The Wisconsin Rural Health Conference is one of the largest health care conferences of its kind in the state. This year’s event was no exception. Nearly 300 Wisconsin health care leaders gathered in Wisconsin Dells June 22-23 to learn more about the issues that impact small and rural hospitals and to hear about innovative delivery models from their peers.
One of the most popular sessions at the Rural Conference continues to be presented by Wisconsin Hospital Association (WHA) President/CEO Eric Borgerding and Rural Wisconsin Health Cooperative (RWHC) Executive Director Tim Size.
Rural Wisconsin hospitals and health systems are fortunate to have two strong advocacy organizations in their corner—WHA and RWHC. The core values of representation and advocacy to ensure their members can continue to provide high-quality, high-value health care in their communities bring the two organizations together.
In his presentation, Size said rural network adequacy tops the list of non-federal priorities for his members. The work being done by WHA with RWHC on this topic is, according to Size, a “great example of the collaboration we have between our organizations.”
Size noted that rural is older, poorer and sicker, and it is taking rural areas longer to recover from the 2008 recession than it has in more urban areas. He is also concerned at what he sees as a focus on racial equity because equity goes much deeper than just race.
He indicated how important racial equity is for our state but strongly added that our understanding of health disparities needs to go further. Equity issues also impact poor, white people in rural areas, according to Size. “We need to have a conversation about equity on multiple levels, and look at where the problems are in all parts of our state and country,” he said.
Borgerding opened his remarks by affirming RWHC is WHA’s strongest partner.
“We are similar organizations, but also very different,” according to Borgerding. “We support and strengthen one another.”
Borgerding described the challenges he sees in health care, most of which are cross-cutting to impact both rural and urban hospitals. The top issues identified by WHA members in a recent survey were reimbursement, coverage for the uninsured, workforce, behavioral health, and in a tie—physician payment and narrow networks.
A top WHA priority is maintaining the coverage gains achieved through Wisconsin’s version of Medicaid expansion coupled with income-based subsidies in the exchange. That has helped reduce uncompensated care in rural hospitals by $34 million, an 18 percent reduction since the first year of Obamacare.
“If you look at exchange coverage, you can see how significant the premium supports in the exchange have been for rural Wisconsin,” Borgerding said. “When most people think of Medicaid they think of urban, but Medicaid plays a critical role in strengthening the rural safety net.”
Borgerding said WHA has strongly advocated with both Speaker Paul Ryan and U.S. Sen. Ron Johnson to maintain the income-based subsidies in the exchange.
Reimbursement is another big issue for WHA’s members. The continuing support in the state Legislature for the Disproportionate Share Hospital (DSH) program has led to a $60 million increase in DSH. And, Borgerding noted that it benefits not just urban, inner-city hospitals, it also benefits rural hospitals.
“Just two budgets ago, the DSH payment was zero,” he added. “These increases are important because 14 of the 22 general med-surgical hospitals that lost money in 2016 were rural. Not all hospitals qualify for DSH, so WHA advocated for another supplement of $1.2 million, and we did it with bipartisan support.”
Workforce is a huge issue for all hospitals and health systems, and WHA and RWHC are working on many levels to create and support the resources necessary to address the issue. Recruiting and retaining physicians has been a focus for several years and much progress has been made on that front, according to Borgerding.
“WHA has been working closely with the RWHC, the medical schools and our members to create new residency programs and expand existing programs using state dollars,” Borgerding said. “It is one of the best examples I have seen of a public/private partnership delivering results.”
Efforts continue to create opportunities for physicians to complete their training in Wisconsin. That successful model is now being used to address shortages in other professions, such as advanced practice nurses and other allied health professionals.
“It’s more than just the supply of health care professionals. WHA is working on legislation that not only addresses the number of employees; we work to remove the impediments that hinder evolving our health care delivery models and clinician capabilities,” Borgerding said.
See a review of the 2017 Wisconsin Rural Health Conference