[Congressional Record Volume 141, Number 104 (Friday, June 23, 1995)]
[Senate]
[Pages S9006-S9007]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                  RURAL HEALTH IMPROVEMENT ACT OF 1995

 Mr. ROCKEFELLER. Mr. President, I am very pleased to be here 
with my colleagues from Montana and Iowa, Senators Baucus and Grassley, 
to introduce a bill for rural America. The point of our bill is to help 
make sure that the people living in rural areas--who are 
disproportionately elderly--will be assured access to vital health care 
services, especially primary care and emergency care services. Our 
legislation is an effort to make sure that senior citizens are not 
forced to travel long distances in emergency situations or for simple, 
but life-saving reasons like getting certain tests.
  Getting reliable access to health care services has always been a 
struggle for the people of rural West Virginia and the rest of the 
country. Now, as major changes are unfolding in the delivery of health 
care and throughout the health care system, many rural hospitals are 
being forced to re-examine and re-focus their mission and their 
capabilities.
  Our bill steps in by giving rural hospitals across the country an 
important option that rural hospitals in West Virginia and 7 other 
States already have to be more responsive to the people in their areas. 
Under this bill, rural hospitals will be relieved of burdensome 
regulations that may interfere with their ability to meet the most 
critical health needs of their local community.
  Currently, most rural hospitals have only one choice when faced with 
declining occupancy rates, declining Medicare and Medicaid 
reimbursement rates, and intense market pressures to lower their costs: 
closing their doors. Small, rural hospitals are simply not able to take 
advantage of the ``law of large numbers'' and economize like larger 
hospitals can. Under our legislation, when a full-service hospital is 
no longer sustainable, critical access hospitals will assure rural 
residents basic access to essential primary care and emergency health 
care services.
  This legislation is modeled on two separate, ongoing rural hospital 
demonstration projects. It is modeled after a demonstration project in 
Montana, called the Medical Assistance Facilities or MAF Program which 
has been in existence since 1990 and the Essential Access Community 
Hospital and Rural Primary Care Hospital Program, more commonly 
referred to as the EACH/RPCH Program which exists in seven States.
  Under these demonstration programs, limits are placed on the number 
of licensed beds and patient length of stays in the participating rural 
hospitals. In exchange, hospitals receive slightly higher Medicare 
payments to cover the important services they do provide--along with 
relief from Federal regulations that are intended for full-scale, acute 
care hospitals.
  We believe, based on new cost information collected by the General 
Accounting Office, that our legislation will actually save the Medicare 
Program money. By giving hospitals some flexibility on staffing and 
other Federal regulations, hospitals can staff-up based on their 
patients' need, not just to meet regulations meant for completely 
different situations. We want to encourage the development of rural 
health networks, to help small, rural hospitals save money and improve 
quality by tapping into the resources of larger, full-service 
hospitals. The labors of health care should be divided according to who 
can do what best, but there absolutely is a role for rural hospitals 
and a reason for Congress to help them survive.
  Mr. President, this legislation will make sure that rural residents 
will have immediate access to emergency care, and that they and their 
families won't be forced to travel long distances for routine medical 
care. Rural residents who need just a short stay in the hospital can 
stay and receive their care at the local hospital rather than traveling 
to a usually more expensive medical center.

[[Page S9007]]

  The magnitude of Medicare cuts that are included in this year's 
budget resolution make this legislation especially critical. We must 
make sure that rural hospitals have the ability to react to huge 
Medicare cuts by becoming more efficient and closing down unused beds 
rather than by simply closing their doors.
  I am very proud to note that West Virginia has been a leader in 
helping small, rural hospitals figure out how to adapt and cope with 
rapidly changing economic circumstances. Webster County Memorial 
Hospital and Broaddus Hospital in Philippi were two of the first few 
hospitals to be designated rural primary care hospitals nationwide. 
Seven other West Virginia hospitals are currently considering making 
the transition.
  According to Steve Gavalchik, the administrator of the Webster County 
Memorial Hospital, if they had not been able to take advantage of the 
EACH/RPCH Program, the hospital might have been able to hang on for 
only about 16 to 18 months more before being forced to shut its doors. 
Now, Webster County hospital can focus on doing a few things well. 
Networking with an essential access community hospital has been 
invaluable as Webster County has made the transition to a rural primary 
care hospital. United Hospital Center, their hospital partner, has 
provided technical assistance, financial advice, quality assurance and 
quality improvement support.

  For the people of Webster County, access to basic and emergency 
health care services would have been severely curtailed if Webster 
County Hospital had been forced to close. The nearest hospital is 43 
minutes away--in the summer. In the winter, the drive is much more 
treacherous and takes up to 1\1/2\ hours or more. Patients with chronic 
obstructive pulmonary disease [COPD], diabetes, pneumonia, and 
congestive heart failure are the most common diagnoses of patients 
admitted for short term stays. Just imagine if these patients, most of 
them elderly were forced to travel an hour or so to get routine 
hospital care, not to mentioned the extra costs that would be involved 
for them and their families.
  Family practice services are now available on site at the hospital 
because the doctors in the town moved into unused space. The doctors' 
practice have benefited from sharing resources, and the local health 
department has moved its headquarters to the hospital complex. As a 
result, the hospital and the local health department are now working 
together in ways they would have never thought of before. More 
important, patients benefit from the ease of having a central place to 
go to take care of their routine health care needs.
  According to the hospital administrator at Broaddus Hospital, 
Susannah Higgins, Broaddus Hospital was also faced with possible 
closure prior to being designated an RPCH hospital. Now, Broaddus can 
function as a mini-hospital. Through its relationships with partner 
hospitals, Broaddus offers oncology, general surgery, ob-gyn clinic 
services on-site on a weekly basis. Family practice and internal 
medicine services are available on a daily basis. Lifesaving emergency 
services are on-site. Just recently a local resident severed his leg in 
a logging accident. He was transported to Broaddus Hospital in a 
private car. By the time he arrived at the emergency room he was in 
extremely, extremely critical condition. Fortunately, he was able to be 
stabilized and was later transported to a medical center. If emergency 
services had not been available in the area, there is a very good 
chance that man would not be alive today. When minutes and seconds 
literally count, a helicopter landing pad cannot take the place of 
having highly trained and qualified emergency doctors and nurses 
available immediately to stabilize and begin emergency care.
  Webster County Memorial Hospital and Broaddus Hospital are examples 
of how rural communities can adapt to a changing health care 
marketplace. This legislation builds on the strengths of the current 
EACH/RPCH program and the Montana MAF program; improves them; and 
expands them to all 50 States so that rural hospitals all across 
America will have the same opportunities.
  Mr. President, under our bill, newly designated critical access 
hospitals would be limited to 15 inpatient days and patient stays would 
have to be the kind involving limited duration--up to 96 hours, 
although exceptions are allowed in special circumstances, such as 
inclement weather or a patient's medical condition.
  In this bill, we ease up on hospital regulations so that critical 
access hospitals can meet the needs of their community and not the 
needs of a Federal bureaucracy. We are not easing up on quality 
standards but have rather allowed hospitals to use common sense when it 
comes to staffing and certain other Federal standards. For instance, if 
there are no inpatient beds occupied, hospitals do not have to have a 
full complement of hospital staff on duty. Medicare reimbursement would 
take into account a small, rural hospital's fixed costs and the 
inability of small, rural hospitals to take advantage of some of the 
cost-saving measures that larger hospitals can implement.
  Our legislation is targeted at the 1,186 rural hospitals nationwide 
with fewer than 50 beds. While these hospitals are essential to 
assuring access to health care services in their local communities, 
these hospitals account for only 2 percent of total Medicare payments 
to hospitals. Our country's small rural hospitals needs special 
attention. This legislation gives them that attention and the ability 
to adapt to a rapidly changing health care world.
  Finally, this legislation would require the Secretary of HHS to 
submit a report by next January on a methodology for Medicare 
reimbursement of telemedicine services. I recently, along with my 
colleague from Maine, Senator Snowe, included an amendment in the 
telecommunications bill--that was passed by the Senate just last week--
that will guarantee rural health care providers affordable transmission 
costs when it comes to telemedicine and other telecommunications 
technology. The provision in the bill we are introducing today is 
another important step to improving access to specialty and state-of-
the-art medical care for rural residents.
  Mr. President, I believe this legislation is critically important 
and, if enacted, will have an important difference on the health of 
rural residents across America. I am honored to be part of this effort, 
and intent on continuing to respond to the health care needs of the 
people in my State and rural America.

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