Summary

Rural areas have different healthcare challenges from those in cities and suburbs. Hospitals and clinics struggle to make ends meet and find doctors willing to live and work nearby. Many specific medical issues such as mental health and drug abuse are more severe in rural areas. We need to devote more attention and resources to getting rural residents access to affordable, high-quality healthcare.

Background

Rural hospitals are rarely highly profitable. They provide important frontline healthcare service to our rural communities, often providing a large amount of care at below cost. Most such hospitals rely on outpatient procedures and routine visits to subsidize their emergency care and other services. The thin margins supporting rural hospitals were exposed to public view during the COVID-19 pandemic. The closure of outpatient clinics due to social distancing measures forced some rural hospitals to cease operations permanently and put many more in dire situations. We need to take steps to ensure rural citizens have quality care close to home.

One of the largest problems rural healthcare providers face is finding qualified professionals who are willing to live nearby and practice in small communities. MOFB supports increasing rural broadband development to enable telemedicine technologies. This can help “virtually” bring experts to rural areas for treatment at dramatically reduced cost. MOFB also supports reducing regulations on Advanced Practice Registered Nurses (APRNs) to allow them to provide routine care in rural areas. Currently APRNs may only practice within a 75-mile radius of their supervising physician. This arbitrary distinction is unnecessary for the vast majority of basic care cases and almost exclusively harms rural communities.

The opioid crisis is a nationwide issue that disproportionately affects Missouri. One in three Missouri families has been impacted by opioids. MOFB supports the use of new tools that include providing medical professionals with the information they need to make informed medical decisions. In recent years individual counties have adopted stand-alone prescription drug monitoring programs (PDMPs). However, Missouri is the last state that does not have a statewide PDMP in place. PDMPs allow medical professionals to see the prescription history of patients and make fully informed decisions. This would allow doctors and pharmacists to see the full prescription history of their patients and allow them to focus of treating their patients’ needs. Although a PDMP is not a silver bullet to address the opioid crisis, it is a powerful tool for medical professionals. It will be a useful step toward curbing the opioid crisis in Missouri.

Closely tied to the opioid crisis, mental health treatment is in short supply in rural areas. Most rural counties in Missouri do not have any licensed professionals specifically trained to treat mental health issues. We must provide more resources to rural citizens to cope with the challenges they face in rural life.

Status

MOFB is working with leaders of the Missouri Hospital Association and USDA’s Rural Development Agency to provide short-term bridge financing for rural hospitals.  Existing cash flow challenges issues have been exacerbated by issues surrounding COVID-19.  As federal legislation to deal with COVID-19 is considered, MOFB is working with members of the Missouri Congressional delegation to provide additional financial and regulatory relief to the state’s rural hospitals.

In the 2020 Missouri legislative session, MOFB supported legislation by Rep. Hannah Kelly (R-Mountain Grove) and Sen. Eric Burlison (R-Battlefield) to allow physicians’ assistants and nurse practitioners to expand their scope of practice. Rep. Kelly’s HB 1816 continues the requirement that APRNs to practice within a collaborative practice arrangement, but it would allow APRNs to practice beyond the current 75-mile restriction in rural areas. HB 1816 was passed by the House Health and Mental Health Policy Committee. In the Senate, Sen. Burlison offered SB 714, which makes changes to the licensure of APRNs. SB 714 was heard and passed by the Senate Seniors Committee. MOFB members see these bills as viable options to bring healthcare access to rural parts of the state.  

In the 2020 legislative session, Rep. Holly Rehder (R-Scott City) and Sen. Tony Luetkemeyer (R-Parkville) introduced legislation to establish a PDMP in Missouri. After forging a compromise to ensure the safety of patient data, the Senate passed the legislation. It now awaits action by the House.

AFBF’s Rural Resilience training provides ready-to-use guidance for recognizing signs of stress and offering support.  MOFB is working with interested county Farm Bureau leaders to identify local health care professionals who can assist with informational events and activities. Many groups are creating additional resources such as this that help simplify a path forward for those struggling.

MOFB Policy

We support efforts to improve the present health care delivery system. Reforms should [include]: Reimburs[ing] rural doctors and hospitals at the same rate as urban health care providers for Medicare/Medicaid treated patients, and Consider[ing] modifying federal and/or state health care programs to focus on rural health care.

To ensure that healthcare, particularly in rural areas, will not be further eroded, Farm Bureau should work with healthcare organizations to support enacted measures to address the problem of the spiraling cost of malpractice insurance and the decline in the number of insurance providers for hospital and physician malpractice insurance.

We believe home health care agencies, especially those that are small and located in rural areas, have been devastated by changes in the federal payment structure. We support efforts to resolve funding problems in a manner that ensures access and does not jeopardize small businesses.

We support a program by state government in cooperation with local individuals and institutions which would provide economic incentives for doctors and registered nurses and licensed practical nurses to practice in rural areas. One such program would be a state-sponsored loan program for medical students and other medical health care professionals with partial forgiveness of the loan if they establish and maintain a practice in a rural area for at least five years.

We support the rural-focused programs of the Missouri Area Health Education Centers (MAHEC), which recruits and provides educational assistance for students from rural areas who are preparing to enter health professions and who will practice in rural areas. We support state funding for the MAHEC separate from, and in addition to, funds currently provided through the Primary Care Resource Initiative for Missouri (PRIMO) program.

We support greater use of non-physician providers to help relieve personnel shortages in underserved rural areas.

We encourage county Farm Bureaus to work cooperatively with other local organizations to help organize and conduct effective physician recruitment programs in their respective rural communities and to explore other local solutions to rural health problems, and to support those physicians by expanding telemedicine and telehealth programs.

We support the implementation/expansion of mental health services in rural Missouri to provide support for law enforcement officers who must deal with troubled individuals. These services need to be an alternative to the 96 hour involuntary hold, or voluntary committal, or do nothing approach for these individuals, which are the three choices currently available to law enforcement for people with mental problems.

We support making it easier for doctors to practice across state lines.

We oppose more restrictive supervision rules for physician assistants and/or nurse practitioners. We favor expansion of nurse practitioners’ and physician assistants’ authority based on their qualifications.

We support the state adopting a statewide Prescription Drug Monitoring Program (PDMP) preventing doctors from unintentionally over prescribing dangerous drugs. We support doctors, nurses, and physician assistants allowing their designees to access and enter the data. We would support making the PDMP mandatory for all providers.

Download the County Opioid Resource Toolkit