Bradley Byrne: Fighting to save Alabama’s rural hospitals
These are positive times for many Alabamians. Our unemployment rate is at an all-time low, major manufacturers continue to locate in our state, and the national championship trophy is back in the state where it belongs. Despite the momentum, our state is certainly not free from challenges. One of the most serious issues facing Alabama hardly ever receives the attention it deserves. I’m talking about the closure of rural hospitals throughout our state. Hospitals are the backbone of many communities in rural Alabama. In addition to being the top employer in many cases, these hospitals are critical when it comes to keeping local residents healthy. Since coming to Congress, I have visited many of these rural hospitals and seen firsthand the challenges they face. Startlingly, since 2011, eleven hospitals have closed in Alabama, and another dozen are in danger of closing in the next two years. Today, the median rural hospital in Alabama is operating at about a minus eleven percent margin and 86% are losing money. You don’t have to be a businessman to realize that is unsustainable. The impact of a hospital closure on a rural community is profound. It can leave those needing emergency or in-patient care with long – and potentially deadly – commutes to the nearest hospital. Some who need care the most simply have no way to make the burdensome trip to a metropolitan area. The closure of rural hospitals also hurts our ability to attract new industry to our state. Without hospital access, many modern employers, such as high-tech manufacturers, will refuse to locate to the areas of our state that need investment and jobs the most. One of the primary issues driving the problem is that Alabama has the lowest Medicare reimbursement rate in the country. Alabama hospitals are reimbursed as much as twenty-one percent below the national average and at rates considerably lower than our state neighbors. Due to a poorly designed formula implemented in the 1980s known as the Medicare Wage Index, the problem continues to compound every year. Consider this: D.W. McMillan Hospital in Brewton, Alabama, near the Florida border, is reimbursed almost twenty percent less for the exact same treatment as a hospital right across the border in Jay, Florida. It isn’t fair, it makes no sense, and it is devastating for our hospitals. Much of the positive development in our state has been a testament to a spirit of teamwork. Leaders in Alabama saw the need to transform our economy and work together to attract new businesses. It will take that very spirit of cooperation and teamwork to solve the problems facing our rural hospitals. When it comes to healthcare, there are a lot of different ideas. Republicans and Democrats have some serious disagreements. It would be easy to retreat to our respective corners and blame the other side for Alabama’s hospital closure problem. But, that’s not productive, and it certainly won’t solve the problem. In Washington, the entire Alabama Congressional Delegation has been working with Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma and Congressional leadership to come up with new and innovative ideas to fix our long-term reimbursement issue. We are committed to thinking outside the box to solve this problem and protect Alabama’s rural hospitals. However, Congressional action alone won’t solve the problem. The solution will require a total team effort from every level of government, as well as assistance from community and business leaders. If Alabama is going to continue to move forward, we must address the challenges facing our rural hospitals and ensure Alabamians have adequate access to hospital care. If we work together as a team, I am hopeful this issue can be resolved. • • • Bradley Byrne is a member of U.S. Congress representing Alabama’s 1st Congressional District.
Alabama legislature approves Rural Hospital Resource Center
The Alabama Legislature has approved a bill to create a resource center housed at the University of Alabama at Birmingham (UAB) Health System to provide support for nonprofit, rural, public hospitals in the state that are facing economic pressures. SB351, sponsored by Jasper-Republican state Sen. Greg Reed and it’s House companion bill HB446 sponsored by Cullman-Republican Randall Shedd, would create the Alabama Rural Hospital Resource Center, staffed and managed by the UAB Health System. It would assist rural public hospitals in areas including purchasing and supply chain, strategic planning, insurance and cost reporting, coding, recruitment, and compliance. “I believe that increasing access to quality health care for Alabamians in rural areas is essential,” Reed said. “The physicians and researchers at UAB are among the best in the world, and this new center will give Alabama’s rural hospitals direct access to game-changing innovations in medicine and health care management.” Shedd said the bill will help ensure appropriate health care is available to all Alabamians. “This is a concept that provides benefit to all parties involved, but most of all to the residents of rural Alabama who have seen their local hospital close or be forced to cut services,” Shedd added. “This can help ensure that appropriate health care is available to all Alabamians where they live and work.” The plan would call for the UAB Health System to add staff to provide expertise, advice and resources to hospitals that request assistance. “As the flagship health enterprise in the state, UAB has robust systems in place in the areas where a rural hospital might have needs — areas including coding, supply chain or regulatory compliance,” weighed-in Will Ferniany, Ph.D., CEO of the UAB Health System. “We can offer our knowledge, insights, and support as a means of helping rural hospitals across the state remain viable and open.” Ferniany says the resource center is one part of a larger effort by the UAB Health System to help stabilize small, rural hospitals and improve access to needed medical care for all residents of Alabama. That effort gained steam following a 2016 law enabling universities with medical schools to create University Health Authorities. “Many rural hospitals are in crisis,” Ferniany explained. “The resource center is designed to help keep those nonprofit, public hospitals operational so that Alabamians can get medical care close to home when appropriate. That helps ensure that a tertiary care facility like UAB Hospital will have available resources for the situations for which we are uniquely positioned to provide care — including Level 1 trauma, transplantation, and advanced cancer care, for example.” Hospitals that are eligible to request assistance from the center would be located in areas that meet federal designations of rural areas or have a shortage of health care resources under federal guidelines. More than 30 public hospitals in Alabama meet those criteria. The bill now goes to Gov. Kay Ivey for her signature, and the center will need approval from the University of Alabama System Board of Trustees.
Las Vegas hospitals swamped with victims after country music festival shooting
The victims just kept coming. In cars, in ambulances waiting four or five deep, from the walking wounded to the barely alive, they arrived in droves. “I have no idea who I operated on,” said Dr. Jay Coates, a trauma surgeon whose hospital took in many of the wounded after a gunman opened fire from his 32nd-floor hotel suite Sunday night on a country music concert below. “They were coming in so fast, we were taking care of bodies. We were just trying to keep people from dying.” It was the deadliest mass shooting in modern U.S. history, with at least 59 killed and 527 injured, some by gunfire, some during the chaotic escape. University Medical Center of Southern Nevada was one of many hospitals that were overflowing. “Every bed was full,” Coates said. “We had people in the hallways, people outside and more people coming in.” He said the huge, horrifying wounds on his operating table told him this shooting was something different. “It was very clear that the first patient I took back and operated on that this was a high-powered weapon,” Coates said. “This wasn’t a normal street weapon. This was something that did a lot of damage when it entered the body cavity.” The gunman, 64-year-old high-stakes gambler and retired accountant Stephen Paddock, killed himself as authorities stormed his hotel room at the Mandalay Bay hotel casino. He had 23 guns – some with scopes – in the room where he had been staying since Thursday. He knocked out two windows to create sniper’s perches he used to rain bullets on the crowd of 22,000 some 500 yards away. He also had two “bump stocks” that can be used to modify weapons to make them fully automatic, according to two U.S. officials briefed by law enforcement who spoke on condition of anonymity because the investigation is still unfolding. At Paddock’s home, authorities found 19 more guns, explosives and thousands of rounds of ammunition. Also, several pounds of ammonium nitrate, a fertilizer that can be turned into explosives, were in his car, authorities said. Republished with permission from the Associated Press.
Poll finds Medicaid recipients still choosing ER visits over primary or urgent care
Medicaid patients are still visiting emergency rooms rather than primary care or urgent care physicians, according to a poll released Monday by the American College of Emergency Physicians. More than half of 2,098 doctors surveyed (56 percent) said that the number of Medicaid patients visiting emergency rooms has increased during the past year. The ACEP poll also reported a sharp increase in the volume of emergency room patients since the Affordable Care Act insurance coverage mandate took effect. About 75 percent of doctors surveyed saw an overall increase in the volume of ER patients; 28 percent reported a significant rise in the number of emergency patients. The study writers said in a prepared statement that the statistics were evidence that efforts by policymakers and health insurance providers to drive Medicaid patients out of emergency departments and into primary care are not working. Those findings arrive at a crucial time in the debate over Medicaid expansion in Alabama. Democratic legislators continue to urge Gov. Robert Bentley to expand Medicaid. Senate Democrats pledged to shut down the rest of the Legislative Session with filibusters on every bill in protest to a resolution passed by Republican leaders opposing Medicaid expansion. Sen. Tripp Pittman, who sponsored the Senate resolution, told Yellowhammer News that he and other leaders harbored deep concerns about raising the number of people receiving public assistance. “This resolution expresses my resolve to be fiscally responsible and protect taxpayer funds,” Pittman said. “Medicaid reform legislation has already been put in place, and we need to measure the outcome of those reforms before rashly expanding Medicaid. Right now, we simply can’t afford to expand Medicaid.”
