Rural Matters

Michelle chats with Brian Doerr, Senior Vice President of Information Technology and Security, and Privacy Officer for Community Hospital Corporation of Plano, Texas; Carrie Zbierski, Chief Nursing Officer at North Texas Medical Center; and Andra Smith, Director of Practice Management at North Texas Medical Center about the evolving telemedicine presence in rural America and its capability to deliver specialty health services. Before the pandemic, Doerr notes, rural areas accesses telemedicine in a limited way, due to regulatory and reimbursement restrictions and lack of flexibility. But those barriers are being relaxed now, says Doerr. For example, he explains, remote telehealth visits by rural hospitals can be reimbursed by CMS or other payors, including commercial payors, who are moving cautiously in this area. Doeer expects continuing growth in this area, even after COVID-19, Zbierski says that more hospitals are interested in the use of telemedicine access specialty care providers, such as cardiologists and pulmonologists, to treat patients without them having to come into hospitals. Smith notes that because patients within her clinics are now learning how to use this new technology, their care management can becomes more than just annual visits. This episode is a must-listen for anyone interested in the challenges and opportunities of telehealth and its incredibly dramatic use in rural areas. This episode is sponsored by CHCH, www.communityhospitalcorp.com.

In this sixth and final installment of our excellent series, Living in Rural America —2022 and Beyond, produced in collaboration with and supported by the Robert Wood Johnson Foundation, Michelle discusses the future of rural with three outstanding guests: Dee Davis, Founder and President of the Center for Rural Strategies; David Lipsetz, President and CEO of the Housing Assistance Council (HAC); and Valerie Lefler. Founder and Executive Director of Feonix — Mobility Rising.

Davis discusses the best options for small towns facing economic challenges, the political divide between urban and rural communities and its effect on democratic institutions, and the impact of divergent media in the rural space. Lipsetz talks about the impact of housing issues on health, wealth, and education in rural communities, and how his organization is helping rural communities take advantage of opportunities in this space. Lefler discusses transportation barriers faced by rural communities, the connection between rural healthcare and mobility challenges, and how Feonix is working to provide solutions in these areas. This episode and the entire six-part series is sponsored by the Robert Wood Johnson Foundation., the nation’s largest philanthropy dedicated solely to health. For more information on RWJF, visit rwjf.org or on Twitter @rwjf.

Michelle chats with Thomas Kimsey, president & CEO of Thomas USAF Group, LLC. Kimsey manages and oversees more than $100 million in loan origination and underwriting annually. Big bank lenders often do not play in the rural space, Kimsey notes, so this is where the USDA Rural Development Loan Program, and its Community Facility Program, come in, through its direct and guaranteed loans. Last year, this program loaned almost $3 billion to provide and rebuild rural infrastructure. Thomas USAF has participated in many Community Facility projects, such as medical offices at a rural hospital in Nevada and a 10-bed geri-psych facility in rural Georgia.  Were it not for the Community Facility Program, this funding might not have been readily available, according to Kimsey. The Community Facility Program also can assist in efforts surrounding public safety and municipal buildings. These projects often originate through state rural development offices, he notes, with a pre-application to USDA, which would include what nonprofit is participating in the project. Finally, Kimsey notes, USDA also can assist in debt refinancing. This episode was sponsored by Thomas USAF, which on December 4 is sponsoring the 20th Annual National Rural Lenders Roundtable in Washington, D.C, www.nrlrt.com; by Rural Assembly, ruralassembly.org; and by FTW Robotics, www.ftw-robotics.com.

In this kickoff to Rural Matters’ first in-depth, four-part series, Rural Communities: Conquering Challenges, Optimizing Opportunities, Michelle and three guests take a deep dive on what it’s like — and what it could be like in the future — to live in Rural America, exploring the recent findings of a survey conducted by the Robert Wood Johnson Foundation and Harvard University School of Public Health. The three guests are Dr. Robert J. Blendon, Richard L. Menschel Professor and Senior Associate Dean for Policy Translation and Leadership Development at the Harvard School of Public Health who serves as co-director of the Robert Wood Johnson Foundation/Harvard School of Public Health project on understanding Americans' Health Agenda; Ed Sivak, Chief Policy and Communications Officer for Hope Enterprise Corporation/ Hope Credit Union (HOPE); and Luke Shaefer, University of Michigan Professor of Social Work in the School of Social Work and Professor of Public Policy in the Gerald R. Ford School of Public Policy; and Director of Poverty Solutions. The majority of those living in rural America are optimistic about the future, but many others are concerned about their economic future and, in particular, the opioid crisis, according to Blendon. The survey results show that about half in rural America say they could not pay a “surprise” bill of $1,000. In addition, Blendon notes, rural residents say they need outside help to deal with many of their problems, including that their health insurance coverage doesn’t enable them to seek certain local providers. In addition, he notes, one in five rural residents has difficulty getting Internet coverage, which creates all sorts of barriers, including in terms of health care. Sivak notes that in 9 out of 10 persistent poverty countries, many of them in the rural areas, the unemployment rate exceeds the national average. Access to a financial institution, such as Hope, really matters, he concludes. Shaefer points out that rural communities are disproportionately represented among the 100 most vulnerable communities in the United States. The bottom line, according to the guests, is that life in rural America today is indeed challenging for many residents and that outside help is needed, but because of volunteer efforts, local “superheroes,” and innovative solutions that hopefully can be sustaining, there are realistic opportunities to address the problems. This episode — and the entire four-part series — is sponsored by the Robert Wood Johnson Foundation, RWJF.org, @rwjf. This episode also was sponsored by Thomas USAF, who is sponsoring the 20th Annual National Rural Lenders Roundtable in Washington, DC on December 4, www.nrlrt.com.

Michelle chats with Katrina Badger, program officer with the Robert Wood Johnson Foundation, about the work of the foundation to build a culture of health and her particular focus on creating the community conditions that foster improved health. Badger discusses a poll that was released at the recent Life in Rural America symposium, which was a collaboration among the Foundation, NPR, and Harvard, that focused on rural issues. Just organizing the event was a learning experience, Badger notes. One of the takeaways of the symposium, she says, was that Rural America is not a monolithic space but a diverse one. Many rural communities have won the Culture of Health prize, Badger points out. Another key point: Economic opportunity is critical for success for rural residents and communities. Yet another insight: Innovation knows no area code. Badger notes that a key question that must be asked is how can we build power for rural communities to implement what are known to be successful policies. And a final takeaway: Equity conversation, whether racial or economic or some other kind of equity, is equally critical in the rural context. This episode was sponsored by For the Win Robotics, www.ftw-robotics.com; REC Foundation, www.roboticseducation.org;  and the Rural Assembly, https://ruralassembly.org

For more on the Robert Wood Johnson Foundation symposium, visit www.rwjf.org/ruralhealth