Bill Menner believes there are gaping holes when it comes to rural health care in the Midwest — holes that need to be filled by more doctors, nurses and other health services providers.
Menner, who served for eight years as USDA’s rural development director in Iowa, currently is the president of the Iowa Rural Health Association and works as a private consultant out of his Grinnell, Iowa, office.
He says Iowa has 89 hospitals that are considered rural. Add those to hospitals in larger cities, and it appears the state has a sufficient inventory.
“We have that, but there are still places in the state where there are barriers for rural residents to access those services,” Menner says. “The state of rural health care is fragile because there are places where finding health services is difficult.”
He says 20% of Iowa’s hospitals are struggling financially, with much of that attributed to lower Medicare reimbursement rates than in other states.
“Iowa and other rural states tend to have more patients who are on Medicare and Medicaid,” Menner says. “Those payment issues tend to make it tougher to recruit health care professionals.”
Included in Iowa’s inventory of hospitals are 82 that are considered critical access facilities. That should allow for good coverage for most Iowans, says Megan Hartwig, coordinator of the State Office for Rural Health, a division of the Iowa Department of Public Health.
But, she says, there is always room for improvement. Hartwig says one issue is transportation.
“For many rural residents, it can be difficult to just travel to a clinic or hospital,” she says, adding Iowa does have a regional transit system that serves rural communities.
Like most rural states, Iowa offers a variety of programs designed to not only recruit physicians, but to help supplement hospitals and clinics financially.
Hartwig says most of Iowa’s counties carry a governor’s shortage designation. According to the Health Resources and Services Administration, governors may designate areas of their state as shortage areas specifically for the purpose of rural health clinic certification.Regions must meet certain criteria, including a high ratio of residents per physician.
Hartwig says programs are available to help rural hospitals with equipment and facility improvements. Other programs assist with Medicare and other reimbursements. She says the Primary Care Recruitment & Retention Endeavor, or PRIMECARRE, allows for the state to help physicians, dentists and mental health specialists pay student loans in exchange for serving two years at a designated site.
Many rural communities are also seeing a decline in emergency management services (EMS).
“One of the things that we hear from our partners at EMS is that in many rural communities, EMS is run through the volunteer fire department and first responders who are volunteers,” Hartwig says. “Many of these volunteers are aging, and many communities are having a difficult time recruiting new, younger volunteers.”
She says many rural hospitals and behavioral health centers are making use of telehealth service to help expand offerings for residents.
Menner, who serves on the board of directors for Unity
Point Health in Grinnell and Des Moines, says rural communities will continue to be at a disadvantage when it comes to recruiting health care professionals.
Rural health care needs to be better, he says, to continue to meet the needs of residents outside of metropolitan areas.
“This is a local, state and national program, and it’s going to take all of us working together to make it better,” Menner says. “For many rural residents, this is becoming a life and death issue.”