Rural Health Situation a Microcosm of Changes, Challenges Across the State

Providers and stakeholders from across the state gathered last week in Sacramento to brainstorm, commiserate and help lay out the future of rural medicine in California.

The first step is acknowledging the many changes and challenges in rural practices right now, said Gail Nickerson, director of rural health services at Adventist Health in Roseville and one of the organizers of last week’s two-day annual conference of the California State Rural Health Association.

“Things are changing. We’re trying to figure out the best way we can go forward,” Nickerson said.

Rural providers have a greater percentage of Medi-Cal patients in their payer mix than other areas, Nickerson said.

“There are more hospitals closing in rural areas than we have had for a while,” she said. “And I’m hearing that more people as they retire are moving to rural areas.

“People say we have more older, more sicker and more poorer,” Nickerson said.

On top of the financial issues of caring for an older and sicker population, rural areas also face a severe shortage of providers — particularly specialists. Now, with the introduction of Medi-Cal managed care to the rural system, providers have to handle new payment methods, as well.

That’s a lot of both challenge and change, Nickerson said.

“If you have to deal with several different plans, it’s not the same as just billing the state,” she said of the move from Medi-Cal fee-for-service payments to a managed care system.

“Paying us based on cost, that’s what has helped keep us going,” Nickerson said. “We’re hoping those things in the long run will make a difference, by focusing on helping people stay healthier.”

Medi-Cal managed care also has a transportation benefit, which is a major plus for rural patients, Nickerson said.

Because rural areas have a smaller population spread out over such a large area, rural medicine often can be an afterthought to the big policy plans pursued by state and federal officials, Nickerson said.

“Almost everything that’s happening we don’t know exactly how we fit in,” she said. “It’s a little tricky. But we hope it all can work out.”

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