Welcome to the Virtual Event we are having. This is concerning confronting the healthcare crisis in Rural America. Today we are releasing recommendations for this. Im bill hoagland, a Senior Vice President with the center, and have the distinct pleasure of working with and overseeing our health care project. We have a very full agenda. Let me get a few logistics out of the way quickly. We are all adjusting to this new way of conducting meetings and events. We hope everything works out as we go through and i want to say thank you to the Production Company for helping us put this on. For those of you who have joined this zoom platform, you will receive a message shortly from one of our staff, morgan bailey, in the chat box function with a link to the report. For the viewers, the cspan viewers and others who wish to get a copy of the report, you can go to our website, bipartisan policy. Org, and a link will be on the bpc events page under the health section. Later this morning, you will have an opportunity to submit your questions to our Task Force Members via the q and a function at the bottom of your screen. Event purpose of this personally coming from a rural , area of indiana with our family farm still operational, this is a personal issue with me. Over 126 hospitals have closed since 2010. An estimate of nearly 560 hospitals were at risk of closing, even before covid19 outbreak. Dr. Susan turney is the chief executive of the Marshfield Clinic Health System in wisconsin, a system that we work with at bpc. She was recently quoted, the Rural Health Care was in a crisis before this pandemic, and that funding to stabilize systems today is critical so we can continue to survive. We are hopeful an agreement can be reached in congress, even in the senate, and maybe later today to add additional funding to our Hospital Systems that are so in dire need of assistance. And particularly those in rural areas. At the outset, we would like to thank the Helmsley Charitable trust for its work we have done with the rural task force. We launched this project over a year ago long before covid19 was an issue. We believe many of the recommendations today can help stabilize rural hospitals during this Current Crisis and better support the Rural Health Care system post crisis. Our task force was cochaired by olivia snow, who will will hear from. Along with two other cochairs, former governor Ronnie Musgrove of mississippi, and Tommy Thompson of wisconsin. The bp staff and Task Force Members visited rural hospitals in New Hampshire and iowa, maine, tennessee, vermont, even wisconsin. We also have the insights of an honorary Bipartisan Congressional Task force on Rural Health Care, including senators Chuck Grassley of iowa, cana smith of minnesota, bill cassidy of louisiana, angus king of maine, congressman Jodey Arrington of texas, and congresswoman taurus small of new mexico. Senator grassley has not been able to join us this morning, but has given me a statement to read. That will be followed by a video from congresswoman small, and one from senator cassidy. Before i turn it over to the director of the Health Project for discussion with members of the task force, senator grassleys statement. As a solutionsoriented organization, the Bipartisan Policy Center has the leadership bench from which to help shape the Rural Health Care debate. I welcome and encourage the bpc advocacy efforts that bring a range of policy options to the table. As chairman of the Senate Finance committee, i have in working over the past year to develop a targeted set of common sense policies that help isolate Rural Communities provide reasonable access and needed medical care as close to home as possible. I will continue leveraging my leadership positions to champion innovative, costeffective, and highquality Rural Health Care policy solutions. I will review the policy options released today carefully. It is my hope that these recommendations will spur more candid dialogue among the unique challenges facing our Rural Health Care delivery system. This is important as lawmakers develop Meaningful Solutions and Work Together to have a bipartisan path forward. Cross Party Coalitions are the best way to turn targeted Rural Health Care solutions into law. I ask them to work with me to help build that kind of Bipartisan Coalition as i work on formulating policies that will get more lawmakers on board in washington. The bottom line is, Rural Health Care matters. Many Rural Communities are struggling to Keep Health Care Services Available to their residents. This is especially true with the pressures of the ongoing nationwide fight against covid19. The sacrifices and efforts to stop the virus have shut down that u. S. Economy and life as we know it this virus has and will continue to invade small towns and big cities. One thing we can count on is our rural hospitals and providers are standing guard on the front lines ready to care for the People Living in their own communities. Even as the devastating effects of the Public Health emergency deal a blow to the economy and exhaust health care professionals, we can see communities banding together to help neighbors in need in ways big and small. Americas entrepreneurs, medical scholars, innovators, data scientists, and captains of industry are collaborating through our civic organizations, economic institutions, and all levels of government to stop the spread, save lives, and solve problems. We need to harness that same energy to make sure rural providers are equipped to address the unique needs of their communities now and in the future. Pitching in and pulling together the resilience of the american spirit will guide us to better days ahead. Thank you. At this time, we will have a smallfrom congresswoman from new mexico. I apologize. I guess it is grassley. Thank you for joining the bipartisan policy for this first a Virtual Event. The Task Force Report and policy recommendation. Communities across the country are facing unprecedented time. We are having to fight to keep families safe and their lives together. All of america is hurting right now. Many Rural Communities are hurting. Since the start of this emergency i have fought for , emergency funding for Rural Health Care facilities, expanding telehealth in our rural areas, and protecting the Rural Health Care world. I have also joined my colleagues on both sides of the aisle and demand federal accountability to our Rural Community and calls for the administration to establish a rural covid19 task force. This Public Health crisis only heightens the need for bipartisan collaboration with a solutions that listen to our communities and take swift action. As we continue to fight the spread of covid19, partisan andtics must be set aside pass legislation for our Rural Community. Covid19 has also shown the importance of continuing this work even after the crisis. Challenges like access to food, reliable broadband, Health Care Must be addressed to ensure we are serving families no matter where they live. I introduced isolation to incentivize medical professionals and expand teleHealth Services. The fight for rural families will continue. The Task Force Recommendations are critical. Thank you for joining the bipartisan policy today. I look forward to working with many of you in the future. Obviously hoagland that was senator cassidy appearing instead of congresswoman torres. As i said we are all learning , this new technology. Hopefully we can work out some of these bugs. Now could we try to have senator cassidys video . Sen cassidy bill cassidy here, a doctor, but also a senator. In my medical practice i used to work in a hospital. That included many that had to come from our away from Rural Communities. Then i realized these folks have transportation. A lot of folks in Rural Communities relying on others which is to say they may or may not have transportation. I am aware of the challenges, but how do we improve access and care to those in Rural Communities . This has been highlighted by the Novel Coronavirus epidemic. Although right now, the Rural Communities have been relatively unscathed, i saw an article in the New York Times in which we begin to see increasing numbers of cases in the Rural Communities. Our challenge is how to preserve increased access, improve care in Rural Communities, and the future is now. The cost of health care is too high. Insurance deductibles on these change plans are extremely high. The cost of medications are very high. If you look at diabetes in the rural areas, more of them are going to be diabetics, so the cost of insulin will be a particular problem. Its also difficult to recruit providers to rural areas. It is kind of a vicious cycle, in that the economic fortune of a community declines, and there is appeal to a spouse. They have another career where they work if there is an economic decline, which means your workforce gets older and the kids grow up and move away. Then again, you have more economic decline, because you dont have a young doctor to attract a family with the assurance of good health care. You need to reverse that somehow. Statistically, those in rural areas are older, not just the workforce, but everybody. A little bit older and more chronic disease. So again we have a challenge how , to preserve access to health care in rural areas, improve it to raise it up. What are we attempting to do . The Novel Coronavirus epidemic is going to give us a lot of tragedy. It has disrupted our economy. There might be good things that come out of it. For example, we are expanding the use of telehealth. That is wise. Now a provider can communicate with the person across town, across the state, and deliver services. We had that capability before in rural areas. Because of the need to implement this because of the virus they , are going to scale. Going to scale would be beneficial. Secondly, we are making more use of home health. Before, a patient would go to the doctor, the doctor would evaluate them, fill out a form and they would go home with. Expanded use of telehealth, it may be physically seeing the patients, but they can monitor Blood Pressure with a Blood Pressure cuff or a oxygen oximeter, and those at home 100 miles away from the doctor that have to see if there is an issue consent home health to the home and have the condition addressed and the patient never needs to come in. If a patient in a rural area for transportation, maybe they did not have transportation, we kind of eliminate that as an issue of expanded use of remote monitoring, telehealth as well as home health. I will also point out under this , current law, we are allowing standard use of telehealth. It doesnt have to be something with a videoconference. It can be a smart phone in which somebody speaks to the doctor this way, and it is communicated on the smartphone. That may or may not stay in place after the coronavirus, but i think we are becoming more innovative on how to use current technology. Theres is a special need as well for maternal health. If you look at those outcomes they cannot be as good for those children ifvering they come from rural areas as they are in suburban or urban areas. We have to address that as a special case. Theres a lot of effort to do that. Im sponsoring some of that in federal legislation. So we continue, if you will, by a variety of circumstances to attempt to preserve our health care in the rural area and improve. , one thingan we do we do is draw the attention of leaders and policymakers and those who we also have to explore this and understand in a way which unless you have been there, you may not understand. We have to understand someone who lives 50 miles away from the doctor who has a call that is 40 who has a car that is 40 years old may not be able to get to the doctor. That fundamental lack of understanding, the circumstances of a poor persons life who lives in a rural area, that limits the imagination of what we are attempting to do. We have to come up with novel financing plans. Theres been a lot of attempts. For example, through the Affordable Care act and other organizations to reduce the costs. But if those folks are in the rural area they should be , sharing with the rural hospitals. You need to preserve the rural hospital so the patient has a place to go if there is an emergency. A place to go to get labs done. It also provides employment for the economy. By the way, did i say she doesnt have good access . This brings the care closer to her. The mission of the rural hospital will evolve, but there still needs to be sharing through financial policies. This would allow them to keep the doors open. I think there has to be novel ways of delivering health care. My practice involved Public Health. We vaccinated 6000 children are hepatitis b and we did it by bringing vaccinations to the classroom at no cost to the parents and teachers. We vaccinated the children at school. We brought the health care to the student. We need to think of other ways to bring the health care, for example a mobile mammography unit so that the person does not have to drive 50 miles to get a mammogram. She can have it through a mobile unit. I think you have the concept. I thank you. Our mutual goal is how to improve access and improve health care in the rural areas. It is important for the patients and important for the economics in the rural area. Thing, if theres one thing the coronavirus taught us, we are in it together. I would also add it acknowledges we are in it together. Thank you. Vice pres. Hoagland i would like to introduce the task force panel. So, marilyn, it is up to you. Good morning, everyone. Thank you for joining us. I would like to introduce our panel who is going to help us understand what in the report. We will go over the highlights of the report. They are members of our task force. We have two of our cochairs with us majority leader tom daschle. ,he is also a cofounder of the bpc. We have former senator olivia snow of maine, who is also a cochair of the task force. Shes also a senior fellow and board member at the bpc. A former congressman from iowa with us and also chris jennings, founder and president of jennings policy strategies. You will also remember he was in the clinton and obama white houses working on health care and he is a senior fellow at bpc. We also have gail belinsky, senior fellow at project health. She is also a former administrator of the Health Care Financing administration, which we now know as the centers for medicare and medicaid services. Id like to repeat a couple of the housekeeping points. First, if you have a question at any time during this event, you may go ahead and ask. You will click on the q and a feature and submit your question. I will go ahead and ask the panelists as many questions as we have time for. You will also notice there is a chat function in zoom. If you click on chat, you will not be speaking with one another, but what you can use chat for is to receive information from us at the bpc. For example, our staff has posted the link to our report. If you would like to see that link, go ahead and open chat. You will see the url for that and see the report. The other thing i wanted to tell you is you have either gotten into zoom, but the other way to watch this webinar is through youtube. The way to do that is to go to the website, bipartisanpolicy. Org. Click on events, and you will see a link to watch this. At this time, i will turn it over to our Task Force Members who will go through the highlights of our report. We will start with senator daschle. Daschle thank you very much. Today, we have announced the release of our recommendations on the Rural Health Task force. For the last year, my colleagues and i have worked to find Common Ground to stabilize and improve the challenges facing Rural Communities. Even before the stress of covid19, these problems were urgent. As a senator, representing south dakota, i have long understood that the population in Rural America is older and sicker. The people there are less likely to have insurance. As covid19 spreads across the country, a situation for Rural Communities is more dire than ever before. Now south dakota is the nations number one hotspot for the coronavirus because of the latest outbreak. This virus has no borders and shows how fragile the Rural Health Care system really is. More than 100 rural hospitals have closed since 2010. At risk ofy 600 are folding. Rural areaseople in have no choice but to drive long distances to get the health care they need. Too often, they simply forgo that care completely. Add covid19 to the mix, and struggling rural hospitals are now desperate. The coronavirus has caused significant financial pressures to these hospitals. Many of which are laying off and furloughing employees. Some are laying off as much as half of their entire staff. Like other hospitals around the country, they have postponed elective procedures. While some hospitals can absorb the financial impact, many rural hospitals dont have Profit Margins that would allow that. Congress has responded to covid19 with legislation and regulation, opening the doors in new ways for patients to receive care. Downclinicians breaking barriers to help with telehealth in particular. Many of these measures are temporary. While covid19 will eventually end the need for telehealth and services, we will see an even greater reliance on these approaches as time goes forward. Following site visits in iowa, New Hampshire, maine, wisconsin, tennessee, and vermont, and numerous interviews with rural Health Experts and stakeholders, our task force is releasing policy recommendations that will help stabilize rural hospitals in the short term and create pathways to transform over the longterm. But to transform in ways that meet the changing needs of Rural Communities, we are also recommending policy changes to make it easier for rural providers to move to valuebased care and encourage clinicians to come to rural areas and stay there. To stop the wave of unit of obstetric unit closures and improve access to care by breaking down barriers to those teleHealth Services. Im going to turn it over to olivia, one of my fellow task force cochairs. Unfortunately as it was noted, two of our other chairs could not be with us today, but they have been very invaluable as we have continued our work. With that, olivia. Thank you. I certainly appreciate the opportunity to join other members of the task force. I also want to show my appreciation to the Bipartisan Policy Center and Helmsley Charitable trust for making this task force possible in the first place at such a critical and timely issue, especially now in the midst of this pandemic. As one who represented maine i , am familiar with all of the issues surrounding the challenges confronting rural hospitals and rural clinics, and Rural Services in Rural Communities. Im pleased to be a part of this initiative. I will focus on the recommendations in our task force regarding the substantial number of rural hospital closures over the last decade. And we know the financial pressures that have been exacerbated as a result of the covid19 crisis. We wanted to address a number of these issues that we think are important to the sustainability of rural facilities. Traditionally, care has been centered in inpatient hospital settings. Many patients receive care in both Community Settings and outpatients. That has contributed to a significant decline in hospital revenue to enable communities in rural facilities to transition to a model that makes sense, and we recognize in the task force that the community has different needs. So we decided first and foremost to develop recommendations to stabilize rural hospitals and rural clinics by first providing immediate Financial Relief over the next three years. We think that is a timeframe that is essential or communities to make the transition to transformation of the model. Congress can do this first by providing immediate Financial Relief from a 2 reduction in as reliefare, as well from medicare debt payment reductions. In the emergency relief package, congress included a temporary suspension of the sequestration cuts through the end of 2020. We also propose that congress should increase financial assistance, in terms of reimbursement. Currently, these hospitals receive about 101 of their costs. We consider the sequestration cuts that have occurred as 99 of their costs being reimbursed. Obviously they dont break even. So by providing the 3 increase in conjunction with the medicare sequester relief, that would be a net reimbursement that would equal about 104 of their costs. We happen to think this level of funding would enable them to remain operating and at the same time build and invest in stronger Health Care Services. These measures are temporary. As i said, intended to stabilize rural hospitals and rural clinics as they determine the best pathway forward. We also propose in our Task Force Report establishing pathways for transformation so that these measures are flexible in that we include various payment models that will fit the need of specific communities. For those who want to make this transformation possible, for communities and Rural Communities, they need to submit a hospital Transformation Plan. That assessment is similar to the assessment currently conducted by rural hospitals. It would also include input from all of the stakeholders in a particular community to ensure the Transformation Plan reflects the need of that community. One of the first models we proposed is called the rural Emergency Hospital designation. This would allow rural hospitals to transform from an inpatient hospital facility to one that provides outpatient Emergency Services, or other services, such as extended care services. We also include several payment models, one that would include 110 costbased reimbursement. And the global payment, third is the medicare outpatient prospective Payment System. Either combined with a grant for other services or based on per member, per visit, and predicated on the number of anticipated patients in a specific community. Another model that we proposed is the extended Rural Services. Under this model, it would allow rural hospitals that either closed or no longer provide certain services. We can talk to several qualified Health Centers, Health Clinics from adding these services and being paid for them so they are no longer available in the hospital. Such as urgent care or Emergency Services or both. And we also call upon the center for medicare and Medicaid Innovation to develop proposals that would call together multiple payers and providers based on the global budget and model, similar to the global payment model currently being tested in the state of pennsylvania. We also are calling upon the center to promote models for the integration of Rural Health Care clinics, as well as rural hospitals. With that, i will turn it over to my college to talk about the transformation of clinician payments. Thank you very much. I am going to be focusing on clinician payments and maternal care. While we have seen the country moving towards valuebased care, this has been much harder and slower in rural areas. Some of the reporting requirements can overwhelm smaller organizations, and lower volume of services there means there are fewer to spread the overhead costs over so it makes it difficult for rural providers to take on financial risks. Our task force has recommended a number of fixes to the current Payment System to enable more of the patient centered care, including an lemonade in coinsurance and services. We suggested using readily available medicare claims data to reduce the Administrative Burden of quality reporting. Ultimately, medicares Innovation Center will need to increase access to payment demonstrations that are flexible enough to meet the needs of Rural Communities. Our task force has made several important recommendations to improve maternal care in rural areas. While maternal and infant mortality, unfortunately, has been increasing across the country, the rates are higher in rural areas. This has been caused by lack of access to local obstetric services. Between the years 2004 and 2014, for example, 9 of rural hospitals closed their obstetric of ruralaving half counties without any hospitalbased maternal care at all. One study found the loss of the service resulted in an increase in preterm births and births that occurred outside of the hospital. To make sure women can receive adequate prenatal care and continue being able to deliver their babies locally, the Task Force Recommends increasing the of obstetric services. Medicaid covers more than half of the deliveries. And there is a lot of variation in state payment rates. Many of the rural hospitals as we have heard are not even breaking even. The secretary of hhs should be able to reimburse rural for care in the Health Professional shortage areas at the National Median commercial rate. We also recommend congress increases funding for education or Training Programs to make sure primary care clinicians will have the necessary skills to deliver prenatal care and other maternal services. I will turn this over to chris jennings, who will talk about our recommendations. Chris thank you. It is certainly no secret that rural areas face Significant Health Care Workforce shortages, both for primary care clinicians and specialists. It will be an old movie that has the same ending if we dont more effectively highlight problems, produce new and viable policies, and make a compelling case toward change and effective implementation. Lets start with the compelling problems. It is undeniable that we have a Rural Health Primary Care shortfall. Without action, it will clearly get worse before it gets better. Rural areas have only 40 primary care physicians for every 100,000 people. That compares with 53 in urban areas. That gap is so much greater for specialists. Rural areas have 30 specialists for every 100,000 people, compared to 263 specialists in urban areas. To be clear, and to address many of the issues that have been raised, that disparity is much worse when it comes to access considerations related to the long distances between providers and patients. To make matters worse, nearly one third of primary care providers in rural areas are over the age of 56 and nearing retirement. This picture may be even worse than it appears when it comes to primary care shortages, because it appears in Nurse Practitioners and physician assistants are classified as primary care clinicians, even when practicing as specialists. Amongst our first recommendations is to make sure we have a clear line of sight into the problem by recommending the Health Services and Service Administration assign a specific Specialty Classification to have a more accurate assessment of the problem we face. As we do that, we recommend an independent review. In this case we would suggest by either eao or the National County of sciences of all rural workforce programs within hersa to determine which programs are effective, which should be prioritized, amendment and sunset. But the task force clearly was not satisfied on waiting for another review when we face a rural Health Crisis now. If you know these numbers, that shouldnt surprise you. We strongly believe you cant expect the same policy to deliver new results. Because of our experience in this area, the task force has concluded we know enough to make new recommendations and take some bold actions. We are recommending incentives that would both encourage clinicians who moved to rural areas to stay there, and also make greater use of the existing workforce. First the Task Force Recommends providing federal tax credits to clinicians who practice in rural areas. This is not being done now. Incentives such as loan forgiveness programs already bring some clinicians into rural areas, keeping them there has really been a challenge. Tax credits in two states, oregon and new mexico, have already proven effective for retention. One of the most difficult objectives any community faces. Although the state experience is encouraging, we believe a limited number of states and the inadequacy of the tax credits are suppressing the potential for this policy. In the current covid19 environment, states simply will not have the ability to lose even more revenue through tax credits at the very time they are losing all of this revenue coming into the coffers. Assets we recommend as an example of tripling the value of these credits and escalating amounts over three years. The task force also recommends that we notably expand the number of j1 visas from the conrad 30 to 50. These allow International Medical graduates to stay in the United States for an additional three years to practice in shortage areas. Third, the task force embraces the importance of making greater use of the existing workforce. We recommended the hhs secretary assess the impact of the reimbursement to Health Care Providers that it currently doesnt cover, such as pharmacists and social workers. We also believe if a strong case could be made, the effective use of these providers could enhance the overall value and medical outcome of the patients they serve. Also, there is a documented urgent need for additional behavioral Health Care Services. We know that in particular through the isolation issues that many of us are aware of. Medicare does not cover marriage and family therapists, and licensed Mental Health care counselors. This is a case even though they are included in the Public Health service act and may be called into service by the national Health Service corps. We believe medicare should step up and cover these providers. We have more recommendations,ut i encourage you to review but for my last duty, i reflect on the past. 30 years ago to this year i had the privilege of staffing the socalled pepper commission. Congressman tom cocky was even then a compelling advocate to addressing the unique challenges of Rural Health Care in new and innovative ways. It is my pleasure to turn it over to the congressman to discuss our recommendations on telehealth. Thank you very much. Now that i am a, it has been great to work again with you and all the members of the task force. Some 30 years ago when congressman Mike Steinert and i cofounded the Rural Health Caucus in the house, we believed that technology was the key to delivering Health Care Services to Rural America. Then it was just a dream and today it is becoming a reality. The task force sees health i. T. As essential to expanding access to care in rural areas. The response to covid19 has focused on getting care to people who cannot see their doctors facetoface. This is an everyday problem. Before covid19 and will be after in rural areas. Where people live long distances from medical care. After the threat of covid19 has passed, rural residents will continue to need telehealth and other virtual technologies. One good thing emerging from the covid19 epidemic is that congress and the Trump Administration waived Many Medicare restrictions for telehealth, easing restrictions around the site of service and allowing telehealth for patients not already established with a clinician. There is also new flexibilities allowing phone calls and other nonvisual visits to be paid for. Congress has temporarily allowed a patients home to be an originating telehealth site and this is very important. These changes make sense. And one key to making telehealth a real option for Rural Americans. All of these changes should be permanent and not require a waiver. Rural Health Clinics and fqhcs should be permanently allowed as distant telehealth sites. These changes that have been made in response to covid19 are consistent with the Task Force Recommendations so we have been pleased to see them implemented. In addition to these changes, Congress Also should allow clinicians to provide services to Medicare Beneficiaries across state borders, and eligibility of teleHealth Services should be based on where the provider is where thestead of patient is located. Right now a clinician must get a separate license in each state where he or she is providing teleHealth Services which can limit the ability of providers to offer care to Rural Communities. Covid19 has provided us with a valuable learning experience to see how well some of these changes are working and how we can use them after this pandemic. They have demonstrated that telehealth can function well, very well in connecting patients and their clinicians. And we must make these changes permanent and build upon them. Finally, the Task Force Recommends expanding access to broadband in rural areas. Broadband is the essential tool for providing high quality teleHealth Services, and yet about a quarter of Rural Americans and a third of those on tribal lands do not have access to adequate broadband. With that, my colleagues and i have explained the highlights of our task forces recommendations. Marilyn will let you know where you can find our report and the rest of our recommendations. Arilyn fantastic. Thank you to all of the members of the task force. If you are looking for the report, open the chat function in zoom and you will see a link to the report there. If you would like to ask a question, open up the q a q a tab in zoom and you will be able to send a question in. I will see the questions. I will ask as many of the questions to the panel as time permits. We will start with the real elephant in the room and that is covid19. As bill mentioned when we first started working as a task force, we were not thinking about covid19. But now it is a reality affect andcorners of the country including in a big way rural areas. Chris, i wanted to ask you if you could talk a little bit about what we can expect there may be a covid relief package in the senate today. We know that already there has been 100 billion legislated for hospitals. There was no indication in that legislation for how that would be split up. I would love to hear from all the Task Force Members about what we do need. We have been hearing from a number of rural hospitals and all hospitals everywhere that this is not enough. For the rural hospitals that have had to put a pause on their elective procedures and this is where they make their money, they are really having a lot of trouble. And we are hearing from some of these hospitals that have already been struggling with less than a wiis worth of cash on hand and now they are losing millions of dollars that they are potentially going to have to consider cutting back services or folding altogether. Chris, can you kick us off . Tell us what we can potentially see in the senate today. What additional help we could see and then i would love to have the other panelists jump in with their thoughts. Chris sure it is a pleasure. , as most of these members of congress can attest, when you have moments like this, much intenses done over very periods of time and you are digging out what you just passed occasionally and we are reading through that now. Last night, there was an agreement for another 450 billion for covid19 related activities. Apparently 100 billion of that 450 billion will be dedicated for Additional Health care investments, a full 75 billion for hospitals. And there is some initial reporting that a significant portion, probably that means a little more than a disproportionate portion of that may be going to rural areas. There is a lot of members who are extremely concerned about the infrastructure challenges and service challenges that this disease poses on their communities. We are seeing that being raised in a host of other areas as well and that gets applied, for testing to testing, capacity and distribution. There continues to be a debate among republicans and democrats in the administration on how best to allocate this testing, how to ensure capacity, how to distribute it, with the democrats hoping for a little bit more federal leadership and the president indicating a little more comfort with relying on local and state communities to make some decisions. So all of which is to say, yes, you mentioned 100 billion for providers last round and this is another 100 billion of health care. There is almost inevitably going to be a big push for a 4. 0 version. Although this is now being called 3. 5. I anticipate that to begin with in hours. This is expected to be passed this afternoon with the house passing soon after. We need to watch and dig through the details for the exact allocations and formulas. Could i get other members of our panel to weigh in if you would like . All hospitals are struggling here. So how do we what is the proportion of funding, do we even know . We need to understand that hospitals were struggling before this. In 2018, that was the first time that hospitals were seeking were seeing positive operating margins after several years of not having that happen. And so, there is not a lot of resiliency for many hospitals. Rural hospitals have had even more challenges, but this has been a pretty challenging time in general. It is recognizing that the covid crisis is coming on what had already been a fiscally stressed time. When we talk about testing, i think we have to be smart about how we approach it. We need to think about the advantages of sampling to give us a hint of those areas where there needs to be aggressive involvement in those areas where you may be able to have more selective involvement. There is no way in the near term we are going to have enough Testing Available for 100 of the 330 million of us to get tested, nor should that be necessary. But you do want to go to the areas in the populations that are most at risk, do testing there, and let that guide us as to whether or not you need to do more testing in an area or whether you can move on. There is some notion on how sampling can help so we can use these resources in a smart way. Following up on that, many of the rural hospitals were in financial trouble already. The covid19 virus has exacerbated the problem in so far as it has caused many facilities not to engage in routine activities such as elective surgeries and as a result, their revenue is going down as a result of covid19. The aid from the federal government to these rural hospitals is really important in order for these hospitals to be able to survive and it is justified because of the fact that it is Government Policies that have resulted in this temporary reduction in the systems to rural hospitals. I dont know what is in the bill related to telehealth. I certainly hope there is also some Financial Support for the advancement of the kinds of things i talked about in the report related to telehealth. That is an avenue for delivering the services and ensuring there is reimbursement for those services that are delivered via telehealth is really critical. I would add it has been summed up well. Obviously we will not know how this will go, and i think he is right that this package will go in multiple stages. It is really important for congress to really get a handle on the problem that exists most especially in rural hospitals. I know there was indication yesterday that there are spikes in rural parts of maine and in other parts of the country. They are already facing the enormity of financial problems and i think it is important that congress understands exactly what is the breath of the problem that exists for hospitals at multiple levels. As has been mentioned, many of the hospitals have had to forgo elective surgeries, not receiving any revenue. I know some of the hospitals here in maine have already furloughed employees and reduced salaries. It is becoming a greater challenge. I think it will be important for those of us that are on the front lines in this report, but also for hospitals to be able to communicate to their elected officials exactly what is transpiring. Both to deal with the immediacy to the problem, but also the cascading effect it is having on hospitals that are already under great financial constraints. If i could pick up on what olympia just said it is important for us to keep our focus on the short term and dealing with the crisis as it continues to expand throughout rural areas. That is first and foremost. I think we have to do it with an eye to the longerterm as well. One day the covid19 crisis will end or at least diminish and then we will have circumstances involving the infrastructure that we will have to address. It is important for us to think about it in four buckets. Obviously resources, we talked about the need for resources in a series of different capacities. Resources are critical includine critical, including increasing the reimbursement rate to critical access hospitals and finding ways to deal the sequestration issue. There are a number of things we have to look at, in addition to telehealth, that require more resources. The second is regulatory. We have to figure out ways to ensure there is more regulatory flexibility for hospitals and providers. That regulatory relief and flexibility and pragmatic approach, as we look at allocations in Rural America, is essential. The third is workforce. We have to understand the workforce in Rural America in particular is continuing to an even greater problem. So sending the National Health ways tocorps and other really augment our workforce is going to be critical. Of course, telemedicine plays into that. , finally finally, the need for transformation. All four of those buckets are going to be critical, not only in the shortterm but as we look at the long term. Thank you, senator. Congressman, i wanted to get back to you regarding telehealth. You laid out what has already happened and the incredible progress we have made in a short period of time. One of our questioners is asking about the emphasis on medicare. A lot of what we are talking about is coming through medicare, yet we have a lot of people in this country in medicaid and in commercial insurance, commercial coverage. How does this apply to that . I would love for others to jump in as well. What more do we need to do . As senator daschle said, a lot of payment issues related to medicare have been addressed. State, therethe are other issues relating to payments that affect Insurance Companies and medicaid. It is a complex set of issues that confront telehealth providers and teleHealth Services throughout the country. It varies from state to state, what is permitted and what is not permitted and schedules. There is a lot to do. The federal government can do a portion of it, but state is also important. Is an article that just appeared in the Des Moines Register on april 13. It was titled, rapid rollout of teleHealth Services in iowa. We are just going crazy with it, one doctor says. It outlined many of the challenges confronting telehealth, as well as how there has been this explosion of teleHealth Services in the state of iowa. In that article, there were three things that i pulled out as lessons. The first is the waivers we have, the payments and ability to deliver services, things need to be made permanent and more regulatory were firm debt reform is needed to facilitate telehealth. Toreform is needed facilitate telehealth. Second is we need complicity. The federal programs and state programs and all the different requirements that one has to jump through in order to qualify for this payment or that payment is so complex. These rural areas, particularly rural health providers, whether it is doctors practicing alone or a rural health hospital, they do not have the staff to be able to just manage all of these requirements. Requirements is so important for these smaller providers. As i, we need investment alluded to earlier. One point relating to that is many rural areas, a lot of rural areas are served by Rural Telephone companies or rural cable companies. There are over 1000 small Telephone Companies across the country. They receive a lot of federal assistance through various means in order to provide service to their customers. The big problem is in rural areas served by large companies. The at t, verizon, those companies. They do not receive that reimbursement to serve rural areas and do not have incentive to make investment as a result. Something needs to be done to address the Broadband Service to rural areas. In order to encourage the delivery of the infrastructure that is necessary in those areas. I think if we look at those things, how to get investment in broadband, how to simplify all the requirements, how to provide the regulatory relief like making some of these waivers permanent and then doing other regulatory restructuring, that is going to do a lot to help rural areas. Would anybody else like to weigh in on that before we move on . Ok. The report recommendations focus heavily on stabilizing rural basisals on a temporary to give them the opportunity to transform into other kinds of models that best meet Community Needs. Why do we need to even think about these kinds of transformations . Do we currently have a mismatch between what some of these hospitals, fullservice hospitals, and what the unity needs . What the Community Needs . The answer is yes. We are hearing today about some of the responses that are already being proposed. I think we are going to see changes that have started as a result of the covid experience that are not going to go away. I do not think we are going to revert back to some of the restrictions because we have all been able to experience some of the benefits of allowing greater flexibility, just as we are speaking now from our various ,omes to share these views telehealth is going to change. It is important in some rural areas it has been important in some rural areas for years. It has improved significantly since i first observed it being used in the early 1990s, when i was in the early 1990s. I would not want to have my body being affected use and some of the telehealth that was available then, but transmission capability has improved significant. The introduction of broadband to many areas. What were going to have to do is to sit back when we are out of the covid emergency and understand the benefits that we have experienced of going through this period and choose to adopt those that have been very helpful. Toehealth, i think, is going change how health care is delivered, especially for rural areas especially important for rural areas and central cities where distances may not be as great but the time it takes to get to Healthcare Services can be significant. Manynk you will see changes in medicare, in medicaid evenessed to go forward once we are outside of this emergency period and all for the better. Just emphasize something tom said earlier, telehealth is really going to be critical, but critical to telehealth is broadband and we have some serious challenges in parts of Rural America, especially in s. D. L. There are many parts in south dakota that still struggle to acquire fundamental broadband and access telehealth effectively. We are going to have to recognize that broadband issues are unaddressed in many parts of Rural America and we have to put resources and priority on acquisition of broadband if we are going to produce the teleHealth Services that are going to be necessary Going Forward. , this is going to accelerate these initiatives. It certainly should. Technology and limitation has basically been fractured across the country. Rate amonged the ee revising telik munication laws. Think about where we are today and where we should be. Some of the changes that have been given a temporary designation in the emergency relief package should become permanent. We should begin this process now because we have to remedy the gaps that exist in our Health Care System and in the Rural Community. This will provide greater thention because of immediacy of the problem and urgency that exists. What we need to do as a country to provide comprehensive examination of these issues and to address them in a conservative way. Get you to expand on that a bit. I want to get back to the household transformation. We have proposals to allow one of the pathways to allow hospitals to transition into something that will look more like a standalone emergency department, plus Outpatient Services across may be some observation beds. Of course, the task force wrote these recommendations before we were in the middle of a covid pandemic. One of our questioners is asking, is that going to could potentially cause us to bedsa shortage of hospital , especially icu beds, when they are potentially most needed . Aboutu talk a little bit why the task force decided to flexibility in these proposals . Primarily, detrimentally, we heard from a wide range of stakeholders about the need to develop financially sustainable models. This would occur over three years, three years for the immediate Financial Relief i , the additional assistance we recommend congress provide for reimbursement we think is important. Obviously communities can then assess how they want to of thisin the aftermath covid crisis and what the impact will be on various communities. They can incorporate that into community assessment. We would expect it to take place for the next three years, through 2023. They can incorporate all of these changes and then determine what would actually be there requirement or what type of facility would benefit their community. I think the attribute of our determine whatto option and what model and they are not required to make this transformation. That is a choice and an option that would be available to whatnities as they rethink their needs are in their particular community. Brings minority populations, the tribal representatives. We have a variety of stakeholders who will have the ability to provide the kind of information important to make decisions. Also what is important is this is not an immediate change. This would happen gradually over point if the community or rural hospitals decide they want to proceed, they could ultimately adopt a transformation model and then decide they want to revert back to a critical to be a critical access hospital. They could pivot back and forth in the future if they determine that was what was warranted. I am wondering if you could add a little bit to that to talk about, in addition to creating new transformation pathways, the task force also decided to provide various opportunities for how to pay hospitals. You spoke a little bit about this before. Why the need to provide flex ability in . Where do you think we are headed or where we should be headed in terms of payment . How do you see as moving forward . For flexibility and the need for flexibility is areas in particular do not have many of the the urban areas with their higher density have, can draw on. What we were talking about is the need for more broadband. It is not an issue in most urban areas. We need to be smarter in recognizing that we need to show some flexibility, greater flexibility, then has been available in the past. It was why my comment that i beingthe results of forced to be more flexible as a result of covid19 experience is going to mean that Health Care Delivery, particularly of telehealth as a more normal way for clinicians and patients to howract, is going to change health care is delivered Going Forward. It will be especially important in rural areas because of the distancesy and high that are frequently required and because of the scarcity in some areas in certain types of specialists. It is going to change everywhere. I think the genie is out of the bottle. People have realized how with thet it can be nowof visual communication as a result of sites like zoom or other means to have telehealth. You can have many interactions between clinicians and patients without forcing them to actually be physically present. Not for everything, of course, but for a lot. , as somebody who is a former administrator, i understand the reasons for some of the inflexibility. Governments are pressed to be fair in terms of how they treat different areas, to always worry areas are taking advantage, but we have been forced to realize that rural flexibility that has not been available. If we want to allow people to remain in rural areas and enable them to receive the kind of health care they need and deserve, we are going to have to be a little more flexible and find other ways to address other concerns. We consistently heard from stakeholders that our solution does not work. Value of theis the approach we have taken in this report to give them the option. Then they can assign it to what suits their local Health Delivery need. As you alluded to earlier, when we were to liberating the it wasin this report, before covid19 hit. Much of what we saw was about the Health Care Systems in rural years, whenlier there were more patients, longer hospital stays, and so on. Part of our liberation was focused on how to make the system more efficient and sustainable. Casesould result, in some , in fewer hospital beds in communities. Now, we have a different perspective than perhaps the perspective we had when we were deliberating about these issues. Need for the a ability to suddenly have influxes of patients and the capacity to me to this immediate, substantial need. It is hard to do that in areas where you do not have the Financial Resources to sustain that kind of facility and infrastructure. I think we face a real dilemma in the country as a whole, particularly in rural areas, about how much infrastructure can you sustain for the kind of pandemic or emergency situation like we are facing now versus what you can sustain for the ongoing care that is a question of how much resources will be beds in rural areas then you need on an ongoing basis. Askedk the question you is an interesting one and one that has risen as a result of this experience of the last couple months. It probably was not given full consideration by us. One last point about this issue, which will be debated, what is our response Going Forward on capacity . That is going to have implications for rural and urban but is this issue of how we can better prevent the demand on capacity the first place. That really gets to more sentinel capabilities come up more testing capabilities and infrastructure, more prevention. Ofare also seeing a host social and societal problems exposedw that are being in meaningful ways. There is going to be a huge reflection on what we have just gone through and how we reacted to it, what remains, and how we should change it. Exciting. Ys, it is in some ways, it may kick us in the pants to address these issues that have gone unaddressed. That is all i wanted to say. I wanted to elaborate on one point chris made, and that is the importance of Public Health across the board. I was shocked regionally to learn that we lost 50,000 jobs in Public Health, over 25 of the workforce in Public Health, between through thousand 2008 and 2017. We have seen a devastating attrition of Public Health officials at the local and state level. The accounts for a lot of proactive work we should do to avoid these situations Going Forward. Recognize a greater investment in Public Health then we have in recent years. Let me put one question to my colleagues that has been troubling me. We are going to feel torn between being able to respond to the need for Surge Capacity but on annting to have ongoing basis the volume of beds or icus or other spence of Health Care Facilities that will be required during a pandemic or other emergency. Thinking about how we can be smarter and how we accommodate the need for Surge Capacity will be one of these issues where we get through this Current Crisis that will require smart heads to think only about. Calmly about your and the use of the mercy and comfort about. The use of the mercy and comfort setting up comfort, setting up field hospitals, there are a lot of interesting things. It will be useful to sit back afterwards and incumbent on all of us to think about these issues, to think about how to be better prepared next time Something Like this happens. As we all know, it will. We do not know when and what he calls will be, but we are confident it will happen again. What the cause will be, but we are confident it will happen again. Islet me add to what gail saying here. One of the pathways to transformation involves global budgets. Gail, i would like to hear what you have to say and what the others have to say about how global budgets could potentially provide some flexibility to Health Care Systems and states as a whole to pivot. Is at thennsylvania beginning stages of testing a Global Payments model. The recommendation of our task force has been to ask the center for medicare and medicaid how toion to look at expand on that model so it could be workable for other states. We know the pennsylvania model was geared specifically for pennsylvania. Paymentsea of global is to give government a step onk and not put constraints the various elements of spending that a state or hospital or physician might have to be accounting for. We have been moving in the direction of more and more Global Payments since the 1980s, when prospective payments was adopted as a model to reimburse hospitals under medicare, where the payment was based on the diagnosis and. Ischarge precisely how the payment was used was left up to the hospital. There are various issues that have arisen about whether and wheno account for quality you use Global Payments and whether to put recording requirements or quality requirements. Is to give aa governmental unit more flexibility in how funding is spent. I think that is going to continue to go forward in the future. What do we want to know in its place, in response for giving greater flexibility to the institutions . What kind of reporting would make us feel assured in the areas that matter . Is it noise of the about the outcomes knowing something about the outcomes . At at risksions populations are being that at risk populations are being cared for . The way we pay positions under medicare, we moved from a very microlevel approach on the relative value scale where you have physicians being paid on a basis of 10,000 units to various attempts to try to get more value based payment. We are still struggling in that are andarding where we where we need to be. These are not easy issues, but i think the notion of getting to broader payments, allowing for , what kind ofty information and assurances need to be provided, is the position we find ourselves in. Abouthave been talking the hospitals in rural areas up to this point, but i wanted to of you all about the needs clinics. We have rural Health Clinics. Often they are attached to hospitals. E have Health Centers as well ae of our models would allow qualifiedfederally Health Center to expand services when the area has launched Hospital Services loss Hospital Services or lost a hospital altogether. To allow them to expand to add Emergency Services and get paid properly to add to that. What is the issue we are facing here with the clinics . When we are seeing hospitals disappear, are we seeing clinicians disappear as well . What is the need here, and why the response we have chosen . Shout out to give a to the kennedy Health Centers. They have done a phenomenal job. We find they are overwhelmed right now because people have in many cases lost Health Insurance as a result of the dramatic increase in unemployment. 22 million americans have filed for unemployment insurance. As unemployment continues to become even more severe, clinics around the country, especially in Rural America, are feeling the full impact of the additional demand. Resources are going to be critical. Some degree of recognition of many of the things weve already talked about, providing them with greater flexibility, making sure we maximize scope of practice to ensure that the has the Infrastructure Resources and ability to meet the demand, that is critical. I do not think we fully appreciated that today. I think theres going to be greater attention to that as we. Ddress covid as we look to the fourth phase, those resources are going to be essential. We have to make sure they are given the priority they deserve. I concur. It is clear that rural Health Clinics play a pivotal role in those communities. They are medically underserved areas. They draw a number of providers who otherwise might not be available in a real area and already 400 Rural Health Care 2012,s have closed since federally qualified Health Centers. Residents3. 8 million that have been impacted. Devastating and we do have to recognize and to provide resources and to elevate the reimbursement as well for rural Health Clinics. One of our proposals for independent physician owned clinics that receive a lesser reimbursement than the hospital rate, we recommend providing 115 per visit and also, as tom nurseted, increasing practitioners and physician to expand the offerings. These are the approaches we should be taking to evaluate as well. Obi services ob services, we know a lot of these hospitals services. G ob this is an extensive universe hospitals. We know that. It is generally a money loser for hospitals. Why did the task force recommend bncreasing payment rates for o services . The task force also recommended training for primary care clinicians and other clinicians to allow them to better be able care and prenatal deliveries. During our visits, we heard from one Hospital Executive that they have stop and drops. We asked, what is a stop and drop . The guy told us, we have a lot ob we do not have services, yet we have a lot of pregnant women coming in. They are in labor, ready to deliver their baby, but they have not had a day of prenatal care at all and we do not have services. The problems with the lack of services are affecting outcomes. Important . So how big is the problem, and why are we recommending increase payments and training . Increased payments and training . Maybe i answered all of that. I think he really did answer the question for us. If youre going to welcome and encourage a young for young families to stay in rural areas, you need to make it easy for young families to expand, and that means having Services Available. Want to make it impossible for families to be deliver in the areas, to have to go elsewhere. If you are serious about wanting to have rural areas be able to support young families, you need to make sure federal services are there and pediatric care is available. Without the services young families need, you will be fighting a losing battle. How big a problem are payment rates . Obare payment rates for services, whether rural or not . This has been a struggle. In part, the payment needs to be a single payment made for services. If you do not have a large cases, those kinds of averages can cause a problem. Us in ourseveral of discussions have pointed out the need to have payments which reflect the lower use but very obtical nature that having services means. That was why the recommendation for having them at National Averages rather than having it just for the local area that might be involved. If youecognizing that attract and maintain young families in rural areas, you have provided services that are most important to them. We have not talked a lot about the workforce challenges. We have a lot of challenges right now with covid19. Beyond covid19, and rural areas, we have an extensive problem with workforce. In rural areas, what makes it hard for clinics and hospitals areas . To rural to get people . To rural areas . Why is this such a big problem . I can speak from the experience i had over the years as a representative of south dakota. I think smaller communities ,truggle because they are older sicker, and have greater demands. A physician or Nurse Practitioner in a rural setting is on the dirt job 20. I think physicians and others on the job 24 7. I think physicians and others are looking for a more balanced life. They know if they moved to a Rural Community they have enormous demands put upon them unless they can find relief. Part of the problem is just the ofllenge of the existence such limited access to providers in these rural settings. That is part of it. A physician, as a nurse, you are looking for places to raise children. Limited access to other social services, community services, and the kinds of things you expect in normal suburban and urban settings do not exist in Rural America. It is harder to recruit for that reason. It is why we have to create a robust incentive program, whether it is tax relief, finding ways to ensure that these physicians and providers can be compensated more robustly. Given what we know now, it is an enormous demand on them and their families. Ahead. Go ahead, chris. , i was going to say that again, this is not new, but we have seen these challenges forever. The difficulty of attracting spouses as well. You cannot just think about the financial incentive. You have to think about the infrastructure and its attractiveness to the family. That becomes harder and harder when you think about these things. Forceelieve this task expressed frustration about doing the same old, same old, which is why one of our proposals really is to be aggressive on the whole workforce issue and put new ideas on the table that i outlined previously. I will not go through them again. I do believe the telemedicine capabilities, if we can really address the broadband issue, which everyone on this zoom meeting pulls our hair out on this issue. Snowe andsenator and senatortauke daschle. I cannot even look at them without thinking about that. The first Place Congress went on covid19 was putting substantial dollars come at resources, and flex ability and telemedicine dollars, resources, and flexibility in telemedicine. When people see that and his potential capabilities in certain its potential capabilities in certain areas, we may see that is something we can build on and justify some significant investment in the broadband area. To turn it back to congressman tauke. I was want to say i think what tom daschle said is accurate in terms of the questions relating to lifestyle and availability and good schools and all these other potential issues one has in rural areas. Another big factor is this. Whether rural areas or urban , why is it that in an is part of thet it is because of the paperwork, the regulatory challenges. I alluded to this earlier. Our system is so complex. We cannot understand our own insurance, most of us, or why we get something that is reimbursed or does not get reimbursed or the amount gets reimbursed. If you are a single practitioner in a rural area and you have to try to work through all of that for medicare come up for medicaid, for various Insurance Programs medicare, for medicaid, for various Insurance Programs, the paperwork you are dealing with is overwhelming. Most physicians do not have to deal with that because they have back office staff to take care of that sort of thing. One of the challenges, in addition to the lifestyle allow s how do you how do you get people who are practicing medicine in rural areas to spend time actually engaged in working with patients rather than having to deal with and thehe paperwork other difficulties involved in involved . I understand we have had questions about why we have not focused on frontier communities. We should emphasize this is building on what we did in our earlier report a couple years ago. I think it has become at least two reports together that give us a cumbrians view comprehensive view of our concern for rural health and proposals to address it. I think we need to look at it especially as we address frontier communities. I did want to make sure people realize this builds upon a report we put together, a staff report, not a task force. We did have staff visit in south dakota, north dakota, specifically north dakota. Specifically, Frontier Health was a critical issue, not just rural health. We should post that as well. Mention isg i will this is one of the reasons why the task force decided to offer as many different pathways and possible, soons as that things could be flexible. The one thing we heard over and over again in rural areas was, if you have seen one rural area, you have seen one rural area. Certainly every area we visited was very different, had different needs, had a different had different, workforce challenges. Many of the same challenges, but there were differences. This is certainly we have a lot more work to do in addressing Rural Health Care challenges. This was one of the reasons why we on the task force felt it was necessary to offer many options and be as flexible as possible. I want to say one last thing about workforce, particularly primary care offices that are frequently not getting the same amount of attention as hospitals are. When people talk about hospital relief, and they did in the previous covid, not the one today, it also included significant dollars for primary care physicians across primary care physicians, physicians across the board. This is critical now. We are seeing a moment in time where people are not going to their physicians. They cannot keep their offices open. Officesre one of those that was thinking about retiring early to set up a whole process again and rehire people, i am notid if those dollars do continue during this stopgap period we could see a number of these offices close at a moment when we need them. As much as we talk about hospitals, we do need to talk about physicians offices in this moment to give them stopgap protections. Ok. Ask one ofs our questioners asks about the careof nurses, primary physicians, teleHealth Workers, i. T. Experts. Should we pay education expenses for people who enter the shortage areas . I am a supporter of using loan forgiveness for attracting need and are not able to attract. Ishink this is one that increasingly attractive as the cost of training goes up. Couldould be something we make more extensive use. Even for physicians, we can do because, although historically this has not worked as well, the cost of medical school and length of training has increased significantly. Especially for all the other Health Workers, which are also in short supply, i think it is something that is worth trying. I would agree. Is critical incentives to continue to explore and implement. Can worko make sure we on these kinds of initiatives for the future to create draw to Rural Communities. What f the areas, when it comes to workforce, that we have heard a lot about is access to mental Health Services and behavioral Health Services. Pollct, we conducted a through Morning Consult in partnership with the American Heart Association at the beginning of this project. What people in rural areas told us was very high on their list of concerns about access was their ability to access Mental Health or behavioral Health Care Services. A bigger challenge in rural areas to get these services . As an extension to that, is it possible that some of this new telehealth ability is going to help in this area even beyond covid19 . It is an Area Military has been actively using, particularly with mental Health Services. Thatnk it may be something or was notous obvious to me, that mental Health Services would be amenable to telehealth, but the military has reported quite Successful Use in this. One of the reasons there is a particular shortage in this area is that there is a shortage generally in terms of mental Health Services. Basically, rural areas are competing with urban areas for a specialty that is in short supply. This is another place where at least one of the challenges reported has been a lower reimbursement given the amount of time that is typically required to provide services. It may well be an area where support Health Workers that are not being used as imaginatively as they could. V. A. Is something where the and military may have some models to share that would be useful in providing health care. In particular, i think the military has been successful in using Mental Health produced by telehealth. Is fair to say there are very few mental Health Professionals in it is fair to say that there are very few mental Health Professionals in most rural areas. There are shortages of other kinds of health care specialists. There is a figure shortage in the Mental Health area. That means traveling bigger shortage in the Mental Health area. That means traveling long distances. The Des Moines Register article i alluded to earlier highlighted Significant Growth in mental Health Services via broadband and not just mental Health Services as we often think of them but also things like family counseling. We are sheltering in place now strainsind some of the of family life can be exacerbated during this time. Having access to Counseling Services via telehealth makes a lot of sense and also gives real help to a lot of people. I think one of the things this that thes is Communication Services that can be available in rural areas can deliver a lot of terrific benefits. That would include in the Mental Health area. Downthink we are getting to the last five minutes here. Maybe the best thing to do is to let everybody make any final comments, and then i will close it out since we are just about out of time. Absolutely. We would love to have your final comments, panelists. If there is something in particular you would love to see duringin the short term this covid crisis as it relates to rural or in the longer term, what is most important to you here or what would you like to say as we wrap up . I just want to thank the and ourtaff at the bpc sponsors again. This has been an important project. I cannot think of a more timely result of the covid crisis. I appreciate all the work that has gone into this. Each of my colleagues on the task force and the commitment of time and effort they have made. Thanks to each of you and especially to our great staff. Thank you all very much. I want to stress my gratitude to all of you and everyone involved in this process and invite our viewers as well to provide feedback on this report. Beginning of a Significant Initiative that we hope will draw attention and assideration in congress they move forward on these issues. We appreciate the legislative support from senator grassley and all those who will be contributing to this effort. We have useless as a catalyst especially because used this as a catalyst especially because of this time. I serve on the board of the Bipartisan Policy Center Action Network, the group that advocates for policy recommendations on capitol hill. Think all our work is a task force wraps up and the results of this report is the Action Network needs to get to work and push these policy suggestions with our friends on capitol hill. It is tough. It is a tough time to push these things. On the other hand, with crisis comes opportunity. This crisis has shown the tremendous need for and benefits of things like telehealth and other things that can improve the delivery of services and Rural Community. Unities can communities. We need to find a way to make sure the use of telehealth is continued to be reimbursed by by thee, especially private payers. Medicare and medicaid have enough pressures. They may be more amenable. Makell be important to sure private payers follow suit. I will conclude by saying it has been a great privilege to work with my Task Force Members and staff to produce this report. I agree with congressman tauke that this moment is an onortunity to really build the focused attention we are on the Health Care Systems and the opportunity to overcome barriers to access in a much more effective way. Now and a big appetite into the future. You can feel it. People all around washington are focused on how did we use covid19 experiences to improve our Health Care Delivery system. I know the Bipartisan Policy Center will not just focus on real issues but a whole array of other issues. Group will behis a big part of that. I should take that opportunity to let folks know we are launching a Behavioral Health Integration Task force where the group will be working together to break down barriers andntegrating Mental Health behavioral Health Services with primary care physical Health Services. Thank you. You, senator daschle. It is not just in washington. It is also in states looking on how they can better improve Health Care Delivery. I think this is a federalstate relationship. I want to thank you all for joining us. A number of people have remained the whole two hours or so of that spirit that is really great. I want to apologize. As i said at the outset, this is a new experience for us, dealing with this kind of new technology. I want to apologize to congresswoman small to the difficulty we had earlier with her video. We want to particularly give a bpc staffto to the of maryland and all the work the staff is put into this. And our chief medical advisor. Bpc that we will take this through our and we hope that they either consider it in the current package or there will be more packages, i am sure as we go forward for the rest of the year. Haveer shoutout, we another video webinar tomorrow. Go to the website and get a link to where we will talk about the interaction between Artificial Intelligence and how it can be used in the current pandemic. Thank you all, thank you viewers, stay in touch and stay safe. Thank you very much. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] today, new Jersey Governor Phil Murphy wiri
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