Rural hospitals are facing many trials

Published 8:39 am Wednesday, December 3, 2014

By U.S. Rep. Bradley Byrne

As the old adage goes, you can’t fully understand something until you experience it yourself. That is why I committed earlier this year to visit each hospital in Alabama’s First Congressional District. From Monroe County Hospital in Monroeville to North Baldwin Infirmary in Bay Minette, I am proud to have now visited 16 hospitals in total.

At each hospital, I was sincerely impressed by the knowledge, dedication, and compassion of the doctors, nurses, and administrators I met. There is no doubt our local communities are well served by these medical facilities. That said, this is a challenging time for hospitals all across the United States. In Alabama alone, ten hospitals have been forced to close their doors over the past few years.

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Prior to the passage of the Affordable Care Act, commonly known as Obamacare, hospitals were already facing serious challenges in both compliance and funding. Since the passage of Obamacare, the number of challenges has only increased. These challenges impact each and every hospital, but they have a real impact on our more rural hospitals.

It is important to note that in most of these rural communities, the hospital is more than just a medical facility: it is often the lifeblood of the local economy. Most hospitals employ up to 200 people with great wages and benefits, and many have foundations which provide critical funding to community projects.
The number one comment I heard at each of the hospitals, regardless of the size, was that the patient count has gone up but the revenue has gone down. Anyone with a basic understanding of economics knows this is an unsustainable business model.  The top culprit for this problem is Obamacare.  Under the law, many people have higher deductibles which most simply can’t afford. In turn, hospitals and doctors are having to eat the cost from these patients.

Let’s not forget: Obamacare was designed to make health care more affordable and more accessible. The opposite is happening. Health care costs are on the rise. Physicians are being driven into retirement. Possibly worst of all, many hospitals are being forced to shut their doors.

Another serious issue plaguing our hospitals are low Medicare reimbursement rates. One of the major issues regarding reimbursement rates for hospitals in Alabama is the Medicare Area Wage Index formula, which associates reimbursement levels to salary levels. Hospitals update their wage information each year to reflect the salaries of staff, but the index is budget neutral across the country so that when wages in one area go up payments to other areas go down, unfairly penalizing hospitals in mostly rural areas.

Alabama has particularly suffered under the Medicare Wage Index and has one of the lowest levels of reimbursement. We need to recalculate the Wage Index to remove the inherent inequalities and provide reasonable payment to all hospitals for the services they provide.

Now is an incredibly critical time for the medical community, and I intend to work with my colleagues in Congress to protect our local hospitals and improve health care in our country.