Spokane7
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December 18, 2011 in City
Talk at federal, state levels alarms rural hospitals for future
They know they must participate in budget cuts
Terissa Norris has her temperature checked last Wednesday at Providence St. Joseph Hospital in Chewelah, Wash. Norris fears that cuts in health care will eliminate smaller hospitals like St. Joseph and she would be forced to travel to Spokane for health care.
(Full-size photo)(All photos)
Many of Eastern Washington’s small hospitals are bracing for cutbacks as federal and state governments look to save money.
Consider Providence St. Joseph Hospital in Chewelah: On any given day perhaps nine of its 25 patient beds are occupied. Two of those patients might have private insurance. One might not pay the medical bill. The rest will be covered by government programs such as Medicare and Medicaid.
And yet the hospital has made money in four of the past five years, in part because rural hospitals receive richer payments from government than larger urban hospitals to care for proportionally higher numbers of the poor, elderly and uninsured who populate rural America.
It’s a bottom-line boost that has kept 38 hospitals in rural Washington afloat. But that extra money from Medicare and Medicaid is drawing the attention of budget cutters.
If proposals to retool and scale back the payments are adopted, up to half of these hospitals could be closed within a matter of years, say administrators and policy analysts.
Twice this year the federal government has pointed to its “critical access hospitals” program as ripe for change. The White House believes it can save $6 billion over the next decade by trimming the Medicare dollars it sends to these 1,300 hospitals stretched across the country.
A worse prospect for regional hospitals, however, is the continuing budget woes of state government.
The Washington Legislature is expected to consider a bill that changes the way it pays Medicaid bills submitted by critical access hospitals. The savings from HB 2130 to state taxpayers could reach $27 million a year.
Hospital supporters say such savings would translate into a double-whammy because the $27 million state cut would be accompanied by the loss of $27 million in federal matching funds, for a total loss of $54 million in Medicaid funding to Washington’s small hospitals.
“We’re talking about a throat-cut,” said Tom Martin, the chief executive of Lincoln Hospital in Davenport, who is pushing back against the possibility of cutting hospital funding.
The Davenport hospital is the only health care facility along U.S. Highway 2 between Spokane and Wenatchee. Physicians and nurses there mend broken bones from car accidents, treat people hurt in boating accidents on nearby Lake Roosevelt and sew shut wounds from farming mishaps.
Most often, though, the hospital and its network of clinics and nursing homes help the elderly fight pneumonia, recover from falls and cope with diabetes-related illnesses and other common problems.
“We care for the people of this community,” said Martin. “We’re the safety net. If we have to cut services, it’s going to have a severe and negative effect on people.”
State officials acknowledge the dire consequences of trying to shave $2 billion from the state budget.
“This is due to the horrible economic crisis we’re currently in,” said Sandy Stith, hospital finance officer for the state Health Care Authority.
“In looking for areas where we actually have the ability to make cuts at this point in time, they have become rather few and far between,” she said.
‘Necessary providers’
Congress created its critical care access program in 1997 following a wave of rural hospital closures, said Cassie Sauer, a spokeswoman for the Washington State Hospital Association.
Sen. Max Baucus, D-Mont., helped push the legislation through in large part to ensure people in far-flung places like small-town Montana could have reasonably close access to a hospital. It also ensured the elderly could stay in their hometowns rather than have to move to larger towns and cities for hospital care.
Under the law, hospitals at least 35 miles from another hospital would be reimbursed their actual costs, plus 1 percent, of caring for Medicare patients. Urban hospitals, conversely, are paid set amounts for specific treatments and services, which vary by location.
The trade-off required small hospitals to keep just 25 beds and limit the average patient stay to fewer than four days.
The plan began to work and small hospitals stabilized while still caring primarily for the poor and elderly on government programs.
In some instances, states began using the program to help almost all of their small hospitals gain entry, even if they didn’t obviously qualify. They did so by labeling such hospitals “necessary providers,” structuring guidelines that enabled more small hospitals to slip into the more-generous payment program even if they were in close proximity to other hospitals.
Of the 38 critical access hospitals in Washington, for example, only seven meet the federal government’s original distance criteria. But they all meet at least one “necessary provider” criterion outlined by the state, which can include high numbers of poor and elderly patients or financial vulnerability that would leave rural patients without nearby 24-hour emergency room care.
Not much wiggle room
Last week Terissa Norris recovered from a blood transfusion at St. Joseph Hospital.
It was the second hospital trip in a year, brought about by exposure to black mold in a building that had been flooded. She wouldn’t go anywhere else.
“I love this place,” said Norris, 57.
Planted by Catholic nuns 80 years ago between hospitals in Spokane and Colville, St. Joseph is an important mainstay of Chewelah’s quality of life and economy.
“A lot of us up here don’t want to go to the city, Spokane, for medical treatment,” Norris said. “It’s too expensive. We’d have to drive down there. Our families would have to travel too far for visits.
“It would be a very severe, bad mistake if something were to happen to this hospital.”
St. Joseph is now owned by Providence Health Care, which also runs the hospital in nearby Colville as well as Providence Holy Family Hospital and Providence Sacred Heart Medical Center in Spokane.
If deep cuts in Medicare and Medicaid payments undercut St. Joseph’s financial position, it could prompt Providence to begin a review. The hospital system would weigh many factors and meet with community leaders before deciding whether to continue operating the hospital at a loss, reduce service, combine with another hospital or close. Providence closed its hospital in Deer Park in 2008.
Smaller hospitals need the better payments from Medicare and Medicaid because they don’t have the ability to pass on costs incurred from bad debts and low reimbursements to patients with private health insurance, a practice commonly called cost shifting, said Bob Campbell, who oversees St. Joseph. Nor do small hospitals have enough patients to spread out and absorb the high, fixed costs of meeting quality standards.
Campbell said small hospitals know that they must participate in budget cuts.
“But to do this within one year? A 50 percent cut to Medicaid payments? And not come up with a strategy to sit down with us and say, ‘What can be done?’ It’s too much,” Campbell said.
“We know conversations need to be had during these tough budget times. Should there be two hospitals in Chewelah and Colville? That’s a legitimate question,” he said. “But give us time to do the analysis, talk to the community and help us decide if we can then continue to provide top medical care in these communities.
“Let’s go through a process that’s rational rather than just draconian cuts.”
When it comes to raising revenues, however, small hospitals and their communities are torn. The half-cent sales tax increase floated by Gov. Chris Gregoire received a chilly reception in Davenport because it wouldn’t offset proposed cuts to critical access hospitals, said Deral Boleneus, a Lincoln Hospital board member and past Lincoln County commissioner.
The hospital district supporting Lincoln Hospital collects taxes each year to support building projects and technology purchases. Hospital administrator Martin is expected to manage an operating budget that runs near break-even.
It’s an arrangement that has helped the hospital enjoy continued support from voters.
“What we’re opposed to is an all-cuts budget,” said Sauer of the hospital association. “What we can agree to at this point is a blend of mild cuts, finding more efficiencies in state government, and increases in revenue, but not necessarily tax increases as they have been proposed.”
Parishes giving $1.5 million toward settling sex cases 
oneanddone on December 18 at 4:36 a.m.
Unfortunately this is another case of “I don’t wanna…” As the saying goes, beggars can’t be choosers. If balancing the budget means some people have to drive a little further then it’s just a new fact of life. Unless of course the legislature wants to increase business taxes and/or cut tax breaks, in which case I’m all for that. Ladies and gents, the status quo is dead.
dataxman on December 18 at 6:58 a.m.
oneanddone - I agree, let’s get all tax breaks on the table. Be they deduction (mtg. interest, sales tax, etc) or exemptions (MM&E, food, etc). We can’t demand services and expect everyone else to pay for it
Diana on December 18 at 7:37 a.m.
It’s easy for oneanddone to say, “I don’t wanna…”, especially since in this context, he doesn’t hafta…
IHike4Fun on December 18 at 8:11 a.m.
Diana, I totally agree!
JBlim on December 18 at 8:42 a.m.
Oneanddone: ” . . some people have to drive a little further then it’s just a new fact of life . .”
or death if one dies on the way.
Indie on December 18 at 9:42 a.m.
The rural folks overwhelmingly support McMorris Rogers so let them tell her they support revenue increases in general (state and Federal) and that they support the Affordable Health Care Act - all of which will reduce or elimate this screwed up health devliery system we have. If they tell her but she sticks with the Republican plan (which there isn’t one) then they should consider a new representative in District 5
The_Seer on December 18 at 10:06 a.m.
And the Tea Baggers were apoplectic about non-existent death panels. Go figure.
If you are old, broke, and live in the increasingly destitute rurality America, it’s your fault!
de3 on December 18 at 10:29 a.m.
Most hospitals and medical practices charge $10 to $20 per minute of access to the provider. Doesn’t matter if that is an office visit or an overnight stay in a hospital - it’ll cost ‘ya $10 to $20 per minute. Prices rise each year at 2 to 3 times the inflation rate.
Until someone addresses this, just finding someone else to pay the bill will eventually run out of other people’s money too.
meadman on December 18 at 10:45 a.m.
Indie — excellent point.
Chewelah_Boy_In_lib_land on December 18 at 11:58 a.m.
Hmmmm……figures the big city names would jump on this to show how “bad” these “outsiders” are. Oneanddone: Chewelah has a metro population of 3000, Spoklahoma: 300,000. Mount Carmel (in Colville….23 miles from St. Joseph’s) is a nasty drive to make in the winter…..ask my dad when he had to drive my mother to the hospital in 1985 because St. Joseph’s had been decertified for normal live births. Or ask my mom what happened in 1973 when she had to walk a quarter mile down the road to my grandparents, climb thru a 2nd story window(doors were locked,) and call my dad to DRIVE HER (and I….still somewhat inside) TO DEACONESS–-60 miles away(i failed to mention my two other siblings born in 1979 and 1987…..in Chewelah…while St. Joseph’s was certified…..are you getting my point yet people?!) How ‘bout the elderly living in the long term care unit that’s attached to that hospital???……”screw them…..move them to Spokane to a nursing home…they’ll be “fine” with the care there!” While the care may be fine, the family that used to visit with Grandma or Grandpa on a daily basis won’t be making that trip to Spokane very often. The dad out on L&I from a logging accident and needing physical therapy??–—he can’t afford to drive to Spokane because the state won’t pay him mileage to get his therapy(when it’s currently offered in that little town.) Or what about the Grandmother fighting Cancer, and can’t afford to pay the mortgage payment AND a twice a week drive to Spokane for treatment?? Who’s going tell her to give up her entire life just because “oh we had to close down because you can get better care 40 miles away, sorry.” Yeah, there is more than Spokcompton in Eastern Washington…..those “outsiders” provide a hell of a lot more than you think in raw materials in this region and you’re gonna tell ALL OF THEM to pack sand?! Yeah, I may not live there anymore, but my family and friends do (outside of Spokane) and I see the point of the “little guy” in this.
“Let’s go through a process that’s rational rather than just draconian cuts.”
These “threats” come all the time. The majority of the people outside the “Spokane Bubble” live with the choices you inside the bubble make on a daily basis. Let those in the communities these hospitals serve fight for (or against) these services as they see fit.
The McMoRo and Obama slams are unimportant in this case. ANYONE STANDING PARTISAN in this needs to step back and think about your fellow man, and not a friggin’ party line cause, PERIOD!
As a U.S. Army Veteran with 6 years MEDEVAC experience, I did not care who I helped when I got on site, just that they stayed stable in my care, and healed properly when we got them to the hospital…….try flying traffic patterns with a patient because TWO of the hospitals thought to be Trauma Centers were decertified and you can’t make it to your first choice because the “Golden Hour” has 10 minutes left in it and it’s a 30 min flight, it’s not the greatest feeling knowing your patient may die because a hospital you knew was operating a month earlier shut down. I’ve made pit stops in small town hospitals like my hometown’s because of by the Grace of God there was a trauma doc that “just happened to be on call” and they helped…..not a matter of “oh, we’re not qualified for……..” it was “How can we help?!” Take these places away, and see the entire safety net of Eastern Washington’s health care diminish.
Orphan on December 18 at 3:51 p.m.
Gee a community of 3000 cant support a hospital without subsidies, what a revelation.
Either move closer to services or go without it is not societies responsability to take care of you if you make bad decisions on where to live.
Hospitals take private donations, all those 3000 folks need to do to keep their hospital open is donate some cash every year about $500 per person would work. I guess they would rather buy gasoline and drive to Coleville or Spokane than donate to the hospital.
This is a great example of what wrong with our country and simply boils down to we want too keep our hospital open but we want to do it with someone elses money.
BTW I live very rural and responce time here is 30 to 45 minutes for the sheriff, fire department or ambulance. I dont expect anyone else to pay for my decisions.
greenlibertarian on December 18 at 5:18 p.m.
Chewelah_Boy_In_lib_land, that you for your service and your cogent and concerned thoughts on this matter.
Rural medicine is one of the MANY problems facing our health care system, providers, and people.
Just another example of the failing system in this country.
Oh but if you can afford cosmetic surgery and treatments, you’re in luck, that’s the MOST growing part of medicine.
greenlibertarian on December 18 at 5:18 p.m.
Thank you, I meant.
Pigrobin on December 18 at 5:41 p.m.
Looks like this will help in emergencies…seems to be cheap coverage ($59/year) for those who live out in the hinterlands:
https://www.nwmedstar.org/Sub.aspx?id=470&linkidentifier=id&itemid=470
Hiker on December 18 at 6:03 p.m.
I would much rather support healthcare than the following subsidized services rural areas receive:
- Post offices
- Small school districts that can cost as much as three times per student compared to larger districts. (We have over 190 districts in Washington state with 2500 students or less. All of these have superintendents and central staff that increase overhead, but don’t increase the quality of education.)
- County governments. Why do we need any counties with less than 100,000 people?
- Farm subsidies
- Ethanol subsidies
- Small airports and subsidized flights to major airports
- Roads
Rural areas need to decide what’s most important. As a society, we can’t afford it all.
Scottcycle on December 18 at 6:52 p.m.
” Nor do small hospitals have enough patients to spread out and absorb the high, fixed costs of meeting quality standards.”
That points to one important area where both State and Federal governments could help maintain emergency care facilities in rural areas. Drop the required standards for all the latest medical equipment and other details that drive up the costs of staying open. Its better to have something available than closing these facilities because they can’t afford all the best. I’m sure there are countless examples out there of how rural facilities could just focus on meeting the most critical standards and accomplish their mission.
Teseract on December 18 at 6:56 p.m.
@PigRobin - Well worth it. My ex-wife was hit head on by a guy with a suspended license and no insurance driving on the wrong side of the road on a back road in rural Whitman county. My eldest daughter had a ride in a Medstar chopper to Sacred Heart.
The bill for the flight? $16,800.
If you have insurance you’ll pay your copay, and your deductible, and your “co-insurance” which may cover 70-80% of it. The rest will be on you. You could pay for the Medstar coverage for the rest of your life and have plenty left over for that.
Note that Medstar is owned by a non-profit company (Inland Northwest Health Services) and from what I’ve heard Medstar isn’t exactly a profit center even charging those prices.
Shadedmuse on December 18 at 8:29 p.m.
I say close all hospitals in eastern washington including all Spokane hospitols and if you need hospitol then go to Harbourview in Seattle, make spokane doctors and nurses go and get real jobs at government ran hospitols and not these private four profit hospitols in eastern washington.
And their is no way Spokane has 300,000 people and no way chewelah has 3000. tacoma is three times the size of spokane. Spokane is like the 6th largest city in washington.
Spokane is a non growth market shrinking every day of the week.
Lulubelle on December 18 at 9:03 p.m.
Maybe these sorts of cuts in Federal subsidies will wake rural Eastern WA up to the fact that Republicans are not there friends. McMorris-Rodgers would rather extend tax cuts to the wealthiest Americans and corporations than fund programs for those of us that need them.
We get what we vote for.
Shadedmuse on December 18 at 9:15 p.m.
In november send Cathy McMo-Mo a message she cant ignore. Bye bye Kathy Mcmo-mo and take your boy with you.
Jeffrey_Grey on December 19 at 2:42 a.m.
‘If you choose to live in rural areas without all the services available in the city, that’s your fault for making a foolish choice without considering all the ramifications.’
And once everyone moves to the cities, all our farming and lumbering and mining and ranching and all the thousand-and-one other things that we depend upon rural America to provide - well, we’ll just do all that in our own back yards and on the roofs of our apartment buildings.
Or maybe all the farmers and lumberjacks and miners and ranchers, et al. could just commute a few hundred miles every day.
Maybe rural-route dwellers aren’t the ones who are failing to consider all the ramifications.
owlcroft on December 22 at 10:31 p.m.
The emphasis on “the poor” and the under-privileged in general is severly misleading. Critical-Access Hospitals serve whole communities, and often more: the hospital in Ritzville handles great numbers of injuries from accidents on I-90 and US 395. Without that hospital, both area residents and travelers face long trips to far-off facilities, when so often minutes mean the difference between life and death.
The underprivileged are only one part of the community CAHs serve, but—because such hospitals are all almost always on a knife edge of solvency—a major cut there (or in any other segment) means, not reduced service to the underprivileged, but no service to the entire community.
Enact these cuts, and there will be real, nontrivial, continuing body counts as the result.