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Rural, small hospitals may get break from federal rule

Matt Kalish Correspondent

Rural and small hospitals across the Inland Northwest may soon see relief from a federal rule that critics argue could stretch physicians too thin and could lead to fewer medical services being available.

The rule requires that a doctor be present in a department during routine procedures, such as blood transfusions and some immunizations. While it passed in 2009, it wasn’t enforced at small hospitals until this year.

Legislation prohibiting continued enforcement of the rule cleared the U.S. Senate this week and is headed to the House.

Unlike large hospitals, small and rural facilities often have no physicians on the premises, though they can be called in for emergencies quickly, if needed.

Tom Martin, administrator of Lincoln Hospital in Davenport, Wash., said Thursday the federal requirement is costing hospitals and their patients and those costs will continue to mount.

“You’re wearing people out. Now they’re having to come in for a procedure (when) they didn’t have to be here before,” Martin said. “It’s a perspective that’s coming out of an urban center; they’re not understanding how we operate in rural communities.”

Like most rural hospitals, Lincoln Hospital doesn’t typically have physicians in the building unless a procedure or appointment is scheduled. The emergency department at Lincoln is staffed by nurses and an on-call doctor is summoned when needed.

Odessa Memorial Healthcare Center CEO Mo Sheldon said repealing the rule gives rural hospitals needed flexibility. The current policy could force patients to drive long distances for care, if a doctor is not available, she said.

“Rural hospitals have been providing these services with quality and efficiency,” Sheldon said. “Our communities risk losing needed services due to the potential increased cost associated with implementing a direct supervision policy.”

On-call doctors at rural hospitals must be within 20 minutes of the hospital, according to Martin, of Lincoln Hospital. He added that the Davenport hospital has never had issues arising from doctors not being present during the procedures specified under the federal rule.

The federal rule applied only to Medicare and Medicaid patients, but those patients are the majority of people treated at most small and rural hospitals, according to the American Hospital Association.

The figure is 70 percent at Lincoln Hospital, Martin said.

In Washington and Idaho, more than 2.8 million people are enrolled in Medicare or Medicaid. Washington has 98 hospitals, with 39 considered small or rural hospitals, according to the Washington State Hospital Association.

U.S. Rep. Cathy McMorris Rodgers, a Spokane Republican, is among those critical of the decision to begin enforcing the rule at small and rural hospitals.

“I fully support Senator (Jerry) Moran’s efforts to serve as a check on the administration that is more focused on burdensome regulations for critical-access hospitals than it is on strengthening what is often the only source of care in rural communities,” she said.

Providence Health and Services spokeswoman Jennifer Gilchrist said in an email that Providence supports the change and previously had lobbied Congress to eliminate the rule.

Providence operates rural hospitals in Colville and Chewelah, Wash.

A spokeswoman for the American Hospital Association said in an email Wednesday that the group was pleased with the bill’s passage and called on Congress to pass additional regulatory changes.

“This is an important stop-gap to help provide hospitals relief from the burdensome regulations that (the Centers for Medicare and Medicaid Services) has put in place,” Lisa Kidder said.

The House has yet to vote on the bill or schedule committee hearings, but it’s likely to pass. The Senate bill was passed unanimously just two weeks after being introduced.

Matt Kalish, a student in the University of Missouri Washington, D.C., Reporting Program, is a correspondent for The Spokesman-Review. He can be reached at
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