State lawmakers and health care executives met Thursday at the University of Pittsburgh at Bradford to discuss difficulties rural hospitals face, with one lawmaker saying he is “truly scared” about the future of rural health systems.
The public hearing, which focused on rural hospital and healthcare sustainability, was hosted by the Center for Rural Pennsylvania Board of Directors. State Sen. Gene Yaw, R-Lycoming, chairman, and state Rep. Eddie Day Pashinski, D-Wilkes Barre, vice chair, heard from healthcare professionals and advocates from across the state on what works for them and what does not.
U.S. Rep. Glenn “GT” Thompson, R-Pa., provided written testimony on the topic. In it he states that before becoming a congressman, he spent 30 years in healthcare and understands the challenges and the importance of “access to quality healthcare in rural communities.”
The testimony continues, “since passage of (the Affordable Care Act), my worst nightmares have become a reality as the law’s interpretation continues to drive up costs, saddle small businesses with burdensome regulations, and impose unfunded mandates on people throughout the Commonwealth by shifting costs from the federal government to the states.”
Thompson, whose 15th Congressional District includes McKean, Potter, Cameron and Elk counties, applauds the increase in telehealth, and has introduced legislation related to it and reimbursements for using such technology. He said, in his testimony, “it is imperative rural Americans can conveniently and confidently access health care services, and we must always strive to eliminate the barriers rural residents have encountered when asking for the care they deserve.”
Richard Esch, president, University of Pittsburgh at Bradford and member of the Center for Rural Pennsylvania board, opened the hearing with welcoming statements but also informed the legislators of the significant challenges facing the immediate Pitt-Bradford and surrounding Bradford community.
“Families of prospective students want reassurance,” he said. “Having a facility a mile a way was reassuring. And, our nursing students must have a place to do their clinicals.”
Later, during her panel testimony, Dr. Jill Owens, president of Upper Allegheny Health Systems, added that she would train as many new nurses as she could, but added, “as the number of beds decrease in rural hospitals, so do the number of patients” for students to train with.
Which, Yaw acknowledged, is a big part of the issue. “There seems to be a bottleneck, finding instructors to teach nursing,” he said.
But, that is not the only issue. State Rep. Martin Causer, R-Turtlepoint, said he was “truly scared” for rural healthcare’s viability.
“The focus is critical. There is rural, and then there is ‘super rural,’ and that is where you are today,” he told the board. “Sometimes you have to get access to a helicopter and can’t. I am afraid that some might not understand.”
The Rural Emergency Hospital (REH) model, a federal-level plan not yet adopted by Pennsylvania, addresses or attempts to address concerns over closures of existing hospitals in rural communities. However, the model would reduce the number of beds available for in-patient treatment and transfer to an emergency oriented provider with separate areas for other services.
Causer expressed his concern, stating, “Reducing beds? We just came through a pandemic. What happens if we need them back and can’t get them?”
Kate Slatt, vice president of innovative payment and care delivery with The Hospital and Healthsystem Association of Pennsylvania, clarified the underlying thought behind an “REH is for hospitals who have no other opportunity. The belief is that ‘any care is better than no care.’”
Most of the policies, programs and initiatives, said Lisa Davis, director of the Pennsylvania Office of Rural Health and Outreach and an associate professor of health policy and administration at Penn State University, “were created without any input from the communities they impact.”
Yaw and Pashinski listened intently to Owens’ testimony about the financial crisis Bradford Regional Medical Center and Olean (N.Y.) General Hospital faced during the pandemic. Owens spoke of nurses who were encouraged to travel during that time which led to the cost of $2 million to $3 million, to use an agency to staff both hospitals. However, she noted that using the agency did not solve the nursing shortage because the staff from the agency were not as reliable. Volume dropped and revenue dropped, she said.
Additionally, the hospitals experienced supply chain issues, increases in the cost of supplies, and increases in the cost of pharmaceuticals, Owens said.
In her written testimony, Owens summarized, “the cost of care for patients is dramatically higher than in 2019 and yet reimbursement remains largely unchanged. The payment system must adapt to the increase in cost as well as begin to reward the system that helps keep patients healthy, instead of the acute/sick care model it is accustomed to funding on a fee for service basis. Otherwise, geographic healthcare deserts will begin to appear from the financial pressures rather than a system designed to really lower the cost of care for the entire population that it serves, which is the ultimate goal for the American healthcare system today.”
Yaw and Pashinski asked Davis how to fix the crisis. She offered that “the best way would be to invite all the stakeholders to get together, brush off their biases, and lay it all on the table.” Both agreed they would be “in.”
Eric Kiehl, director of policy and partnerships with the Pennsylvania Association of Community Health Centers, explained there are services available for those who don’t have insurance, are underinsured, or who are located in an underserved area. He was asked how his organization has been able to find and keep physicians when the big hospitals complain that they cannot. Kiehl responded that he makes sure that the doctors are part of the community and that the community takes in the doctors. He said he has about an 80% retention rate. However, he asked that the legislatures look at the certification process for physicians and dentists who already have credentials from another state because this has been a big hurdle in recruiting for him.
And, there are hospital systems that are making it work in Pennsylvania. Wendy Lazo, president of St. Luke’s Hospital — Miners Campus in Schuylkill County, presented during the hearing as well. Lazo pointed out that the award-winning hospital took time and a lot of work to build, but that the investment in each community was worth it.
Yaw and Pashinski, after listening to three panels of speakers, committed to working on the issues causing the devastating crisis in rural areas.
