Rural Health Care at a Crossroads

by David Gorn

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How to handle and benefit from changes affecting health care will be the central topic of conversation at the annual conference of the California State Rural Health Association, according to Steve Barrow, its executive director.

The rural health conference takes place today and tomorrow in Anaheim.

Rural communities, with higher percentages of Medi-Cal beneficiaries and seniors, feel the effects of change more than other parts of California -- and those percentages are increasing, according to Barrow. Add in the difficulties of distance between patients and providers and the dearth of providers in the rural setting, and you have a population that likely will be affected more by the changes at the federal, state and local levels, Barrow said.

"With all of these changes happening -- the move to Medi-Cal managed care, the implementation of federal health care reform, the expansion of telehealth -- people need to understand, not any of them are done yet," Barrow said. "With the state plans, the federal plans, everything is still in major flux. Electronic health records, telehealth and broadband expansion, those are not done. Conversion of people to Medi-Cal managed care, that's a major complication and not done yet."

Since all of those moving pieces will have a greater affect on rural areas, he said, that's one big reason why this week's conference is so important, he said.

"One of the big issues in all of this will come down to -- Do we have the primary care network of clinicians available to service all of this new coverage?" Barrow said. "Do we have the workforce? Do we have the primary care network to handle this, and what will the rates be? That's one of those big bugaboos, people do talk about the clinician shortage, but I don't think people understand how important that really will be."

California's  provider shortage is particularly acute in rural areas. The state is expected to lose many physicians to retirement over the next several years  "and there's no educational capacity to replace them," Barrow said. "Workforce is a huge issue that not enough people are paying attention to, it's true that people are sticking their heads in the sand over workforce," he said.

That's one of two major challenges ahead for rural medicine, he said.

"Medi-Cal managed care will be the other sea change as everyone gets used to the managed care environment and how the money will fit within all of that," Barrow said.

The list of challenges does seem a little endless sometimes, Barrow said, but that doesn't make them any less important. "I could go through each issue and show how that relates to rural medicine," he said, "but at the end of the day, the question is, you've built the house, and now you have to ask if anyone's living there."

Barrow sees the conference as a way for rural stakeholders to share ideas for improving rural care through all the changes afoot.

"If everything works right, if the Healthy Families transition goes well, if the telehealth tool is developed more, if we can get the providers, if all of those things go well, then what people will see will be very different," Barrow said. "The rural clinics and rural hospitals we've been used to using will feel like modern times. And that's good. But we have a ways to go. We have a lot of titanic ships to move."

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if this passes how will it affect a rural community.

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