A task force chaired by Kansas Lt. Gov. Jeff Colyer to address problems in rural health care determined that expanding telemedicine, addressing workforce shortages and giving providers more flexibility were key to Kansas’ future.
The Rural Health Working Group wrapped up a year of meetings Tuesday and is now compiling a set of recommendations to present to the Legislature ahead of the session that begins Jan. 9.
Those recommendations will not include expanding Medicaid under the Affordable Care Act — something rural hospital officials say would help their bottom line, but Colyer and other conservative Republicans say is a nonstarter.
The work group members did not discuss that option Tuesday, but Colyer said the items they did discuss present a more comprehensive, long-term plan to securing health care access in rural areas.
“This isn’t a simple answer: Do one or two things and we’re done,” Colyer said. “This is how do we evolve as a state over the next 20 years.”
Several people on the nine-member panel were absent Tuesday, but those in attendance agreed on several areas of emphasis.
Breaking down barriers to telemedicine — including a lack of commercial insurance coverage and reliable rural broadband internet service — were seen as essential.
Rep. Dan Hawkins, a Republican from Wichita who chairs the House Health and Human Services Committee, said providers treating patients remotely using tools like videoconferencing will become normal, rather than a novelty, in psychiatry and other medical specialties.
“I think it’s going to become a mainstream part of health care in general,” he said.
Hawkins said Rep. Jim Kelly, a Republican from Independence, has been leading the telemedicine charge in the Legislature and likely would propose more on that issue next session.
Workforce shortages
The panel also largely agreed more must be done to increase the number of qualified health care workers in rural areas, especially as the population ages.
Kari Bruffett, director of policy for the Kansas Health Institute and former secretary of the Kansas Department for Aging and Disability Services, proposed a scholarship program for students interested in becoming licensed nurses or long-term care workers in rural areas. The Kansas Health Institute is the parent organization of the editorially independent KHI News Service.
Colyer and Hawkins both agreed that licensing new mid-level providers, who would have more practice rights than nurses but less than doctors, also could be part of the equation.
But Hawkins warned that those turf battles are often fierce.
“I’m not sure where that will go,” Hawkins said. “It’s a very divisive issue when you put nurses and doctors … in the same room talking about that. It gets kind of crazy sometimes.”
Jenifer Cook, a physician from Russell on the work group, said any new mid-level licenses have to be established carefully and deliberately. Trusted mid-level providers who have been working under physicians for years don’t concern her, she said, but the potential for hundreds of recent graduates coming out to practice solo after earning a certificate online does.
“They need that residency that we all had … before being on their own,” Cook said.
Colyer said after the meeting that the potential of mid-level providers should be discussed in “all facets of Kansas health care,” including dental care. The state’s dentists traditionally have opposed mid-level dental providers.
More flexibility and funds
The work group also agreed that the state should give hospitals and other rural providers the licensing flexibility to branch off and provide services like psychiatric beds and long-term care, which are both in demand and potential sources of new revenue.
Colyer said “micro-hospitals” like one planned for Overland Park should be considered for rural areas, and Bruffett said the Rainbow Services Inc. crisis stabilization center in Kansas City could be a model for filling mental health needs in other communities.
But Hawkins said the state also needs to address problems within KanCare, its managed care Medicaid system.
He said it takes providers longer to get claims processed and paid under Medicaid than under private insurance, even though they’re usually deemed valid claims.
“Why does that happen?” Hawkins asked. “Why do we have a system where over and over and over again providers have to fight to get paid?”
Susan Mosier, secretary of the Kansas Department of Health and Environment, said her agency is working on changing its claims reporting system so that it has more oversight as claims are processed by the three managed care organizations that administer KanCare.
The work group also heard a presentation from Mike Randol, the state’s Medicaid director, about ways to restore a 4 percent cut to Medicaid reimbursements.
The cut has drawn strong opposition from providers since it was made earlier this year to help temporarily balance the state budget.
Randol laid out three options, all of which are designed to draw down more federal Medicaid dollars: raising a tax on providers, including hospitals; raising a tax on managed care organizations, including the three KanCare companies; or raising a “bed tax” on long-term care facilities, including nursing homes.
Andy Marso is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach him on Twitter @andymarso.
