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Hospitals that serve rural areas are disappearing. APTA is supporting efforts to stop and even reverse that trend.

"Medical deserts are appearing across rural America, leaving many of our nation's most vulnerable populations without timely access to care," according to the National Rural Health Association (NRHA), which estimates that between the 79 rural hospitals that have closed since 2010 and the additional 673 facilities that are on the brink of shutting their doors, the US is at risk of losing a third of its rural hospitals in the near future.

The primary drivers behind the decline, according to NRHA, are federal cuts that began with the 2013 budget sequestration and so-called "bad debt cuts" imposed on facilities with certain levels of Medicare beneficiaries unable to make their cost-sharing payments. The organization is working to stop those and other damaging cuts, and APTA has joined in that effort. APTA is a member of NRHA.

Like NRHA, APTA is advocating for passage of the Save Rural Hospitals Act (HR 2957). Introduced by Rep Same Graves (R-MO), the measure would stabilize rural hospitals by ending many of the Medicare cuts that are threatening the survival of the facilities. Additionally, the legislation introduces a new delivery model that would allow small rural hospitals and critical access hospitals (CAHs) to be recognized as community outpatient hospitals (COHs), a designation that would open up more possibilities for emergency and outpatient care in rural areas. To date, the legislation has 18 cosponsors in the House.

APTA's support of the legislation is consistent with its positions on US Centers for Medicare and Medicaid (CMS) proposed rules for next year's outpatient and inpatient prospective payment systems. In the proposed outpatient rule—still not finalized—CMS says it will back off on enforcement of requirements for direct supervision of outpatient therapeutic services for critical access and small rural hospitals. The finalized inpatient payment rule includes language making medical record reviews a "low priority" when it comes to the requirement that physicians must certify that a patient admitted to a CAH will be discharged or transferred within 96 hours of admission. APTA supported both measures as much-needed changes that would help ease burdens on rural hospitals and CAHs.

The association also is facilitating communication between physical therapists and physical therapist assistants who support rural hospitals and CAHs: recently, APTA launched a "rural health hub," an online community that allows members to share thoughts, questions, and strategies on working to keep rural care alive. Email with your name and member number to gain access.

"Rural hospitals are vital to the health and wellbeing of more than 62 million Americans," writes APTA President Sharon Dunn, PT, PhD, in APTA's letter of support for the Save Rural Hospitals Act. "Keeping these rural hospitals open is a necessity for so many Americans who need essential health care services."

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