Remember the Republicans’ Rural Health Fund? It’s a Joke.

The grant will be dispersed over five years, and CMS will monitor how states implement their proposals, which means that many states may be reluctant to try something that could be truly transformative but would take longer to show results. Cochlan-McClain said that she would like to see more states provide funds for hospitals to move away from a fee-for-service model, which is how they’re reimbursed for care now, to one that provides a global, fixed fund for taking care of a patient population.

Describing the latter model, she said, “They are paid more based on the outcomes of that patient’s health and care, and less on the number of times they are seen in the clinic.” Because rural health clinics have a lower volume of services, this kind of payment system would allow them to focus on patients’ needs, from preventative care to mental health, and would pay them for how well the patient does over time, she said. “It’s a smarter way to take care of patients, and because it is one of the strategic goals in the applications, we are hopeful that states wrote to it,” she said.

Pennsylvaniahas been testing such a model. But five years would be a short time to implement such a dramatic change to paying for health care, she said. Rural areas already have a shortage of health care professionals. If doctors in rural areas can’t get paid as well as they can in larger cities, no amount of workforce training, which the fund supports, will keep them there.