Rural Health: Things You Need to Know

SUMMARY
As a contractor for Medicare, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Kepro provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode will be centered on rural health. One of the things we'll talk about today with our guest is some of the challenges that are unique to people that live in a rural setting and some of the ways that they encounter some of those issues and ways that Kepro can help them.

For more information about Kepro BFCC-QIO, please visit www.keproqio.com.

KEY TOPICS
00:55: Overview, introduction
04:45 Definition of rural; things that people living in a rural health location have to deal with
22:00 Resources

SUBSCRIBE
Subscribe to our newsletters: Case Review Connections, On the Healthcare Front

RESOURCES

• Immediate Advocacy: www.keproqio.com/ImmediateAdvocacy
• Information for stakeholders: www.keproqio.com/partners
• Rural health: www.cms.gov/About-CMS/Agency-Information/OMH/equity-initiatives/rural-health

Music: Motivational Upbeat Corporate by RinkevichMusic
https://soundcloud.com/rinkevichmusic
Video Link: https://youtu.be/U78mgVaM12M

Transcript

Welcome to Aging Health Matters, a podcast from Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. The information in today’s show may help you or someone you know in their healthcare journey. Thanks for joining us; now let’s get started.

Scott Fortin
Hello everyone, and welcome to another edition of Kepro's podcast where we bring you relevant topics that apply to people with Medicare. My name is Scott Fortin, and I've been with you on some of the previous podcasts. I'm hoping that you've had the chance to listen to some of those. If not, I'd urge you to go listen to some of the different topics that we've covered.

Today's topic that we're going to be covering is going to be rural health and why it matters to you. In the context of what we do in the Beneficiary and Family Centered Care Quality Improvement Organizations or BFCC-QIOs, there are a lot of different ways that we help people, as we've discussed in other podcasts, but to give you a quick overview again, we do things such as appeals, we do quality of care concerns, and we also do Immediate Advocacy. We cover, along with another contractor, all of the states and territories of the United States, and Kepro has 29 of those states.

Today's podcast will be centered on rural health, and one of the things that we do at Kepro is we make sure that our ability to help people centers around health equity as one of the considerations. That concept, by its definition, is that everyone has a fair and just opportunity to be as healthy as possible and to get the best care that they need.

One of the things we'll talk about today with our guest is some of the challenges that are unique to people that live in a rural setting and some of the ways that they encounter some of those issues and ways that Kepro can help them. So my guest today is one of our Outreach Specialists from Kepro, Nancy Jobe. Hi Nancy.

Nancy Jobe
Hello.

Scott Fortin
Welcome to the podcast and to give you a little introduction about Nancy and then letting her finish the introduction to herself. Nancy takes care of a lot of our regions in the states that we cover that are of a rural nature. So Nancy is our relative expert on some of these rural affairs and some of the challenges that are faced by the stakeholders that she works with and by design, through that, the people that are affected by it in those areas. Nancy, if you could tell the audience a little bit about yourself beyond that and how you work with some of our stakeholders.

Nancy Jobe
Thank you, Scott. As an Outreach Specialist, my job is to spread the word of what it is that Kepro can do to help Medicare beneficiaries. I have a large area in that I am covering states from Colorado to Alaska. So you can imagine I have quite a bit of the rural health issues that will take place there, and I work with a lot of the different counties and associations in the rural setting. So with that being said, as an Outreach Specialist, it's really important to get that word out to as many people as we can. So I'm working with Medicare beneficiaries, providers, different associations, and anyone that has contact with Medicare beneficiaries. So it's really important that we let those Medicare beneficiaries know that they have certain rights and opportunities to get some of their issues resolved, and they do that by contacting Kepro.

Scott Fortin
Wonderful. Thank you, Nancy. So let's get into the meat of the podcast; a little bit from my personal standpoint where I live geographically is somewhat of a suburban, outside of an urban area, on the edge of a rural area, so part of me understands some of the concepts of rural health and what it is by its definition, but I know, Nancy, that you've lived in more of a rural setting in your time in the past, and I know that you understand that a little bit. So could you maybe define for the audience a little bit what rural health really is and kind of how we break that down into how many people are affected by that, as an example?

Nancy Jobe
Sure. The Centers for Medicare and Medicaid Services (CMS), they defined a rural location as anything that's outside of a large metropolitan area. However, there are some pieces of rural health that are actually in the metropolitan area, and I’ll explain that. For instance, CMS includes all tribal areas and US territories as part of the Rural Health initiative as well, so therefore there could be some tribal areas in it inside a metropolitan area, but most people kind of realize that rural health is more of the remote areas, very small population cities, this kind of thing, and there’s probably about 60 million Americans that live in in rural areas with many of them being Medicare beneficiaries.

Scott Fortin
Great. That's wonderful insight. And I know, Nancy, that knowing you personally, as I do, I know that you  have some of your own examples and some personal things that you've had family wise, people with Medicare and of that age group. I know that living in a more rural type of community,  I know you've seen some of the unique challenges with that. So can you tell people what you've seen with some of your loved ones and your personal experience as well as your work experience? What really kind of affects people of the Medicare population, a little bit more specifically in the rural communities that they live in?

Nancy Jobe
That's correct. Scott. I did move from a metropolitan area, and now I'm living in a small town of 12,000 people. So there's a big cultural change as well, but I had no idea how much of the health culture changed as well. My parents moved with me, and I had to get them all set up with their healthcare needs in this area, and some of the things that people that live in a rural health setting have to deal with are one getting an appointment just with a primary care physician, we had to wait six months. So that's a long wait. If you're planning on moving from metropolitan to rural, I would say think ahead. And with that six-month wait for that for just a primary care, you can imagine with specialists what you have to deal with, and sometimes there aren't specialists in the in the smaller communities, and you're going to have to make that drive. I mean for us we have to drive an hour to get to a specialist. Those are some of the pieces that people that live in the metropolitan area really don't realize that's going to have to be something that is going to be a change in their daily health care needs.

I know I live in a retirement area, so there's lots of people that move down here that are Medicare beneficiaries, and they're all dealing with the same thing as far as trying to get those appointments and with the specialists. And one thing to know, you finally find a specialist, and there's one that wants to live in a rural area, they have a tendency not to stay. They come and go. So you are always switching up your physician or your specialist. So you find someone that you really care about and you like and you feel comfortable with, and then they're going to move on you. And now you either have to, you could follow them, which is something that happened with us, with a specialist moving to the larger metropolitan area to get out of the rural setting. And so it's an hour drive. You can choose to follow him that hour and drive that to see him or start all over with the new specialist. So those are some of the things that people really don't realize. We have a small hospital here, and it's just kind of a break off of the larger hospital in the metropolitan area, so if you're going to need some major surgery or something along that line, you obviously aren't going to be able to do that locally in your community. You're going to have to have that distance of traveling back and forth, for even the family members. You don't think about that. But the family members having to come take care of you and get you to those appointments and the location, that's a distance to travel.

Rural people, they learned to adjust to it. As far as knowing that their health care is not going to be as easily accessible. And one of the things is even if you even look at insurance, the Medicare Advantage plans, in a metropolitan area, you may have five or six to choose from. In a rural community, you may not have any to choose from, or if you do, you have one to choose from. So it's a lot of different changes that take place for a person living in that rural community.

Another piece of insurance that rural Medicare beneficiaries purchase, they purchase that Life Flight, that helicopter service, They have an annual fee because if they have a dire emergency and have got to get to the larger hospital, it's going to need to be done through a Life Flight, so they carry insurance for that. So there are all kinds of different pieces of the pie in a rural setting than in a metropolitan setting you don't even consider or even think about, but you have to in a rural setting. OK, let's just say now you're needing some additional care after care or skilled nursing care or something along that line, there's not much to choose from in a rural setting, and so your loved one may be having to be in a skilled nursing facility that's going to be an hour drive for you to be able to even contact them or visit them. So those are those are kind of things that you have to really deal with in the rural setting that I know I didn't really consider moving into the rural setting. It's beautiful and everything, but you really got to think about your healthcare needs when you're making those changes into a rural setting, and those people in the rural settings that have lived it all their life, they know how to adjust to what they need. But it doesn't necessarily make it any better for them.

Scott Fortin
That's great information. And one of the things we always talk about in the healthcare community is lack of access. And I know that you've mentioned that a couple of times. Talk about the sheer number of providers. One of the things that that also affects is your choice. You know you mentioned skilled nursing facilities. If you do end up in a hospital and you have to go for rehabilitation somewhere to get yourself stronger, to get back home, if you're in more of a urban or suburban type of setting, you may have five choices available to you. In a smaller community, you may have two with a lower amount of beds. So if those beds are filled, then that also might create a bump where a person's going to need to look for different services in a different way, where they may have to go home with home health or rehab versus going to a rehab center. So some of those things are really a consideration of, as you said, what's available to them and also the other point I wanted to hit on that you mentioned was the concept of Medicare replacement, Medicare Advantage plans and their availability. Correct me if I'm wrong, Nancy, but I know you've dealt with a lot of these Medicare Advantage over the years. A lot of those are community-based type of things when you get to a Medicare Advantage versus a traditional Medicare, I know it's a little bit off topic, but I know that there seems to be more community-based type of assistance for people with Medicare Advantage than there is with traditional Medicare. Would you say that's true?

Nancy Jobe
I think some of that could be true, but I mean with the Medicare Advantage, well, I know even in this area, the one that is available is attached to the local hospital. So if you're not really a fan of that one and you're going to be going to another one, then you’re just out of luck, you're going to have to go with traditional and supplement or something along that way because the Medicare Advantages are just geared towards certain places, and you're limited who you can see.

Scott Fortin
Gotcha. So it affects your networking and your referrals and everything, beyond just the distance that you have to travel and the specialty is. So I mean I can definitely see why it would be more challenging for people to live in a rural community that way.

Specifically to what we do and kind of covering how what Kepro does helps people that live in rural communities, one of the things that I know we've talked about in other podcasts, Nancy, is Immediate Advocacy. And so can you maybe kind of tell me a little bit about how the services we have that you talk to people about every day match up with what the needs are in these rural communities?

Nancy Jobe
One of the things that you mentioned earlier resounded with me. A county rural official that I kind of was helping, his mother-in-law was going to be going to a skilled nursing facility, but there was none available in in his county, and he really didn't want to have to put her in one that was going to be an hour drive. So he did reach out to me and then wanted to know if there was anything that he thought that we could do, and I suggested he contact the Helpline and call and get some Immediate Advocacy, so he could find out some more resources that may be available to him, and by doing that, he was able to reach out to Kepro,  and Kepro helped him reach out to a couple of local associations and organizations that were able to make sure that she had some home health. I believe she even needed some help with a ramp being built at the house, and they were able to get them to the right organization, so that he could get the help he needed to be able to keep his mother-in-law in the community with him and not having to travel for her to be in a skilled nursing facility. So he was very appreciative of something like that because he had no idea that that was something that we really were able to do, but with the Immediate Advocacy, we're always able to reach out and help be that mediator, so to speak, between the beneficiary and the provider and resources in this kind of a thing, to be able to make a great resolution for him especially and for other people.

Scott Fortin
That's great, Nancy. And as I said in other podcasts we've done, we've really hit on the Immediate Advocacy and how the flexibility of that is one of the biggest tools that we can provide to people to help them through their healthcare journey and cover some of those gaps. One other thing that I thought about, as you were just talking to, Nancy, is I know that you do a lot of training with people that are advocates for seniors, senior health insurance providers, different types of organizations that are patient advocates for Medicare beneficiaries, and one of the things I know dealing with that in more of an urban area. I know that there's a lot of knowledge that those people, many times they're volunteers that are advocating on people's behalf, but your work in training those people, I'm sure a lot of those people in more of an urban or suburban type of setting really see some of these challenges as you just mentioned a lot more maybe and in a different way than people that are in a rural community. So I'm sure that there's really some differences in the application of how they do their job every day, but also how many times per week or per month they've seen some of these specific situations that have occurred to people and can help them through. So would you say that that’s really an issue would be maybe lack of lesser instances of this happening and then as well not knowing where to turn if that does thereby the Immediate Advocacy answer?

Nancy Jobe

My focus is obviously to train as many people as I can, but I know that those people that are in the metropolitan areas don't see the same thing the rural people do, but at the same time, I've recently did a training last week for Alaska, all the SHIP counselors in Alaska that reach out to all Medicare beneficiaries. As you can imagine, yes, there are metropolitan areas, but the majority of Alaska is rural. And it was interesting to me because a lot of them had no idea what Kepro did as far as for even like for the appeal process, and it just so happened on that particular call, there was someone that just that day had someone that didn't feel like they could go home, and we definitely had her call in and try to do an appeal for her discharge. So as she was being discharged from the hospital and didn't feel correct to go home and so just being able to talk to as many people as we can, they find out that Kepro can help with a lot of things, not just Immediate Advocacy like we've talked about, but also with appeal processes and in the rural areas that's really important because most people think they can just go into skilled nursing, but maybe they do need to appeal their discharge until the plan is put into place for them or even if they're in a skilled nursing or in a home health or hospice situation and their services are going to be terminated, it's really important to make sure that they can appeal that to make to make sure they have the best outcome they possibly can for their recovery. So I believe that Kepro’s Helpline can answer a lot of the questions for the metropolitan as well as the rural people.

Scott Fortin
That's great, Nancy, and I really appreciate giving us some education on this end. Obviously some first-hand perspective, not just from working with people in heavily rural community, but also from first-hand knowledge of your own living in one and also experiencing it with your family and loved ones. Is there anything that you'd like to leave the audience with today as far as understanding, if they live in a metro area or suburban area like me, understanding the plight of these folks or some information for people that live in the rural communities that you would make any suggestions about how we can help them and can help them move forward?

Nancy Jobe
It's good. I think it's important that these people in the rural areas don't feel like they're alone and that they do have someone that they can call on whenever they have a healthcare issue that they're not getting resolved and that they know that they can call our Helpline to be able to reach out and get some help and whether it be Immediate Advocacy or the discharge appeals or whatever. Maybe they just had a bad experience, and they want to file a complaint on a provider, so it doesn't happen to someone else. Those are things that we can do, and I think a lot of times these people in the rural areas feel like they're alone because they're not close to a metropolitan area. And I think the people in the metropolitan area need to realize, especially if they're in the health care industry, when people come to them from a rural setting, they need to be kind of guided a little bit, so that they don't feel overwhelmed with everything that's going on there because it may be something they're not used to. So I really feel like if people just all have a perspective that metropolitan and rural are two different places and mindsets and try and help, so that everybody can get the health care that they need.

Scott Fortin

That's great. Thanks, Nancy. I really appreciate all the information you've given us today. You've been a wonderful guest.

Nancy Jobe
Well, thank you, Scott. I appreciate you being able to offer these podcasts, so that people can learn a little bit.

Scott Fortin
Absolutely. And for those of you that have enjoyed Nancy as a guest today, I'm sure that in the future podcasts that'll be coming up, we will have Nancy on those. One of the things that we're looking to do in upcoming podcasts, as I've mentioned in previous podcasts, is that we want to work with Nancy and her counterpart, Kia Weaver, who both work with stakeholders at various levels and different geography, as Nancy mentioned, rural versus suburban and urban. 

We're going to have them come on and have some of these organizations as guests and talk with them about some of these issues that face people with Medicare. So I would urge you to look for our other podcasts, both the ones we've done already and the ones that are upcoming. And so in doing that, I'd also ask you to take a look for our newsletter that we have. We have a beneficiary-themed newsletter that gives you information, such as what Nancy is talking about, talks about concepts like Immediate Advocacy and other things that Kepro does to help you and your health.

A lot of that is available at our website, and our website is also available in the links that show up in the notes for the show, but I'll give it to you here anyway. It is www.keproqio.com, and that is www.K-E-P-R-O-Q-I-O.com.

So again, I would urge you to take a look for some of our upcoming podcasts and also to sign up for our newsletters and take a look at our website where we have a bunch of great information for people that have Medicare and for those that care for them.

Again, Nancy, thanks for your time today, and I hope that all of you listening have a great rest of your day. Take care.