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Editorial: Lifeline for rural hospitals not place to save

Tue., Dec. 20, 2011

The survival of many rural Washington hospitals – the survival of their patients – rides on a proposed $27.2 million cut in state funding for facilities more than 35 miles from urban medical centers.

If approved, matching federal Medicare dollars would also be lost, resulting in a total whack of almost $55 million spread among 38 hospitals, most of them in Eastern Washington. Hospital administrators say their institutions cannot afford those losses, and neither can the communities they serve.

Strip away the state and federal assistance, and patients end up at urban hospitals with conditions worsened because they could not get treatment closer to home. Patients and their families must spend money for travel and accommodations, simultaneously losing wages for time away from work.

The hospitals are also major employers in communities like Republic, just as they are in Spokane. And what new employer would consider a community without one?

And what doctor would open or take over a practice without resources other than those in her or his own office? Although the Inland Northwest benefits from a fine telemedicine network, doctors want to offer their patients the best possible treatment, not just diagnosis.

As one rural hospital administrator put it, “In health care, you can’t offer a low-ball-quality product.”

The cutbacks would be especially problematic for the budding University of Washington School of Medicine program in Spokane. The lack of opportunities for clerkships that put students side-by-side with local doctors has been a concern as the curriculum extends to four years. If fewer rural hospitals translates into fewer rural doctors and fewer clerkships, the school may not be able to increase enrollment despite the pressing need for physicians willing to practice in small towns.

Potential closures could also negate the benefits of a bill introduced last week by Rep. Cathy McMorris Rodgers that would rebalance the allocation of federal dollars for graduate medical education. The Graduate Medical Education program funds 10 residency slots per 100,000 people in Eastern Washington, compared with 250 for the same population in Western Washington. The distribution cheats a region with bigger doctor recruiting challenges than the Puget Sound area.

From school bus service to postal delivery to health care, rural communities have become the go-to piggy bank for government and quasi-government officials who have tapped out other resources, including imagination. They don’t lose many votes when a hospital in Coulee City, for a hypothetical example, closes its doors, particularly if they can argue the result is greater efficiency.

Washington already has one of the most efficient health care systems in the country. And among the best, certainly among the lowest-cost, medical school programs dedicated to rural health care for all the Northwest states except Oregon.

Washington legislators made the easy budget cuts in the just-completed special session. Tougher choices await as they look for at least another $1 billion in cuts next month. But too much in human and community health would be put at risk for $27.2 million.