Members of Gov. Sam Brownback’s Rural Health Working Group have their work cut out for them.
Representatives of the state’s hospitals and doctors painted a sobering picture of the problems facing rural providers at the group’s first meeting Tuesday evening.
Melissa Hungerford, a vice president at the Kansas Hospital Association, briefed the working group on a project she has been leading aimed at developing a more sustainable rural health care facility. Though the model isn’t fully developed, Hungerford said the smaller hybrid facilities would offer a more limited range of services than the critical access hospitals, which now serve many rural Kansas communities.
“We can’t keep going the way we’re going without kind of changing the whole system and looking at the system as a whole,” Hungerford said.
She said the search for a new rural health care delivery model is being driven by a combination of factors, which include the low use of existing facilities, declining Medicare reimbursements and the state’s rejection of Medicaid expansion, which to date has cost Kansas health care providers more than $1 billion in additional federal funding.
“Financial issues are a huge challenge,” Hungerford said. “About 69 percent of our rural hospitals are in the red for Medicare.”
The Affordable Care Act reduced Medicare reimbursements to many of the nation’s hospitals but spared the critical access hospitals. Even so, they’ve been hit hard by automatic cuts in the sequestration deal negotiated in 2013 to avert a shutdown of the federal government. Those cuts, which were included at the insistence of conservative Republicans in Congress, have cost rural hospitals about $2.8 billion, according to the research firm iVantage Health Analytics.
Medicaid expansion also is an issue. Hospitals in states that haven’t expanded Medicaid eligibility are under more financial pressure than those in states that have, according to the IVantage study, which found that two-thirds of the more than 670 rural U.S. hospitals most at risk of closing are in non-expansion states.
Thirty-one states and the District of Columbia have expanded Medicaid. Kansas is one of 19 states that haven’t, though lawmakers in three states are actively considering expansion plans.
“We think one of the fundamental problems is the diminishing economic base of our rural communities. That is a substantial barrier to dealing with this (health care) problem.”- Jerry Slaughter, executive director of the Kansas Medical Society
Hungerford included the state’s rejection of Medicaid expansion in a list of factors that she said were threatening rural providers, but the issue wasn’t discussed by the working group, which some say Brownback formed to divert legislative attention from an expansion proposal introduced by the hospital association.
Lt. Gov. Jeff Colyer, whom Brownback appointed to lead the work group, and three of four legislative members selected by the administration are strong opponents of expansion.
In an interview weeks prior to the meeting, Colyer said expansion wouldn’t be off limits for discussion. But he made it clear that he doesn’t believe expanding coverage to an estimated 150,000 low-income Kansas adults, many of whom are now uninsured, would do much to solve the problems of rural providers.
“Medicaid expansion is not the answer for solving every problem that faces us, let’s just be realistic about it,” Colyer said.
Jerry Slaughter, executive director of the Kansas Medical Society, also addressed the working group at Tuesday’s meeting. He said the problems of rural health care providers are merely one symptom of the economic decline affecting many of the state’s rural communities.
“We think one of the fundamental problems is the diminishing economic base of our rural communities,” Slaughter said. “That is a substantial barrier to dealing with this (health care) problem.”
A declining economic base makes it harder for communities to attract health care professionals and generate the tax revenue needed to subsidize hospital operations and fund needed improvements, both Slaughter and Hungerford said.
At the end of the two-hour meeting, Colyer said he wanted to schedule several sessions through the summer and fall, including at least one all-day meeting in a rural community struggling to maintain access to health care services.
“I think we can have a very productive day that will open some eyes and stimulate some conversation,” he said.
Colyer said he would like to have some have preliminary recommendations for Brownback to review by late fall.