Ohio rural healthcare access — an advanced solution?
A sign for an emergency room. (Photo by David DeWitt, Ohio Capital Journal.)
Ohio citizens living in rural areas are dying earlier and more often than people in other parts of the state.
A report from the Health Policy Institute of Ohio found that rural residents are 15% more likely to die before the age of 75 compared to the rest of Ohio.
Many factors make this worse: 17% are living in poverty, 18% lack internet access, 8% do not have a vehicle, and 9% are uninsured — all higher than state averages.
In addition, Ohio rural counties also have far fewer primary care, dental, and mental health providers.
Living in a rural area impacts access to healthcare because of geographic, economic and social barriers, that directly impacts a person’s health and well-being.
As a resident of a rural community for most of my life, I understand the impact that driving hours for healthcare, can have on a family.
I have memories of driving with my mother to take my 85-year-old grandfather for medical care, hours away.
The drive was difficult for him and there were many times he missed appointments because of this.
Although he was covered by Medicare insurance, his healthcare was also impacted by the lack of access to technology for appointment scheduling and management and the inability to drive.
What we really needed, was a medical provider more accessible, to provide care closer to his home.
The Ohio Senate Bill 258, the Better Access to Health Care Act, offers a way to help.
The bill would allow Advanced Practice Registered Nurses (APRNs) to practice more independently.
An APRN is certified to diagnose and treat illness, and prescribe medicine. Right now, APRNs must have a collaboration agreement with a physician. That means APRNs can only work where doctors are available.
Additionally, individual states determine how APRNs may practice. Currently, 27 allow independence, and 23 have limitations placed on their practice.
In the states where APRNs can practice to the highest level of education and training, the overall health ranks much higher, according to the Commonwealth Health ranking national survey.
And in states where APRNs are able to practice independently, people living in rural areas have better access to preventative care.
This is the result of increased use of high-quality health services.
During the COVID-19 pandemic of 2020, many states temporarily lifted restrictions to the APRN practice. The result almost doubled the number of APRNs available to serve rural and underserved communities.
SUBSCRIBE: GET THE MORNING HEADLINES DELIVERED TO YOUR INBOX
The new bill would allow APRNs to practice without the physician collaboration requirement. It also updates nursing standards, prescriptive rules, and how APRNs can provide various health services.
The goal of the bill is to remove administrative barriers while keeping patient safety and education standards strong.
For the rural community, if the bill passes, it could mean more primary care, urgent care, and maternal care.
Hospitals, clinics, community health centers, and private practices could also staff more easily, both in person and virtual visits.
Independently practicing APRNs help organizations overcome staffing barriers and can save money.
For Medicare insurance, primary care from APRNs costs less than care from physicians. Communities also benefit when geographic barriers are reduced, and more providers are available.
Key stakeholders, or entities with a trusted interest, include APRNs, the organizations that employ them, collaborating physicians, and insurers — especially Medicare and Medicaid, since reimbursement can differ for physicians and APRNs.
Some professionals are concerned about clinical experience and training for independent APRNs.
The bill requires 5,000 hours of clinical practice with physician oversight and a 6-month transition-to-practice period with a physician before independent practice.
This step ensures APRN readiness.
Health care is becoming more complex, and APRNs can help shape policy at both the individual and system levels. The Make America Healthy Again initiative aims to lower the burden of chronic disease that affects many Americans.
Improving rural access to care and changing how services are delivered can reduce negative health outcomes.
Rural Ohio needs better access to healthcare services.
If the problem is not addressed, I predict that the death rate will continue to surpass the state average.
Allowing qualified nurse practitioners to practice more easily is a practical step toward improving access to care and healthier underserved communities.
Having been an emergency department nurse for nearly 10 years, I have seen first-hand the impact of rural living on access to healthcare services, as well as the positive impact nurse practitioners are making to the healthcare industry as a whole.
SUPPORT: YOU MAKE OUR WORK POSSIBLE