community. Hospitals are major employers and communities lose jobs, businesses, tax revenue—and people. Doctors, nurses, pharmacists, and other staff employed by the hospital often have to leave the area. GAO found that the availability of healthcare providers in counties with rural hospital closures generally was lower and declined over time.
The crisis in rural healthcare has many causes and the solutions are far from simple. Luckily, our nation’s leaders are starting to take action through various legislative and regulatory approaches. For example, the American Rescue Plan Act of 2021 provides $8.5 billion to reimburse rural healthcare providers for healthcare-related expenses and lost revenues attributable to the COVID-19 pandemic.
Notably, a bipartisan group of Senators has introduced the Save Rural Hospitals Act of 2021, which would help curb the trend of hospital closures in rural communities by making sure hospitals are fairly reimbursed for their services by the federal government. The House has also introduced the Rural Hospital Support Act, bipartisan legislation that would extend and modernize critical federal programs that rural hospitals rely on to properly serve their communities. If passed, these acts would help these community lifelines keep their doors open as we continue to face the lasting repercussions of the pandemic.
Another important solution gaining momentum among policymakers: allowing advanced practice nurses such as Certified Registered Nurse Anesthetists (CRNAs) and other nonphysician providers to practice to the full scope of their education and expertise.
CRNAs are in the thick of responding to this crisis as the sole anesthesia providers in the vast majority of rural hospitals, enabling these facilities to offer surgical, obstetrical, trauma stabilization, interventional diagnostic, and pain management services. Numerous studies have demonstrated that CRNAs provide safe, cost-effectiveanesthesia care.
Importantly, President Biden’s proposed Fiscal Year 2022 budget calls for added funding for the U.S. Department of Health and Human Services (HHS) to protect rural healthcare access and expand the pipeline of rural providers like CRNAs, noting, “The discretionary request also funds efforts to increase the number of individuals from rural areas going to medical school or other training programs, and returning or staying in rural communities to provide care, with a focus on primary care physicians, nurses, nurse practitioners, nurse anesthetists, and other in-demand providers.”
Additionally, in March 2020, the Centers for Medicare & Medicaid Services (CMS) temporarily removed physician supervision of physician assistants and advanced practice nurses to increase the capacity of the U.S. healthcare delivery system during the COVID-19 Public Health Emergency. This allowed CRNAs to step forward as indispensable providers responding to this unprecedented crisis. The waiver was extended by 90 days in April 2021 and HHS has indicated it is likely to remain through the year.
We can help address the rural healthcare crisis by applying the lessons learned during this tragic, unprecedented year. We need to move forward using all of the resources available and make the commonsense measures taken during the pandemic permanent. As these underserved areas need all of the help and resources that CRNAs and other nonphysician providers can give, the barriers that were temporarily waived last year must stay down.
The COVID-19 pandemic has laid bare fundamental, systemic problems within the U.S. healthcare system that will not go away when the pandemic goes away. Clearly, the nation cannot continue down the same path and do what we have always done.
A longtime AANA member, Moore served as the AANA treasurer in 2016-17 and before that as a region director on the AANA Board of Directors for two years. Previously, Moore worked as the director of Perioperative and Anesthesia Services at Passavant Area Hospital in Jacksonville, Illinois, where he managed a $35 million budget and more than 100 employees. Moore is also a retired commissioned officer of the U.S. Army Reserve with more than 22 years of military service.
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