This Is Not a Drill: Speak Up for Rural Hospitals

Guest Editorial by Tim Size, Executive Director, Rural Wisconsin Health Cooperative, Sauk City and Past NRHA President

This is not a monthly test of your outdoor warning siren. I have worked in rural health for over thirty years. We have never faced a situation as threatening as the federal cuts that may hit rural hospitals.   Senator Tom Coburn (an Oklahoma Republican) speaks for many when he said he understands the need to be careful when scaling back government spending. As he told Fox News, “to continue to waste $350 billion a year in the federal government, that’s pure waste or fraud or duplication.”

Waste is often in the eye of the beholder. From my point of view, a strong rural health system is not “waste or fraud or duplication.” America’s rural hospitals are the foundation of health care being local, not just urban. America’s rural hospitals are often at the center of a rural community’s economy. Weakening or eliminating rural hospitals weakens or eliminates local access to health care and local jobs.  I am hopeful that Senator Coburn and other Members of Congress from both parties remain solidly behind rural hospitals. But it is clear that the debt crisis is fertile ground for the surfacing of longstanding anti-rural bias and or plain misunderstandings. In particular, rural hospitals seem to be in the crosshairs from a variety of directions.

 After decades of trying to make an urban-based model of Medicare funding for rural hospitals work, Congress created the Critical Access Hospital program to create a stable network of rural hospitals throughout rural America. That success is now being threatened by a variety of proposals, ranging from eliminating some hospitals, across the board cuts or eliminating the entire program. There is a risk of rural communities being divided from one another, seeing less threat in one proposal versus another. I can only say that when your house is threatened by fire, it’s not the time for talking about which parts to protect and which to let go.

 We know that most rural hospitals are financially just holding their heads above water. Under-payment by government programs has left them vulnerable. A sluggish economy and an increasingly competitive health care marketplace are taking their toll. Medicare and Medicaid are rural hospitals’ largest payers. Additional cuts are likely to tip many rural hospitals into the red and eventual closure. No one knows what is going to happen in Washington over the next few months. As the Serenity prayer teaches us: we need to have the courage to act, the patience to endure and the wisdom to know the difference. I hope for most of you, you will find this a time to act.

Go to NRHA’s Congressional Action Kit where you can easily find the phone, email and fax information for your Senator and Representative. Let them know of your deep concern for the future of rural hospitals and that you are asking them to stand with you and fight to protect that future for rural America.

2 thoughts on “This Is Not a Drill: Speak Up for Rural Hospitals

  1. Tim Cansler

    The majority of rural and Critical Access Hospitals are, on average, more than 50 years old. Advancements in patient care, medical technology and energy efficiency make these hospitals inefficient and expensive to operate. Consequently, these facilities often operate at subpar economic levels. It becomes a vicious cycle; inefficiency leads to poor economic performance, poor economic performance leads to the inability to obtain the financial resources necessary to upgrade and the inability to upgrade leads to ever increasing inefficiency and unprofitable revenue streams.

    Thousands of rural hospitals are in need of significant remodeling or replacement, but finding the capital to finance such an undertaking is difficult.

    Although some funding for needed upgrades is available through USDA, and HUD loans and loan guarantees, these programs represent a considerable cost to the federal government. More importantly, because most rural hospitals are only able to achieve a BBB minus credit rating or less, even these programs are currently unfeasible.

    In addition, due to the current economic situation in our country, we see unprecedented amounts of capital “sitting on the sidelines.”

    We know that the demand for healthcare will increase with the aging of our population but the ability of our third‐party payment system to pay for needed healthcare services will be strained.

    This means that making our healthcare delivery system more efficient will be extremely important to the long‐term sustainability of our rural healthcare system.

    Congress should adopt the Rural Medical Facility Investment and Improvement Act that will connect the demand for the construction of efficient rural hospitals with private investment capital that is currently available.

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