Our Voice: Rural hospitals critical to our nation

Despite months of debate, finger pointing, accusations and every other political tactic imaginable, the national debate over health care and health insurance systems has pretty much ignored one of the most important parts.

Our rural hospitals, which state Rep. Joe Schmick, R-Pullman, recently described as “hanging by a thread,” never entered the discussion. Some may think rural hospitals aren’t that important. They could not be more wrong.

For many of us, our small-town hospitals are as critical to our front-line health care as our primary care physicians. In Washington and Oregon, our rural hospitals are likely to be our first stop if we are sick enough or badly injured and need their care.

Yes, specialists in Seattle, Portland or Spokane are important, but they are unlikely to be anyone’s first health care stop. Instead, in Washington, we have 39 rural hospitals that depend on payments from federal health care, alias Medicare, and are our first line of health care in an emergency. In Oregon, there are another 25 of these “critical access hospitals.”

Tri-Citians may think that they don’t have to worry. After all, we live in a metro area of about 280,000. They would be half right. The Lourdes Health Network in Pasco is among Washington’s 39 critical access hospitals.

In Southeastern and Central Washington, others are in Quincy, Dayton, Ritzville, Pomeroy, Othello, Prosser and Sunnyside.

And for those who have students attending Washington State University in Pullman, both the Pullman and Colfax hospitals of Whitman County are critical access hospitals. In northeastern Oregon, they also include Pendleton, Hermiston, La Grande, Heppner and Enterprise.

In 1997, under the Balanced Budget Act, Congress designated such rural hospitals, under the auspices of the Centers for Medicare and Medicaid Services, as eligible for cost-based Medicare reimbursement because of a wave of small-hospital closures.

With a few exceptions, including Lourdes in Pasco, these hospitals must have 25 or fewer acute care beds, must be 35 or more miles from another hospital, must maintain an annual average length of stay of 96 hours or less for acute care patients and must provide 24/7 emergency care.

It’s a tightly drawn set of qualifications. And for this, the hospitals are eligible for Medicare reimbursement, plus 1 percent.

How is the system working? Not so well. Many of our region’s small hospitals are struggling. And “some CAHs have closed since they originally converted to CAH status,” concedes Rural Health Information Hub, which is funded by the Federal Office of Rural Health Policy.

Dayton’s hospital, in the Columbia County seat, faces a typical task. Roughly half of the county’s 4,000-plus residents live there. Data recently compiled from state and federal agencies indicate 40 percent of the county’s adults suffer from high blood pressure, 48 percent from high cholesterol and 16 percent from diabetes, all chronic conditions requiring careful management and often a local hospital’s services. And in Columbia County, these three health concerns run well above the state average — by about 8 to 10 percent.

Clearly, our small local hospitals are badly needed, but without revisions in the system, we are likely to lose more of them.

When Congress again sits down to the serious business of health care, it needs to cut through the partisanship to resolve this and many other systemic problems. Meanwhile, state Legislatures must do what they can, because Congress has done little but put grandstanding above accomplishment.

This story was originally published September 3, 2017 at 12:10 PM with the headline "Our Voice: Rural hospitals critical to our nation."