[Congressional Record Volume 161, Number 101 (Tuesday, June 23, 2015)]
[Senate]
[Pages S4546-S4547]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. GRASSLEY (for himself and Mr. Gardner):
  S. 1648. A bill to amend title XVIII of the Social Security Act to 
create a sustainable future for rural healthcare; to the Committee on 
Finance.
  Mr. GRASSLEY. Mr. President, I come to the floor today to discuss a 
bill I am introducing, the Rural Emergency Acute Care Hospital Act, or 
REACH Act.
  Since January 2010, 55 rural hospitals have closed their doors. It is 
even more troubling that the pace of rural hospital closures appears to 
be accelerating.
  As you can see from this chart, the number of hospital closures has 
increased each year over the past 5 years. These closures are creating 
a health care crisis for hundreds of thousands of Americans across the 
country.
  The REACH Act will create a new rural hospital model under Medicare 
that will enable struggling rural hospitals to keep their doors open 
and maintain the most critical hospital service: emergency medicine.
  When a rural hospital closes, the community loses the lifesaving 
capabilities of the emergency room. According to the National 
Conference of State Legislatures, 60 percent of trauma deaths in the 
United States occur in rural areas. After a traumatic event, access to 
an emergency room within 1

[[Page S4547]]

hour can make a big difference between life and death.
  Take, for example, Portia Gibbs from North Carolina. At 48, Portia 
suffered a heart attack 75 miles from the nearest emergency room. She 
later died while waiting for a helicopter to arrive that would have 
taken her over the State line to Virginia, where the closest hospital 
was located. If Portia's heart attack had occurred just 1 week earlier, 
Portia would have been transported to a hospital in Belhaven, NC, just 
30 miles away. Unfortunately, the facility in Belhaven had closed just 
6 days before Portia's heart attack, citing insurmountable financial 
struggles.
  Then there is the tragic story of 18-month-old Edith Gonzalez who 
choked on a grape in her hometown of Center, TX. Edith's frantic 
parents rushed her to their local hospital, Shelby Regional Medical 
Center, only to discover that it had closed just weeks earlier. By the 
time little Edith arrived at the next closest hospital, she had passed 
away.
  While we can't say with certainty that both Edith and Portia would 
have survived if their local hospitals had not closed, we know the 
earlier people access care, the better their chances are.
  The term used by emergency medical practitioners is the ``golden 
hour.'' The golden hour is the hour following a traumatic event when 
lifesaving intervention--like that which can be provided in an 
emergency room--has the best chance of impacting survival. In other 
words, the longer a patient has to wait to receive emergency medical 
care, the lower their chances will be for survival.
  Rural hospital closures mean patients have to travel longer distances 
to access emergency medical care. Ensuring that rural communities keep 
their emergency care resources could make the difference between life 
and death. Rural hospital closures also extend beyond the loss of 
emergency services to include economic consequences for rural 
communities. Hospital closures can mean the death of a rural community. 
Approximately 62 million Americans live in rural areas. Rural 
communities play an integral role in the economic stability of this 
country through their invaluable contributions in food production, 
manufacturing, and other vital industries.
  In addition to supporting the medical needs of those who participate 
in rural industry, rural hospitals also serve as the single largest 
employer in a rural community. The economic impacts of closing a 
hospital when no other hospital is close by are devastating. If we care 
about the physical and economic health of rural communities, we must 
make a change that will reverse the trend of accumulating rural 
hospital closures.
  iVantage Analytics compiled a report for the National Rural Health 
Association which identified 283 additional hospitals at risk of 
closure based upon performance indicators that matched those of the 53 
facilities that already closed.
  Allow me to direct the Presiding Officer's attention to this map. 
This map depicts the approximate locations of 53 of the 55 hospitals 
that have closed in the last 5 years.
  I would like to point out that between the printing of this chart and 
today, two additional rural hospitals have closed. That alone is a 
clear indication of the problem I am trying to convey.
  Now, imagine this same map depicting five times the number of 
hospital closures you see here. That is what is what will happen if we 
do not act to protect America's rural hospitals. Furthermore, the loss 
of those additional hospitals would not only impact local economies but 
would also result in a $10.6 billion loss in GDP. It must change, not 
only for the health of rural Americans but also for the health and 
stability of our economy.
  Payment cuts to hospitals are one contributing factor to rural 
hospital closures. More significant, however, is the current Medicare 
payment structure that supports rural hospitals. Today, the Medicare 
payment structure for hospitals is focused on inpatient volume. 
Emergency rooms act as a loss leader, and income is primary generated 
through inpatient stays.
  A RAND study published in 2013 found that the average cost of an 
inpatient stay is 10 times the cost of an emergency room visit. 
Researchers at the University of North Carolina found that many of the 
at-risk rural hospitals around the country have an average of two or 
fewer patients admitted to a hospital on any given day. These hospitals 
can have up to 25 inpatient beds, and if only 2 or fewer of those beds 
are filled every day, that is a utilization rate of 8 percent or less.
  Instead of letting these facilities close because they do not have 
the needed inpatient volume to generate enough revenue, why not let go 
of the underutilized inpatient services in favor of sustaining life-
saving emergency care. That is what the REACH Act does. It provides a 
voluntary pathway for rural hospitals to eliminate their underutilized 
inpatient services and ensure residents have access to emergency 
medical care that saves lives. A key component of the bill that allows 
the rural emergency hospital model to function is the requirement for 
these facilities to have protocols in place for the timely transfer of 
patients who require a higher level of care or inpatient admission.
  The value of the rural emergency hospitals in the case of a life-
threatening emergency will be their ability to administer lifesaving 
measures in order to stabilize a patient before they are transferred to 
a higher level of care.
  In addition to providing lifesaving emergency care, rural emergency 
hospitals will have the flexibility to provide a wide array of 
outpatient services, including observation care, skilled nursing 
facility care, infusion services, hemodialysis, home health, hospice, 
nursing home care, population health, as well as telemedicine services. 
This list is not all-inclusive but is just a sample of the outpatient 
services rural emergency hospitals could provide to their communities. 
The door is left open for rural emergency hospitals to design their 
outpatient services to match the needs of their communities.
  There are roughly 1,300 critical access hospitals in America, 
including 82 in Iowa, the second most just behind Kansas. I am not 
suggesting that 1,300 critical access hospitals will become rural 
emergency hospitals. Some hospitals may never consider giving up their 
inpatient beds, others may consider it in the future, but some critical 
access hospitals need this or something like it right now.
  The rural emergency hospital model, with its outpatient and emergency 
care services, will be good for the health of rural communities and our 
Nation because of the critical care it will provide when and where 
rural Americans need it. When there is a farm accident in the afternoon 
or a heart attack in the middle of the night, that emergency room can 
be the difference between life and death. Medicare needs a payment 
policy that recognizes that simple fact.
  I look forward to continuing to work with my cosponsor Senator 
Gardner, other colleagues, and stakeholders in building a sustainable 
future for rural health care.
                                 ______