Have you wrapped all the presents? Have you looked under the tree? Are the stockings hung with the hope of St. Nick? I hope so. Idaho rural hospitals will be offered a stocking stuffer this year from our federal government that might leave them asking, \u201cWhere\u2019s the pony?\u201d<\/p>\n\n\n\n
This policy shift<\/a> comes in last years budget bill. That\u2019s where most things happen in Washington DC nowadays. No committee hearings on boring budget items or policy decisions. It seems the only public hearings and debates are about things that have plenty of partisan opportunities for sound bites and teeth gnashing. Small town hospitals? Yawn. Unless you live or work there.<\/p>\n\n\n\n This gift is pony droppings.<\/p>\n\n\n\n There has been no doubt some small town hospitals are stressed. A study<\/a> found over 600 are at risk of closing in the next ten years. Over 180 have closed<\/a> in the last 17. So, the budget proposal offers a \u201cfix\u201d.<\/p>\n\n\n\n If a rural hospital promises to not keep patients longer than a day, they will get $3.2M in federal dollars annually. You shift your small hospital from providing inpatient care to being an urgent care facility with a helipad, you get a boost. What are they thinking?<\/p>\n\n\n\n Is inpatient care cheaper at big city hospitals? Is it better? We don\u2019t know the answer to these questions, but we really do know what happens to small towns where the hospitals close. One in 12 jobs in small towns are supported by their small hospitals. After hospitals close small-town populations shrink.<\/p>\n\n\n\n What does the landscape look like here in Idaho? Honestly, not as bad as in many states. If you look at the maps for closures and at-risk rural hospitals, you might as well overlay the map for states that have not expanded Medicaid coverage. We did that. But it took the Idaho voters, not the governor or the legislature to get that done.<\/p>\n\n\n\n Idaho currently has 30 rural hospitals. None had closed in the last 20 years and only two are considered at risk. That is the lowest rate of any state with a substantial rural population. What makes Idaho special? I would argue, good local governance.<\/p>\n\n\n\n If our federal delegation wanted to do something that would substantively help our rural communities instead of gelding their hospital services, there are many choices, many solutions<\/a>. Private insurance companies pay less to rural providers than urban ones for the same services. And rural hospitals have a higher percentage of private insurance patients than urban hospitals do. You can blame Medicare and Medicaid all you want, but there\u2019s good evidence that changing the way rural hospitals are compensated mainly by private insurers, would avoid this problem.<\/p>\n\n\n\n This choking out of rural healthcare has been a long time coming. When the pandemic hit and DC sloshed cash outwards, the rural hospitals got some boost. That dries up on New Years Eve. This \u201csolution\u201d is supposed to forestall some closures by making the local hospitals walk-in urgent care clinics.<\/p>\n\n\n\n I don\u2019t envy the small hospital board members considering this. Should they accept the \u201cgift\u201d their congressmen have offered and close their facility to inpatients? That would mean grandpa\u2019s pneumonia gets him a helicopter ride to the big city. And Billie Jean won\u2019t be having her baby where she was born. No, you can\u2019t make sure babies come out in less than 24 hours.<\/p>\n\n\n\n I see this \u201csolution\u201d as just another example of how we Americans don\u2019t want to face our problems. I\u2019m glad we have these volunteer hospital board members in our communities who understand and want to serve their neighbors. Congress is offering them money to stab their neighbors in the back.<\/p>\n\n\n\n Thank your local hospital board member and wish them a Merry Christmas. They deserve it.<\/p>\n","protected":false},"excerpt":{"rendered":" Have you wrapped all the presents? Have you looked under the tree? Are the stockings hung with the hope of St. Nick? I hope so. Idaho rural hospitals will be offered a stocking stuffer this year from our federal government … Continue reading