‘A net benefit for clinics’: Congressional bill seeks to revamp rural health care service

A new congressional bill to transform rural health clinics (RHCs) could improve the quality of care provided at eight clinic locations on the Island of Hawaii and 21 locations across the state.

These include East Hawaii Health Clinic in Keaau and Waianuenue Avenue and Puuhonu Way in Hilo, Ka’u Hospital Rural Health Clinic, Puna Community Medical Center Rural Health Clinic and Five Mountains of Hawaii, Primary Care Clinic Rural Health Clinic and Women’s Center Rural Health Clinic are all in Waimea.

Introduced by US Rep. Jill Tokuda of Hawaii and several other representatives, the Rural Health Clinic Burden Relief Act would change certain RHC requirements, some of which had not been updated since the program began in 1977.

The bill would adjust current RHC laboratory requirements, allow for more flexible hiring, increase behavioral health services and improve telehealth services.

“For so many people in rural and underserved communities, their only access to health care is through rural health clinics,” Tokuda said in a release. “Communities in my area are not only rural, but remote. Access to critical and specialist care on our neighboring islands often requires a flight. That’s why rural health clinics save lives.”

RHC does not need to “provide directly” services, but rather needs to “promptly obtain” certain laboratory services.

“This lowers costs, reduces clinic overhead, staff costs, maintenance, and gives them the option to manage their clinic and operations according to the needs of their district,” said Lauri Redus, Regional Rural Health Clinic Practice Manager at Hilo Medical . center.

Some lab tests have also become irrelevant since the program began, and tweaking the equipment could lead to better outcomes for patients.

“Now, one of the lab tests that is federally required is a hemoglobin test, and that test really doesn’t mean much anymore,” said Lisa Lantz, president of the Rural Health Association of Hawaii. “Often, when doctors want to check a patient’s hemoglobin levels, they order a complete blood count and differential analysis so they can see why your hemoglobin count is low or high. The hemoglobin test alone won’t tell you what the patient needs.”

The bill could also expand staffing opportunities by allowing a range of nurse practitioners, physician assistants, or certified nurse-midwives to work at the RHC.

“It’s modernizing the provider employment structure, so it’s changing the ability and the way rural health clinics can actually hire providers, and that’s only going to provide more choice,” Redus said. “It helps attract suppliers, especially in rural areas.”

To improve access to care, the bill also addresses telehealth services by allowing RHCs to simplify reimbursement to providers and improving access by providing patients with additional staff assistance during visits.

“A lot of people think it’s only going to affect people who live in Puna districts or in rural areas, but there are some places that are very close to town that are also dead zones,” Lanz said. “Now you can go to a rural health clinic and they can take you to a secure platform for a telehealth visit with a provider, and you’ll also have a nurse, a physician assistant or a nurse practitioner, and they too part of the call”

The federal Health Resources and Services Administration has designated states and counties as mental health professional shortage areas due to a continuing shortage of specialists. If passed, the RHC could expand behavioral health services to serve more patients.

“Behavioral health has an upper limit,” Lantz said. “The RHC doesn’t provide more than 49% of behavioral health care, but since our entire county is a health professional shortage area, this will allow the RHC to provide more behavioral health care, which is fantastic.”

The bill, known as House Resolution 3730, was sent to the Energy and Commerce Committee and the Ways and Means Committee, and if approved, would take effect on January 1, 2024.

“The way the bill was written was almost a net benefit for clinics,” Redus said. “Is there anything else that can be updated? Sure, but you can’t do everything at once.”

Email Grant Phillips at gphillips@hawaiitribune-herald.com

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