A new congressional bill aimed at revamping Rural Health Clinics, or RHCs, could improve the quality of care offered at the eight clinic locations on Hawaii Island.
These include the East Hawaii Health Clinic in Keaau, the clinics on Waianuenue and Puuhonu Way in Hilo, Ka‘u Hospital Rural Health Clinic, Puna Community Medical Center Rural Health Clinic, and Five Mountains Hawaii, Primary Care Clinic Rural Health Center and Women’s Center Rural Health Clinic all in Waimea.
Introduced by U.S. Rep. Jill Tokuda of Hawaii and several other representatives, the Rural Health Clinic Burden Reduction Act would change certain requirements for RHCs, some of which have not been updated since the program began in 1977.
The bill would adjust current RHC laboratory requirements, allow for more flexibility in hiring, increase behavioral health services and improve telehealth access.
“For so many in rural and underserved communities, their only means of accessing health care is through a Rural Health Clinic,” Tokuda said in a release. “Communities in my district are not just rural, they are remote. Access to critical and specialty care on our Neighbor islands often requires travel by air transport. That is why Rural Health Clinics are life savers.”
The bill would apply to over 5,200 RHCs nationwide and 21 throughout the state, and could alter requirements RHCs need for laboratory testing.
Instead of being required to “directly provide” services, the RHCs would just need to “have prompt access” to certain laboratory services.
“That reduces cost, it reduces overhead expense, staff expense, maintenance expense for clinics, and gives them the option to manage their clinic and operations as is needed for their area,” said Lauri Redus, regional rural health clinic practice administrator for Hilo Medical Center.
Some lab tests have become extraneous since the program began as well, and adjusting equipment can lead to better outcomes for patients.
“Right now, one of the federally required laboratory tests is the hemoglobin test, and that testing really doesn’t have a lot of meaning anymore,” said Lisa Rantz, president of the Hawaii State Rural Health Association. “Usually when a doctor wants to check a patient’s hemoglobin level, they order a complete blood count with a differential so they can see why your hemoglobin count is either low or high. Just the hemoglobin test itself doesn’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 RHCs.
“It’s modernizing the employment structure for providers, so it changes the ability and the way that Rural Health Clinics can actually employ providers, which just gives more options,” Redus said. “And it helps attract providers, especially in rural areas.”
To improve access to care, the bill also addresses telehealth services by allowing RHCs to streamline reimbursements for providers and improve access by offering patients additional staff help during a visit.
“A lot of people think this only affects people who live way out in the Puna district or in rural areas, but there are places that are fairly close to town that are dead zones as well,” Rantz said. “Now you could go into the Rural Health Clinic and they can Zoom you on a secure platform to get you that telehealth visit with the provider, and you’d have a nurse or a Physician Assistant or a Nurse Practitioner that’s part of the call too.”
Both the state and County are designated as Mental Health Professional Shortage Areas as by the federal Health Resources and Services Administration due to the ongoing shortage of behavior health specialists.
If the bill passes, adjustments to behavioral health services might also benefit local RHCs.
“Behavioral health has a cap,” Rantz said. “An RHC can’t provide more than 49% of its care as behavioral health, but since our entire County is a health profession shortage area, this would allow RHCs to be able to provide more behavioral health care delivery, which is fantastic.”
The bill, known as both House Resolution 3730, has been referred to both the Energy and Commerce and Ways and Means committees, and if approved, would go into effect on Jan. 1, 2024.
“The way the bill is written, it’s pretty much a net benefit for clinics,” Redus said. “Are there other things that could be updated? Absolutely, but you can’t accomplish everything at one time.”
Email Grant Phillips at gphillips@hawaiitribune-herald.com
