Winsted-Lester Prairie Journal, April 30, 2001

Congressmen address health care crisis

By Rich Glennie

U.S. Rep. Mark Kennedy, R-Minn., along with fellow congressman U.S. Rep. Jerry Weller, R-Ill., heard from local health experts Friday morning that there is a crisis in health care in rural America.

The two congressmen were making the rounds in Kennedy's 2nd Congressional District, and the tour stopped for a rural health care community meeting at the Hutchinson Area Health Care.

Phil Graves, Hutchinson hospital administrator, said he hoped people in Washington, D.C., realize there is a crisis in health care in rural America. "It's a huge crisis. The health of Americans is at risk."

Graves said rural hospitals, like those in McLeod County, have to pay Twin Cities wages or more to get health care providers to locate here. Yet the rural facilities do not get the same Medicare reimbursements for the same services that urban facilities receive.

Combined with that is a shortage of nurses, the rising costs of equipment and new technology as well as the ever increasing demands for health care services by a growing population of older Americans.

"Twenty-five percent of hospitals in Minnesota are losing money," Graves said, "and it's only going to get worse."

Graves also said the balanced budget approach of a previous Congress really hurt rural hospitals, and he said he was thankful some of that Medicare funding was restored. But he said Minnesota hospitals are still behind about $900 million in Medicare reimbursements.

Kennedy said his aim is to visit all 41 hospitals in his southwestern Minnesota district to get input.

He said he knows about the disparity in Medicare reimbursements between rural and urban hospitals. But even more unfair, he said, is the disparity of Medicare reimbursements between hospitals in Minnesota compared to other areas of the country.

As an example, he said Miami hospitals get twice as much reimbursement as those in Minneapolis, even though costs for services are the same, Kennedy said.

Other concerns he has heard include costs of prescription drugs, especially for senior citizens, long-term care reimbursement concerns and staff shortages, especially of nurses.

But what surprised him, however, was the acute issues in rural emergency services.

In many rural areas, Kennedy said, the cost of emergency services, like ambulances and training and certification of emergency medical technicians (EMTs), is similar to metro area, yet the burden is far greater in rural areas.

While many metro emergency services are paid professionals, rural areas often must rely on volunteers to supply the services.

He said those volunteers are very dedicated, but the commitment to do the services is very time consuming and demanding.

"Rural EMS providers are finding it increasingly difficult to continue to provide service, in part because of rules from federal agencies in Washington, D.C.," he said.

Kennedy said he has introduced a bill "to help ensure that rural communities continue to have the emergency care they need."

He said the reimbursement disparities also apply to emergency services. He said federal accountants often will shortchange rural providers by denying claims for ambulance services the accountants deem unnecessary.

Kennedy said his bill will eliminate the bureaucrats' discretion in some reimbursement decisions, while also providing EMS volunteers and services with grants to improve and expand EMS services.

He said grant money would be provided to pay for EMS certification, because many volunteers now pay the costs out of their own pockets.

His bill also would provide money for rural providers to purchase updated equipment and ambulances.

"EMS providers are the backbone of rural health care," Kennedy said. "When our emergency services are threatened, our entire health care system is threatened."

Weller said he also supports Kennedy's bill. Weller represents a portion of Chicago, but also a portion of rural Illinois.

He said one of the problems in Congress on health care legislation is that there are fewer rural representatives than those from urban areas.

He said the current Congress is faced with health care as a big challenge. He said there is action under way on patient's bill of rights, modernized health care, especially the needs for affordable prescription drug coverage, as well as expanding coverage to include the large number of uninsured Americans.

Weller agreed the reimbursement issue is extremely important for rural health care.

"The funding is tilted to where the votes are," Kennedy said of the Miami vs. Minneapolis example.

"We need total reform of health care. But it's a big nut to crack," Kennedy said. "We pay the same premium and taxes as people in Miami, yet get half the reimbursements for services."

It was suggested a system be used like Social Security, where everyone gets the same reimbursements no matter where they live in the U.S.

Asked what the congressmen plan to do to address the staff shortages, Weller said there is legislation to offer loan forgiveness incentives to health care workers or special assistance to them if they serve in rural areas.

"There are tremendous shortages today, and it's only going to get worse tomorrow if not addressed," Weller said.

Weller said there also is a changing demographics occurring with many more people nearing retirement age. "Retirement age is when health care needs go up," he said.

"There is not only a shortage of health care providers, but there will be shortage of taxpayers, too," Kennedy said of the aging population.

A Hutchinson nurse also pointed out that the average age of the health care providers also is increasing because not enough people are entering the field compared to those leaving. She said the average age of hospital registered nursing staff at Hutchinson was 52 years, while the national average is 44 years.

Kennedy said it is not just a problem with RNs. He said only 200 pharmacists graduated last year in Minnesota.

He said farm groups are good at promoting their products, perhaps health care groups need to follow that example to address its staff shortages.

Roger Schultz of Glencoe said the federal government should take the example from the ag programs that are re-evaluated every five years. He said if that approach was taken in other areas, like health care, then adjustments could be made periodically.

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