A Nebraskan's View

Monday, November 30, 2009 COMMUNITY HOSPITALS ARE MORE THAN JUST A SOURCE OF PRIDE

by Senator Ben Nelson

As Nebraska’s Governor and Senator I have had the opportunity to visit most communities throughout our state. One of the things people like to point to with pride in virtually every town is their hospital. Most have been there a long time, have undergone periodic remodeling and updating, and are extremely important to the community for the town’s medical and economic health.

A modern health center is essential to the growth of a community. Without basic services such as health care, rural areas cannot hope to attract new residents or retain existing residents.

Small rural community hospitals throughout Nebraska are what we refer to in Washington as critical access hospitals.

Critical Access Designation is Important When a hospital is designated as critical access it means they are certified to receive cost-based reimbursement from Medicare. That helps improve their financial stability thereby reducing its chances of suffering from the kind of adverse economic problems rural hospitals have suffered from in recent years.

It’s important that Washington understands this but, as is often the case there, when it comes to rural living most people in D.C. just don’t get it.

Many of the bureaucrats who live and work there are used to crowded cities where hospitals are only a short distance away. They don’t appreciate that in states like Nebraska we have a lot of land but not so many people.

When our citizens have an emergency they have to travel further and further to get care. It may not be the most profitable venture to have a hospital in a small rural community, but it sure can mean life or death for local residents if that hospital’s doors were to close.

Nearby Hospitals are Necessary We want to make sure they don’t have to travel too far to get critical care, so I have fight to get the resources necessary to maintain the hospitals we have in rural Nebraska. It’s a never ending fight.

As a member of the Senate Rural Health Caucus, I have pushed legislation to end Medicare’s historic discrimination against states like ours that have to do more with less.

Rural hospitals are more dependent on Medicare payments as part of their total revenue. Medicare accounts for almost 70 percent of total revenue for small, rural hospitals.

Rural hospitals have lower patient volumes but must compete nationally to recruit providers due to the nursing and health professional workforce shortages.

Rural States Were Penalized Medicare’s complex funding formula penalized rural states like Nebraska for practicing cost effective medicine by reimbursing them at a lower rate. Health care providers and hospitals in our state received a lower reimbursement for the same procedure performed in New York.

That unfair practice created a disincentive for doctors and nurses to stay in rural areas. While I have continually fought for critical access hospitals, this year I also introduced legislation to equalize the reimbursement rate between urban and rural America for midsize, yet rural, hospitals like the Columbus Community Hospital.

The bill is entitled the Rural Community Hospital Demonstration Extension Act, and it is the kind of reform I was pleased to see included in the Senate’s health care reform package.

When I see beautiful, state of the art medical centers in rural communities throughout Nebraska it reinforces the work I do in Washington to make sure that the people of rural Nebraska have the health facilities they deserve. It requires constant vigilance but its well worth the effort.