Rural health care summit discusses workforce policy solutions

(Journal photo by Jennifer Theurer.)

At the recent Summit on the Future of Rural Health Care, the legislative outlook session took a deep dive into top health care workforce policy solutions.

The panel featured Clifton Porter, senior vice president of government affairs with the American Health Care Association and National Center for Assisted Living, and Travis Robey, vice president, political affairs with the American Hospital Association. Jerry Penso, president and CEO of the American Medical Group Association, moderated the discussion.

Nursing home staffing

As the rural population ages, one concern is nursing home care. The Biden administration has several proposed rules for minimum staffing levels for nursing homes on the table. When asked about how concerning this is for nursing homes in rural areas, Porter is not happy.

“I’ve never seen a proposed rule be more out of touch with the realities of delivering health care than this one,” he said. “And I say that because I think optimism is important, but reality is as well.”

Actually looking at some of the elements of this proposed rule, Porter said it boils down to a one-size-fits-all plan. That approach does not work and fundamentally that’s what’s being proposed.

A comment period is ongoing for this proposed rule and Porter believes after it’s over, the agency will review and summarize the comments.


Another subject in rural America is immigration. It’s been a challenge getting a longer-term solution Penso said, but in healthcare one out of six registered nurses and one out of four direct care workers are immigrants.

Robey, when questioned about some of the policy ideas and what Congress can do to streamline the immigration system to help solve the workforce issues, said it is difficult to reach a compromise on immigration even in the context of health care.

“It tends to get bogged down in border security politics,” he said, “that you just can’t find common ground or have a gap between Republicans and Democrats.

Porter believes immigration is probably one of the most frustrating issues he has to deal with, mainly because of the macro politics that are getting in the way of common sense.

“If we can’t agree on the big things, what are some of the things we actually can agree on?” he said. “The politics of this is probably the most problematic issue than anything on what I consider to be a very common-sense sort of straightforward type approach that we can actually get some results from.”

When it comes to the physician workforce, especially in the rural setting, what are some things that can help this issue? For Robey, continued expansion will help the number of residency slots that Medicare funds to increase.

In rural communities, foreign born physicians and nurses are such an important part of the workforce. One proposed piece of legislation would allow 25 visas to be 25,000 for nurses and 15,000 for physicians.

“It’s not the perfect solution, but maybe it’s a way to thread the needle,” Robey said.

It’s also important that there be a priority for those areas in the greatest need to have new medical schools in rural areas where there’s a shortage of health care.

“As the data shows if you train in a rural community, you’re more likely to stay in a rural community,” Robey said. “Just like if you train in underserved urban communities are more likely to stay in those communities. So we want to make sure that that we’re training people in rural communities.”

Lifeline for providers

When it comes to telehealth, waivers are expiring in 2025 and if Congress doesn’t permanently extend the waivers and flexibilities that were granted during public health emergencies, they’ll expire. Penso said these telehealth visits served as a lifeline for rural providers.

“I see telehealth as sort of one of the gems that emerged post pandemic,” Porter said. “We were in a situation where we are actually able to prove that telehealth is effective. That telehealth helps solve problems, helps meet needs in rural communities specifically, and frankly, urban communities as well.”

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A lot was learned from that process, and there has to be some common sense in the government as groups push to make these particular waivers permanent.

“There is some legislation and some efforts to help do that, particularly in the long-term care space,” Porter said.

Telehealth could be a solution for some requirements the administration is proposing around mandatory staffing. Porter said telehealth could be a potential solution if allowed in those facilities in rural areas, and that could meet the standard needed to ultimately approve quality care. But he’s concerned at the end of the day, there has to be advancements on some of these issues.

“I think we’re going to make progress on telehealth in this bipartisan agreement,” he said. “For the obvious that this is an excellent solution to solve a lot of our problems, but again, we hope that the administration sees it as a solution potentially in this proposed rule, and maybe advances that as an idea instead of R&D.”

Kylene Scott can be reached at 620-227-1804 or [email protected].