Rural healthcare discussed at recent forum

A legislative forum held Friday, Feb. 24 at the Fontanelle Community Building went into discussions on rural healthcare.

The forum was attended by a good number of local people, plus State Representative Ray “Bubba” Sorensen, a Republican from Greenfield, and Senator Amy Sinclair, a Republican from Allerton. It was sponsored by Adair County Farm Bureau and moderated by Farm Bureau representative Randy Caviness.

Willard Olesen of Greenfield, a member of the Adair County Health System Board of Trustees and a former chairman of that group, asked the legislators about what they can do to help rural hospitals.

Olesen said that for quite some time, rural hospitals have not seen a raise in the reimbursement amount they receive from Medicare for the patient care they give. That alone is putting the survival of many rural hospitals in jeopardy, and the problem is also compounded by other factors. As a result, some have even closed.

To help work through these issues, the federal government began a new designation for hospitals known as Rural Emergency Hospitals. To qualify, Olesen said hospitals would be required to give up their designation as a critical access hospital, a designation Greenfield’s hospital currently has. By definition, critical access hospitals provide healthcare services to rural, often under-served communities.

The new rural emergency hospital designation allows for more funding from Medicaid and Medicare for each patient served, Olesen explained.

“The problem with that is that the hospitals are a huge economic driver for rural development. For example, one of the reasons Cardinal Glass came to Greenfield was that we had a good hospital. They came here with 25 people and in the meantime, they’ve had lots of expansions that could have gone anywhere, but they came here. One of the reasons they came here is we had a good workforce and had a good hospital,” Olesen said. “At times, they’ve had up to 600 people working there.”

If hospitals like Greenfield’s were to take on the rural emergency hospital designation, they wouldn’t be allowed to house patients for more than 24 hours. Right now, Adair County Health System can house up to 25 patients at one time for however long is needed.

“Basically, what it’s doing is that we become a band-aid station. That’s how I view it or how many critics view it,” Olesen said. “Through that, we lose a huge economic driver for our community. Doctors, providers, they don’t want to live in a community that has a band-aid station. They want to live in a community that has a hospital.”

Olesen acknowledged that due to lower patient numbers and therefore lower use of expensive equipment or supplies, healthcare can cost more at a rural hospital. He added he sees raising the Medicare and Medicaid reimbursement rate hospitals receive as one of the primary fixes that can be made for prolonging the life of rural, small community hospitals.

“I’m asking you to do what you can to help the rural hospitals, one of which would be increasing the Medicaid and Medicare reimbursement,” Olesen implored.

Sinclair answered Olesen’s comments by saying that the state has the most influence on Medicaid reimbursement rates. She said that last year, state legislators looked a reimbursement rates for direct care providers and they looked at mental health the year before.

The senator continued by saying that while reimbursement rates are indeed behind what actual costs are, lawmakers have done other things to help rural healthcare recently. They’ve worked on loan repayment plans for nurses, doctors and non-prescribing mental health providers. This year they have focused on non-economic damages relating to medical malpractice.

“As far as becoming a rural emergency hospital, you’re right that there’s an enhanced [reimbursement rate] for becoming a rural emergency hospital. We did pass legislation to allow for them. For a town like Keokuk, that’s where they are. They don’t have a hospital unless they keep a rural emergency hospital,” Sinclair told Olesen. “That legislation allowed them to open back up so they could have their ambulance service back and it allows them to have an emergency room. You’re right that they’re going to have to work with their broader system to get folks transferred out before 24 hours, but I would rather have a band-aid station than no healthcare at all, if those are my two options.”