Rural healthcare providers on Tuesday told members of the House Ways and Means Health Subcommittee that current Medicare regulations threaten to shut the doors of more rural hospitals across the United States.
In the testimony, rural healthcare providers asked for support of the Medical Relief Act, legislation that would end the 96-hour rule for critical access hospitals. They also want to stop the physician on-site rule banning physician assistants from supervising services; and they want an increase in federal dollars to strengthen graduate medical education to get more physicians into rural hospitals.
The committee made no decisions during Tuesday's hearing, but Chairman Kevin Brady, R-Texas, said the committee would take additional comment for 14 days.
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The hearing was the latest held by the Health Subcommittee in the wake of passage of legislation to fix the way Medicare pays physicians, Brady said.
Brady said Medicare regulations are creating rural healthcare disparities and agreed the 96-hour rule must go.
Under the 96 hour rule, doctors at critical access hospitals have to certify that it is reasonable that an individual would be discharged or transferred within 96 hours of being admitted.
"We should provide relief for all our hospitals and providers from overly burdensome regulations and bureaucracies," Brady said. "There is no better place to start that process than with our rural hospitals."
Ranking member Jim McDermott, D-Wash. placed the blame on Republican states that have refused to expand Medicaid, where rural hospital bottom lines are being squeezed.
"Under Republican leadership, 20 states refuse to accept Medicaid expansion," he said. "Their decision has left 4.3 million people without insurance … forcing hospitals, many of them which serve rural areas, to pick up the costs. Not coincidentally, 80 percent of the hospitals that have announced recent closures are in states that chose not to expand Medicaid. It's a problem with party that would prefer to sabotage the president's healthcare program for political purposes rather than try to make it work."
Speakers included Shannon Sorenson, CEO of Brown County Hospital in Ainsworth, Nebraska; Tim Joslin, CEO of Community Regional Medical Centers in Fresno, California; Carrie Saia, CEO of Holton Community Hospital, Kansas; and Dr. Daniel Dirksen from the University of Arizona.
Joslin said the San Joaquin Valley in California is the fifth poorest area of the country. There is a doctor shortage there which could be helped by an increase in graduate medical education funds for the area, he said. Studies show an estimated 30 percent of physicians remain in the region where they have trained for medical school, he said.
"We'd like to grow the program," Joslin said, "but funds are frozen at the 1997 level from Medicare."
Sorenson, of Nebraska, said the patient mix there is over 70 percent Medicare.
"The 96-hour rule is especially burdensome," she said. "It leaves no room for changes in the plan if treatment does not go as anticipated."
Saia, of Kansas, agreed, saying, "This policy places additional unnecessary financial burdens on hospitals."
Also, she said, "the on-site rule will result in changing a thin profitable bottom line to negative bottom line."
Dirksen, a family physician for 30 years, said Medicare has arcane rules that make it difficult for rural hospitals to stay open.
"I think the Two Midnight and 96-hour rule undermine a physician's judgement," he said. "It's unreasonable and unfair to make it a condition of payment; if someone exceeds 96 hours in a critical access hospital they won't get paid."
Cochise in Arizona is the latest hospital to close, he said.
"We've seen 55 rural hospitals close over last five years," he said. "Another 283 are at risk for closure."