"The old models aren't working too well," Myers argued, saying "What people don't realize is that [critical-access] hospitals get three-fourths of their money from the outpatient department" and have relatively few traditional admissions. He said half of them have fewer than four acute-care patients per day, and fewer than two patients who are recuperating or getting skilled-nursing care.
President Obama's proposed budget calls for revoking the CAH status of some hospitals, and rural political clout has declined with the rural share of the nation's population, Myers noted. Then he displayed maps showing that life expectancies of rural Americans are not keeping pace with the rest of the country, and in some areas are declining. "That's really scary," he said.
Myers said those trends mean that CAHs should add health promotion and disease prevention to their job description, and Medicare and Medicaid -- which provide 85 percent of their revenue -- should pay them for performing that function.
He said hospitals have space, expertise and equipment to serve as exercise and medical-education centers, while most rural health departments are "overwhelmed" with a wide array of duties.
The federal payments for disease prevention and health promotion could be limited to hospitals in counties that have a certain percentage of their population on government-subsidized insurance, he said. A CAH designation gives a hospital greater reimbursement in return for its limiting beds, procedures and patient stays.
Other speakers called for new approaches in rural health, despite obstacles.
"Change is not easy. . . . Almost all federal policy tends to shortchange rural, at least initially," said Craig Blakely, dean of the University of Louisville's School of Public Health and Information Sciences.
He said two important targets for prevention activities in rural America are smoking and obesity, which he said is exacerbated by high soft-drink consumption. Soft drinks are a $57-billion-a-year industry, jhe said, "so there's a lot of pushback we're going to be facing if we want to take that on."
Blakely added that much of rural America is poor, and that is associated with poor health, so rural health providers also need to focus on education and employment opportunities for their communities.