Bob,
This might be a bit long to post, but I suspect some list-serv subscribers would
like to hear it.
Donald.O.Kollisch
Transcripts of two really great pieces on NPR May 27 about rural health care.
Also links in case you wanted to listen to the pieces. Both stories really
capture what we're all about so I encourage you to take time to listen or read
them.
Story 1:"NPR : Medicare Payments to Rural Areas"
http://discover.npr.org/features/feature.jhtml?wfId=1276629
Just click on the headline or the audio icon to listen to the story. You'll need
an audio player to hear it and you can find the right one for your computer at
http://www.npr.org/audiohelp/audioplayers.html . If you have any problems,
please visit the NPR audio help page
http://www.npr.org/audiohelp/index.html .
Story 2: "NPR : Gap in Medicare Payments to Rural Areas Under Scrutiny"
http://discover.npr.org/features/feature.jhtml?wfId=1276631 Just click on
the headline or the audio icon to listen to the story.
LOAD-DATE: May 28, 2003
SHOW: All Things Considered (9:00 PM ET) - NPR
May 27, 2003 Tuesday LENGTH: 1491 words
HEADLINE: Medicare payment application in Clarke County, Alabama
ANCHORS: ROBERT SIEGEL; MICHELE NORRIS
REPORTERS: HOWARD BERKES
Doctors and hospitals in rural America say the Medicare system treats them
unfairly because it pays more for care of the elderly in big cities. They say
that disparity threatens access to care in rural places. Congress is trying to
respond with proposals that could cost billions of dollars. We have two reports.
First, NPR's Howard Berkes visits Clarke County,
Alabama, where low Medicare reimbursements affect both human and economic
health.
HOWARD BERKES reporting:
In Thomasville, Alabama, the basement of the Pineview Baptist Church fills with
townspeople and politicians.
Boy Scouts carry Alabama and American flags up onto a podium where two members
of Congress stand. This joint town meeting on the fringes of the poorest region
in Alabama in a time of high unemployment and conflict in Iraq focuses more on
health care than anything else. There are even questions about the arcane
formulas used to determine Medicare payments.
Democratic Congressman Artur Davis responds.
If you live or work in a rural community, you don't get the same reimbursement
formula as someone who lives in a big community. The San Franciscos of the
world, the New Yorks of the world get treated very well under this formula. The
Alabamas of the world don't get treated well.
BERKES: That's apparent at the Thomasville Infirmary, a red-brick hospital with
27 beds serving a rural region of 30,000 people.
Mr. GUS WEISS (ER Nurse): We're expected to do the same job, provide the same
amount of care, the same quality of care, same standard of care as a hospital in
Birmingham, a hospital in New York, a hospital in Los Angeles.
BERKES: But those hospitals don't have the same mix of patients. Close to 60
percent of the people treated at the Thomasville Infirmary are 65 or older and
on Medicare, and Medicare pays less for their treatment than it would pay in
cities and suburbs. Administrator Doug Jones cites one example: pneumonia.
Medicare pays as much as $800 more for treatment for patients
in other states.
Mr. DOUG JONES (Administrator): That's a significant amount of money when you
start talking about over a thousand admissions a year, that you start talking
about, say, you have a $200 difference--that's a couple hundred thousand dollars
a year that you're not being reimbursed that your neighbor across the state line
is.
BERKES: Doctors in Clarke County have similar stories. Steven Fir(ph) is a
family physician in Jackson, which is just down the road from Thomasville.
Dr. STEVEN FIR (Family Physician): So if you look, say, in San Francisco for a
routine chest X-ray they'd get paid $44.86. We get paid $30.06, so we get paid
67 percent of what they get paid, and in an office visit they would get $63 per
visit, but we'd get $46 per visit, which is a 27 percent disparity. You know,
and you say, 'Well, that's just one visit; $17 doesn't sound
like a lot.' But if you're seeing 15 or 20 of those a day, four or five days a
week throughout a year, that's a lot of money, a whole lot of money.
BERKES: The disparate payments are derived from complicated formulas based on
costs, especially wages, office space and real estate. Doctors in hospitals in
San Francisco pay far more for those things than they would in Clarke County,
Alabama. But Doug Jones of the Thomasville Infirmary says the formulas fail to
consider other costs rural doctors and hospitals incur.
Mr. JONES: An urban hospital, because they have more volume, would get greater
discounts for their supplies and their equipment than I'm able to negotiate. In
addition to that, because I don't have the volume that an urban center does, I
don't have that piece of equipment constantly in operation, so I'm not
generating the revenue stream that an urban hospital would be from that piece of
equipment.
BERKES: Jones says servicing equipment costs more due to travel costs for
technicians. And he figures he spends an extra half million dollars a year on
wages to subsidize physicians and other medical professionals who would make
more money elsewhere and might otherwise be tempted to leave.
Mr. JONES: We're just asking to be compensated fairly so that we can provide the
services that need to be provided in our community.
BERKES: The volume of Medicare patients is so high and the rate of reimbursement
is so low that some rural hospitals have closed. The Thomasville Infirmary has
had 10 different owners in 20 years and it's up for sale again.
Mr. JONES: It's a big factor. If a company were making an adequate operating
margin, they would not be selling the hospital.
BERKES: Clarke County is also losing a surgeon and a physician, in part due to
low Medicare reimbursements, even lower payments from the state Medicaid program
for the poor and a relatively high number of charity cases. That troubles
soft-spoken Frank Dozier(ph), Dr. Frank to his patients, whose family legacy
includes a century of doctoring in Thomasville.
Dr. FRANK DOZIER (Community Physician): Some of the foundation is crumbling.
We're seeing small hospitals fall. We're seeing more areas being
physician-underserved areas. And there's a possibility that there, you know, is
a group of people in the rural areas that are just far as, you know, healthcare
goes--they may not have anywhere to turn.
BERKES: Down the road in Jackson, Dr. Steven Fir sees that possibility in his
office every day.
This checkup is for a Medicare patient, a woman 72 years old with so many
ailments she takes 15 different medications a day.
BERKES: Dr. Fir worries that patients like this will lose local access to basic
care and won't seek treatment until they're sicker and require far more
expensive care.
Dr. FIR: She comes in every month pretty well to get her diabetes checked, her
blood pressure checked. You know, she hasn't been in the hospital. She's
maintained, she's done well, she hasn't lost a leg, her vision's been
maintained. We've done a lot of things to keep her costs down and it's taken a
lot of intensive work, but imagine what the costs would be if she was
having a heart attack and had to have bypass surgery, was in the hospital for a
week in intensive care unit. Or either she'd possibly have a stroke and be in a
nursing home for the rest of her life.
BERKES: And then there's simple economics for rural towns struggling to survive
and thrive. Sheldon Day is the mayor of Thomasville, and it's his job to recruit
new industries and newcomers.
Mayor SHELDON DAY (Thomasville, Alabama): They look for good schools; we have
those. They look for good recreation activities; we have those. But one of the
primary things they look for is good health care; they want to know that their
children are going to get good health care, and if they have Grandma and
Grandpa, they want to make sure that the elderly get good
care. And if you can't offer that, then we're at a disadvantage in being able to
attract those type of people to our communities.
BERKES: So Mayor Day liked what he heard at that congressional town meeting at
the Pineview Baptist Church when Congressman Artur Davis took this vow.
Rep. DAVIS: The quality of health care that you receive is very much a function
of where you live. The quality of health care your children get is very much a
function of where they happen to be born. It's a gap that tears at us. It's a
gap that tears at our conscience. And we need to be finding some way to correct
that. I want to thank all of you for being here tonight, and I think something
very good will come out of today. Thank you for coming tonight. Thank you.
BERKES: Congress is now addressing that gap for Clarke County, Alabama, and the
50 million people living in other rural places. Howard Berkes, NPR News.
LOAD-DATE: May 28, 2003
May 27, 2003 Tuesday
LENGTH: 757 words
HEADLINE: How Medicare benefits in rural America affect the US legislative
agenda
REPORTERS: JULIE ROVNER
BODY:
JULIE ROVNER reporting:
I'm Julie Rovner in Washington.
The problems with the way Medicare pays for health care in rural America are
well-known in the halls of Congress, and efforts to fix the inequities are
annual events. But there's one major reason rural interests are more optimistic
this year than ever before. That reason is Chuck Grassley. The plainspoken Iowa
Republican is now chairman of the pivotal Finance Committee, and he's made it
clear fixing Medicare's rural health-care problem is one of his top priorities.
Senator CHUCK GRASSLEY (Republican, Iowa): Rural hospitals or people in rural
states generally are entitled to the same quality of health care as people in
the cities.
ROVNER: And to Grassley that means comparable payments. Next month the Senate,
led by Grassley's committee, will start writing a major Medicare bill to add a
prescription drug benefit and make other reforms to the program. And Grassley
says flatly that there will be no Medicare drug bill unless it also addresses
the inequities in the way Medicare pays for care in rural areas.
Sen. GRASSLEY: If we have a Medicare prescription drug bill, it will get done.
ROVNER: But fixing the rural health problem is likely to take more than one
powerful advocate. House members have long been reluctant to support more
funding for rural health care; that's because many of them represent urban
health-care providers who are in equally bad financial shape. Les Bowman is
president of Detroit Receiving, one of those struggling institutions. The
private non-profit facility which is the city's only level-one trauma center
gets no public funding. But Bowman says it serves everyone who shows up at its
emergency room.
Mr. LES BOWMAN (Detroit Receiving): Our institution alone provides $70 million
of free care, which is almost one-fourth of our budget.
ROVNER: If Detroit Receiving goes under--and Bowman says it could without help
from Washington--it will hurt more than just the city's poor. The hospital also
operates the region's major burn center, takes intensive care patients from
around the state and is leading the area's effort to plan for a potential
bioterrorist attack.
Mr. BOWMAN: We look at the system, for example, in Michigan in the rural
hospitals, and yes, they have trouble. They don't have a good trauma system to
support them. But then when you look at the urban hospitals, we're in worse
trouble than they are.
ROVNER: Last year Detroit Receiving ran a $10 million deficit; this year, Bowman
says, it could lose twice that much. In the past, lawmakers have boosted funding
for rural health care by reducing payments for urban and suburban care,
basically reslicing the Medicare pie. But with so many urban hospitals in
trouble, that's not politically viable this year. That means
rural advocates have to look somewhere else for funds, and where they're looking
is the $400 billion Congress has earmarked for a Medicare drug benefit and other
reforms. But they face a fight on that front, too, from advocates for seniors
who say all that money should be used for prescription drugs. John Rother is
policy director of the senior group AARP.
Mr. JOHN ROTHER (AARP): Seniors will spend about $1.8 trillion for drugs over
the next 10 years, so $400 billion is really only between a fourth and a fifth
of the total amount, so it's not much at all.
ROVNER: His group and others, Rother says, won't look kindly on diverting any of
that money to other Medicare matters.
Mr. ROTHER: AARP believes that we ought to protect as much money as possible for
the drug benefit since it's not going to be very generous to start with, and
that any provider givebacks or increases in payment rates ought to be held for
separate legislation and considered after we enact a drug benefit.
ROVNER: Despite such opposition, Senator Grassley appears to have gotten
hisrural health-care effort off to a good start. He got $25 billion in funding
hikes for rural health-care providers added to the Senate's version of the tax
bill. That funding was dropped during final negotiations on the bill Congress
approved last week, but President Bush wrote Grassley a personal
letter promising to support the rural increases as part of the upcoming Medicare
drug bill. The president's letter, however, has outraged House Republicans who
represent urban and suburban areas. That, in turn, could make it harder for
Congress to pass any Medicare bill this year. Julie Rovner, NPR News,
Washington.
By the numbers: Rural Doctors and Rural Economies
Breeding Young Professionals and Healthier Rural Communities