With U.S. Senator Chuck Grassley
Q: Why are you working to advance Medicare reforms for rural hospitals?
A: This past year, I've heard a good deal of feedback from my town meetings in Iowa that acute health care services in rural areas of our state are at risk. A shrinking pool of patients is exposing a funding shortfall that is hurting small town hospitals. Many people who live in small town Iowa would rank the top four most important institutions in their community as the school, the bank, the hospital and their place of worship. Iowa farmers are spending countless hours bringing in the fall harvest. As too many farm families know, tragic accidents occur around farm machinery, grain bins, tractor roll-overs and power-take-off shafts, when clothing or appendages get caught up in the rotating device. That's when timing and access to critical health care are especially critical. As the population growth in Iowa continues to migrate toward urban, metropolitan hubs, policymakers need to address how the demographic shift affects services in our rural areas. That includes making sure Medicare recipients in sparsely populated communities aren't left without critical health care services, as an example. That's especially true for emergency medicine. The National Conference of State Legislatures reports that 60 percent of trauma deaths take place in rural areas, where only 15 percent of the population lives. Arguably, distance and response time to the nearest E.R. play a contributing factor to saving lives and limbs. By not requiring rural hospitals to maintain inpatient care for participation in the Medicare program, my Rural Emergency Acute Care Hospital (REACH) Act would give eligible hometown hospitals a lifeline to help keep their doors open. In addition to providing emergency medicine, they may also expand their purpose and sustainability by converting space for other medical services to serve their community, such as telemedicine, nursing home care, skilled nursing facility care, infusion services, home health and hospice. A more favorable Medicare payment prescription would resuscitate around-the-clock emergency health care services in rural areas of the country and help keep good-paying jobs and vital medical services available close to home.
Q: How would the REACH Act help?
A: The REACH Act recognizes the unique challenges facing health care providers serving rural communities. Access to primary health care services, particularly emergency medicine, is a critical issue of concern for people who live and work in less populated areas of the country. And rural areas, especially in Iowa, have a greater share of older residents who receive health care services paid for by Medicare. Without a doubt, Medicare creates a big footprint across the network of hospitals and health care providers serving 531,209 Iowans. Medicare spends $4.3 billion per year in Iowa and a lion's share of rural health care providers depend on Medicare business to stay in business. As an outspoken advocate for rural America and a senior member of the Senate Finance Committee, which has legislative jurisdiction and oversight authority of the federal health insurance program for older and disabled citizens, I make it known loud and clear that Medicare needs to measure up to the needs of Iowa taxpayers, beneficiaries and providers. To serve rural residents and modernize Medicare policies to better reflect community needs, I introduced the REACH Act this summer. It would create new flexibility and fix the payment structure so that reimbursements for rural emergency outpatient health care services are not tied to inpatient volume. Basically, a boost in the reimbursement formula (110 percent of reasonable costs) would help rural providers keep their doors open for business, including ambulance and telehealth services. Specifically, free-standing 24-hour emergency medical care outlets in our rural communities would get higher payment injections to help them pay their bills, make payroll and serve local residents. Individual states would apply for certification to participate. My bill also adds incentives to encourage emergency medical professionals to practice in rural areas. The goal of these changes is a budget-neutral proposal with no additional spending overall.
Q: Which rural hospitals would be eligible to participate under the REACH Act?
A: If adopted, my bill would designate as a rural emergency hospital any facility that is a critical access hospital, or a hospital with at most 50 beds located in a county. In addition, a rural emergency hospital must provide 24-hour emergency medical care. And, the facility does not provide acute care inpatient beds. It also must follow protocols for the timely transfer of patients to appropriate inpatient service providers. My bill would require that Medicare Part B cover rural emergency health care services and the ambulance services to transport patients who require inpatient care to a critical access hospital or full-service hospital. Finally, the facility must receive approval from the state and certification by the Department of Health and Human Services.
Friday, October 23, 2015
