Rural health care surging as a major issue

Print Friendly and PDF By: Andy Miller Published: Apr 25, 2014

Hospital leaders, physicians and state lawmakers will be members of a new committee designed to help bolster rural health care in Georgia.

Gov. Nathan Deal on Friday announced appointments to the Rural Hospital Stabilization Committee, created to identify needs of rural facilities and offer potential solutions.

The panel is one of Deal’s strategies to help rural hospitals survive, and comes in the wake of four rural Georgia facilities closing in the past two years.

With those closings and with other hospitals struggling financially, rural health care has become a major issue during this election year.

Hutcheson Medical Center

Hutcheson Medical Center

Among those facilities faltering financially is Hutcheson Medical Center in the northwest Georgia town of Fort Oglethorpe. Hutcheson recently received an advance from the Department of Community Health of more than $800,000 in already scheduled funding. “They needed this to make payroll,’’ DCH Commissioner Clyde Reese said in March.

Cash flow problems recently forced Candler County Hospital in Metter to change how patients make co-pays, and develop new plans to pay vendors to whom the hospital owes money, according to the Metter Advertiser.

And Washington County Regional Medical Center in Sandersville announced this month that it plans to discontinue non-emergency baby deliveries because of financial losses. More than 40 hospitals in rural areas in Georgia have given up deliveries, according to HomeTown Health, an organization of rural hospitals.

“I would say the financial dilemma for rural hospitals in Georgia is much worse than it’s ever been,’’ Jimmy Lewis, CEO of HomeTown Health, told GHN recently.

“The general cash position in most rural hospitals is extremely dire,’’ added Lewis, who is one of the appointees to the Rural Hospital Stabilization Committee.

Some large urban hospitals are also under financial pressure. “On an overall scale, these are the most challenging times that the Georgia hospital community has ever faced,’’ said Kevin Bloye, a Georgia Hospital Association vice president.

Deal said in his statement Friday on the committee appointees, “I recognize the critical need for hospital infrastructure in rural Georgia and remain committed to ensuring citizens throughout the state have the ability to receive the care that they need.”

Other committee members include leaders of hospitals in Hinesville, Lavonia and Blue Ridge; and physicians Angela Highbaugh-Battle, a Hazlehurst pediatrician; Thomas Fitzgerald, an emergency medicine physician in Carrollton; and Jeffrey Harris, an OB/GYN in Jesup.

Rep. Terry England

Rep. Terry England

Deal also appointed state Rep. Terry England (R-Auburn), head of the powerful House Appropriations Committee, and state Sen. David Lucas (D-Macon). Lucas introduced legislation in this year’s General Assembly that would help rural areas such as Hancock County — where the hospital closed several years ago — to build “stabilization centers.’’ These facilities would be for stabilizing the condition of patients at risk of death, and then transferring to them to more distant hospitals for the full range of treatment they need.

Deal himself has pushed a proposed change in licensing rules to permit a struggling rural hospital, or one that recently closed, to offer downsized services that would include an emergency department.

But a drawback has emerged – one that, if unchanged, may lower the chances of these freestanding ERs being built.

Such facilities, as proposed, would not be able to bill Medicare or Medicaid at the current hospital rates, but instead would have to bill those programs at a lower “provider’’ rate, GHN recently reported.

Reese said possible revisions to address this situation would be discussed by the newly formed rural hospital panel.

 

A ‘boundary’ dispute

 

At least one struggling Georgia hospital has an additional problem: its nearness to a neighboring state.

Hutcheson is so near Tennessee that it’s actually in metropolitan Chattanooga. Hutcheson’s difficult financial situation recently prompted Reese to send a letter to the federal Centers for Medicare and Medicaid Services, asking for an exemption to bar nearby Chattanooga hospitals from treating Georgia Medicaid and PeachCare patients.

Such a move would help Hutcheson, Reese wrote, because the Georgia patients’ use of out-of-state hospitals “jeopardizes the financial viability of Hutcheson Medical Center.”

Currently, Georgia Medicaid allows out-of-state hospitals to enroll as providers if they are within 50 miles of the Georgia line.

DCH Commissioner Clyde Reese

DCH Commissioner Clyde Reese

CMS, in its reply to Reese, said Georgia could change the 50-mile rule and require out-of-state hospitals to be closer to Georgia as way to exclude them as providers.

Meanwhile, experts say Georgia’s struggling hospitals, rural and urban, would be helped financially under an expansion of Medicaid, because many of their uninsured patients would then have coverage. But the governor, backed by the leadership in the Legislature, has rejected expansion, citing the costs to the state.

Beth Stephens, health access program director for the consumer group Georgia Watch, said recently that freestanding ERs are “not an alternative to Medicaid expansion.”

Candler County’s interim CEO, Damien Scott, indicated to the Metter Advertiser that expansion would be a good thing.

He noted that funding for care to low-income patients under the Disproportionate Share Hospital (DSH) program is being reduced. “From the hospital’s perspective, it’s disastrous because we don’t have the DSH payments and we don’t have the Medicaid expansion,’’ Scott told the Advertiser.

Deal, a Republican, is running for re-election this year. And his announcement on appointments drew criticism Friday from the camp of his best-known challenger.

“When facing a crisis, Gov. Deal always knows what to do: wait until it’s too late to help, and then pass it off to someone else,” said a statement from Bryan Thomas, spokesman for the gubernatorial campaign of Democratic state Sen. Jason Carter.  ‘‘Real leaders have vision and tackle problems head-on. How much longer will rural Georgians face the loss of their hospitals while the governor waits for someone else to fix the problems?”

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