Rural hospital reimbursement, understaffed facilities and regulations must be improved, U.S. Sen. Doug Jones said during a visit to Lake Martin Community Hospital on Tuesday.
Jones (D-AL) met with community leaders including state Rep. Ed Oliver (R-Dadeville) and Dadeville Mayor Wayne Smith for a luncheon.
Jones called rural hospitals and healthcare the “lifeblood of a community” and said towns dry up when they leave.
“We’re losing rural hospitals because they’re not getting enough money and they’re not getting enough reimbursements from the state,” Jones said. “You cannot operate in the red and expect a hospital like this to stay open, and that’s not to say they aren’t operating in the red, but the fact of the matter is we’ve got to figure out a way to get more reimbursements coming in with our state and federal dollars to folks who are serving our communities like this.”
Finding the sweet spot for regulations and having private insurance companies step up and help with reimbursements is what Jones wants to do in Washington.
“There are a lot of things we can do to kind of get reimbursements up and regulations down,” Jones said. “There needs to be a little bit more equilibrium. That’s one of the things that I keep hearing throughout this conversation (Tuesday).”
Home healthcare also needs better reimbursements, according to Jones.
“More and more people want home healthcare,” Jones said. “They don’t want to be in a hospital if they don’t have to be.”
Ivy Creek CEO Mike Bruce said the hospital used to do MRI scans but stopped because it wasn’t being reimbursed.
“Our costs now are greater than reimbursements,” Bruce said. “We’ve got to make those tough choices whether we do those services or not. And then it compounds with other areas, so for the ER in essence we’re providing free healthcare and not just here but everywhere.”
Chief medical officer Lee England said patients are sent elsewhere because the hospital can’t provide certain tests and the patients get absorbed by the other facility, causing the original hospital to lose more revenue.
“One of my biggest issues is the in- and out-of-network designation that insurance companies place on consumers of healthcare,” England said. “Ultimately access is the key. It does no good for a patient to have commercial insurance, Medicare, Medicaid, if they don’t have access to the care.”
Ambulances also lose reimbursements when taking inpatients to other facilities for the tests, according to Tallapoosa County EMS manager Danny Robinson.
Doctor and nursing shortages are also an issue at rural hospitals because they don’t pay as much as city hospitals, according to Jones. He is working on a bill with Sen. Todd Young (R-IN) to get more nurses in the field.
“It’s a complicated problem and that’s what was so good about listening to so many people here (Tuesday),” Jones said.
Bruce said the Lake Martin Community Hospital staff isn’t as shorthanded as other rural facilities but needs about 10 full-time doctors.
“Reimbursement issues have been dramatically lower especially in Alabama than any other place and rural healthcare has really taken the brunt of that,” Bruce said. “And then compound that with a doctor shortage and nurses shortage and trying to get them in the rural areas.”
Without doctors, the hospital is relying on practitioner nurses.
England works 60 to 72 hours a week at the hospital and said that is typical for most rural doctors.
“When I’m off I’m off, which is nice,” England said. “Most of the doctors that work in facilities like this are working 60-plus hours a week. It’s not unusual.”
Jones said what he heard about Medicaid expansion, grants for maternal health and lowering drug costs will guide his work in Washington and added he will write a letter to Centers for Medicare and Medicaid Services about reimbursements.
“(I) appreciate (Jones’) involvement and coming down and taking the time to listen,” Smith said.