Congressman discusses rural healthcare access

United States Rep. Jason Smith, chairman of the Ways and Means Committee, hosts a roundtable discussion with healthcare professionals from the 8th District at Madison Medical Center, Sept. 11. (Victoria Kemper)

VICTORIA KEMPER, vkemper@dailyjournalonline.com

Eighth District U.S. Rep. Jason Smith, chairman of the House Ways and Means Committee, hosted a roundtable discussion on Monday with healthcare professionals at Madison Medical Center’s West Main Medical Building in Fredericktown.

The roundtable discussions were an opportunity for health care professionals to share their ideas and proposals to improve and expand access to care in rural and underserved communities.

“Thank you to Madison Medical for hosting us,” Smith said. “I wanted to come to a critical access hospital in our congressional district, and this is about as centrally located as possible. That’s why we’re in Fredericktown. It’s pretty much in the middle of our congressional district.”

Smith said last Thursday, Sept. 7, a national Request for Information (RFI) was made by the Ways and Means Committee, asking for people’s input on the many different aspects of care. He said he wanted the first listening sessions to take place in the 8th congressional district.

“This morning, when I was driving from Salem, the only hospital between there and here was in Ironton,” Smith said. “In that, you know, we’ve done everything we can to make sure that it’s still there, but it’s tough for rural hospitals to succeed. If you go from Salem to Poplar Bluff, guess what, there’s none in two hours. And so, if you care about the cost of care, what does it matter if you can’t get care?”

Smith said finding ways to help rural areas’ access to care is important. He said rural communities should be treated the same way as everywhere else, regardless of the zip code.

“We have to look at reimbursements,” Smith said. “We have to look at all kinds of items and it’s not always a popular thing, but rural America has been forgotten. There has not been a chairman of the House Ways and Means Committee that has been focused on rural issues since Medicare was created. That’s huge, and we have a real opportunity to try to make sure different aspects incentivize rural health care and access.”

Smith said the diminished presence of acute care facilities in rural America has had a huge impact in the 8th congressional district.

“We’ve seen five hospitals close since I’ve been congressman, in 10 years,” Smith said. “Some of them not too far from here, but whether it was in Ellington, whether it was Kennett, Doniphan, Farmington, Poplar Bluff, even big communities, we’ve seen closed. There’s only been 12 in the entire state that have closed in that time frame, since 2005, [and] five have been in the eighth congressional district. So, we clearly have a problem.”

Smith said, during a healthcare roundtable in Nashville, an executive of a large healthcare company told him, “healthcare will follow the dollar.”

“And it was a true statement, he’s exactly right,” Smith said. “People wonder why we can’t get a health care workforce in rural America. It’s because we can’t pay as much as in the other areas. They’re reimbursed more in St. Louis and Kansas City than they are here.”

Smith gave an example of a home heart monitoring service which is reimbursed roughly $40 for patients in his district but in San Francisco, the same service is bringing in more than $70.

U.S. Rep. Jason Smith, R-8th District, flanked by aides, requests rural healthcare employees’ feedback Monday in Fredericktown.(Victoria Kemper)

“Where do you think that company is going to focus their resources,” Smith asked.

The room was filled with representatives from all over the congressional district. The topics brought up included telehealth, regulations, staffing, dental services and transportation.

Parkland Health Center President Annette Schnabel said telehealth has been a huge benefit to the community. She said it allows local providers to consult specialists and helps reduce the number of patients who need to be transferred out of the community.

The group discussed the benefits of telehealth and most agreed it was a great option for the patients. One concern brought up was the cost of care. Many in the roundtable informed Smith that providers are paid the same whether they are in telehealth or in person, but the reimbursement is not equivalent. Hospitals reported they have been covering the gap to ensure their patients have this service available.

Madison Medical Center CEO Lisa Twidwell said her facility has telehealth services available as a backup option for the emergency room, but she said getting reimbursed for those services is hard.

Another telehealth challenge discussed was the lack of internet access in the area. Smith assured the group it is getting better every day, but rural internet access definitely still needs improvement.

With only a few minutes left in the discussions, the last topic was transportation and patients spending extended times in the hospital.

Schnabel said the lack of transportation available to rural communities makes it hard for patients to get care or go back home after a visit to the hospital.

“We often have a patient that will present to the emergency room, but they came via ambulance, but they have no way to get home,” Schnabel said. “We can use our own transport on certain patients, but after hours, we actually pay taxis to take patients home.”

Challenges of finding beds for patients, such as psychiatric patients, for transfers out of the emergency room were also a topic which caused Smith to direct his team to “write that down.”

Iron County Medical Center CNO Billie Jo Russel said her facility often has patients waiting in the ER for a bed or for a ride back to the nursing home. She said the patients receive care every day they are there, but the hospital is not paid for those days.

“We just had one that was there for 86 days,” Russell said. “We get no payment. Eighty-six days we had this patient and we took care of her every day and gave her medications just like they would in another facility. It’s just frustrating. We can’t admit them because we’re not a psych facility, and we’re not a locked-down unit. So we have to keep them in the ER.”

Russell said the staff actually became pretty attached to the patient after 86 days, and it was frustrating that it took so long to find a facility.

“Daily we were sending out referrals to try to get someone to accept her,” Russell said. “But people would not accept her because she was originally discharged from the facility that she was at.”

Russell said this is just one example of something which has happened several times. Others in the room said this is also a struggle for them.

“I want to thank you all for being here,” Smith said. “This has been helpful. I appreciate the dialogue.”

Smith said these hospital representatives are the ones who live and breathe these issues and are the best ones to help find solutions

“I’ve never had anyone, I’ve never had a paid lobbyist in D.C. talk about the emergency stays of 80 plus nights, never,” Smith said. “I don’t know if you have heard it, but I have not had a paid lobbyist in D.C. talk about that issue. And so that’s why you need to talk to real people. You are good boots on the ground. So I appreciate that. Thank you for what you’re doing. It’s good to have a lot of folks representing all of our congressional district.”

Smith said his main takeaway from the discussion was that you can find the right solutions for access to health care in rural areas.

“A lot of items we discussed here are items that you don’t necessarily hear in the halls of D.C.,” Smith said. “So this is very beneficial. Hopefully we can craft some policies to make a difference.”