[Congressional Record Volume 161, Number 103 (Thursday, June 25, 2015)]
[Senate]
[Pages S4625-S4626]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                               REACH ACT

  Mr. GARDNER. Madam President, today I wish to discuss the REACH Act, 
legislation that I have introduced with my colleague, the senior 
Senator from Iowa, Mr. Grassley, to establish a new category for 
critical access hospitals in financial distress.
  Rural hospitals are an essential yet vulnerable part of our health 
care system. Rural residents face a unique set of challenges in 
relation to their urban counterparts. According to the American 
Hospital Association, rural residents are typically older, poorer, and 
more likely to have chronic diseases than those living in more 
developed cities. The unique challenges of caring for patients in 
underserved areas are not the only hurdles that face rural hospitals 
today. They have a hard time simply keeping their doors open.
  Since January of 2010, approximately 55 rural hospitals nationwide 
have closed because they could not generate the kind of support or the 
volume necessary to continue operation. In Colorado, nearly 60 percent 
of care for patients in underserved areas is provided by hospitals 
dependent on rural payment mechanisms, and many hospitals are in danger 
of closing their doors.
  I would like to share with you a story about the impact of a rural 
hospital in my hometown of Yuma, CO, as shared by the CEO of the 
hospital. Now, I will also tell you that the name of the CEO of the 
hospital is John Gardner. John Gardner also happens to be the name of 
my father. They are two different people. My father sells farm 
equipment. This John Gardner runs a hospital. I think I can tell you 
that both of them have gotten complaints.
  My dad has gotten complaints about the emergency room bill, and John 
Gardner, this CEO of the hospital, has gotten complaints about a 
tractor overhaul bill. But they are two different people. But this John 
Gardner, the CEO of the hospital, does live right next to me in this 
small town of right around 3,000 people. This is what he said, the CEO 
of the hospital:

       Because we are located in a rural farming community, we see 
     many farming accidents and motor vehicle accidents. Gravel 
     roads are not the driver's friend. In partnership with the 
     city ambulance service, we have invested a lot of time and 
     training and equipment to be prepared to respond to these 
     accidents. We have two young adults in our community who were 
     involved in serious automobile accidents on gravel roads. 
     Both had severe head trauma which without immediate 
     stabilization would have had terminal outcomes.
       Because of our hospital we were able to treat and transport 
     both to level 1 trauma centers for complete treatment and 
     following extensive rehabilitation are now back with their 
     families.

  Stories like this and the invaluable lifesaving services provided by 
rural

[[Page S4626]]

hospitals are why we need a new system, a new system that recognizes 
the financial challenges and obstacles that rural hospitals face today. 
Without an adjustment, there may be more facilities closing. A 2014 
report by the National Rural Health Association identified 283 
additional hospitals at risk of closing.
  Now, we saw 55 nationwide hospitals already close. An additional 283 
rural hospitals around the country are at risk of closing. Ensuring 
that rural communities have access to the lifesaving care they need is 
why I am introducing--and joining Senator Grassley--the Rural Emergency 
Acute Care Hospital Act or the REACH Act.
  The REACH Act aims to allow rural hospitals which are in financial 
distress to become a new category of hospital, called a rural emergency 
hospital. Here is the problem and why we need to pass the REACH Act. 
Under current law, critical access hospitals are classified as 
hospitals maintaining no more than 25 acute care beds. These hospitals 
rely on rural payment mechanism for Medicare reimbursements for 
outpatient, inpatient, laboratory, therapy services, and post-acute 
swing-bed services.
  As the medical service industry has evolved, patients find it more 
and more attractive to have services requiring rural hospital admission 
performed in large city hospitals because inpatient services are 
delivered there on a more routine basis. We see more people leaving 
rural hospitals to go to the city hospitals because they perform these 
inpatient services more regularly.
  The problem, of course, is that leaves rural hospitals without enough 
inpatient volume to cover their costs, oftentimes resulting in hospital 
closures. So when a critical access hospital--again, these are 
hospitals defined under the law as 25 acute care beds. When a critical 
access hospital has to shut its doors for inpatient services, it has to 
stop providing inpatient services, it also means the emergency care 
closes with it.
  So now you have a hospital no longer providing inpatient services and 
no longer offering emergency care. But as highlighted by my hometown 
story--the story I just shared from the CEO of the hospital, timely 
access to emergency services is truly the difference between life and 
death. Those two young men who would have faced a terminal outcome were 
saved because of the availability of a rural hospital emergency room.
  So when dealing with life-threatening injuries, it is critical for 
patients to receive the kind of health care they need, that lifesaving 
care to prevent the terminal outcome within the golden hour. That is 
something doctors and hospitals use--a term for medical professionals--
meaning that hour after injury where it is absolutely critical that 
they receive treatment, that can make the difference between survival--
if they do not receive their care during this critical golden hour, 
their condition could rapidly deteriorate.
  Recent statistics from the National Conference of State Legislatures 
found that 60 percent of trauma deaths in the United States occur in 
rural areas but only represent 15 percent of the overall population. So 
if we are talking about why we need access to rural emergency 
hospitals, the statistic is very clear: 60 percent of rural trauma 
deaths in this country occur amongst a population that only represents 
15 percent of the overall population. That is a pretty dramatic number.
  It is critical that we provide rural hospitals that are under 
financial distress the necessary tools to prevent closures for those 
living in isolated areas, to make sure they have the same access to 
emergency services. The solution is the REACH Act, a solution Senator 
Grassley and I are working on together, to allow rural hospitals in 
financial distress to switch from being a critical access hospital to 
this new category called a rural emergency hospital.
  This new category would offer reimbursement rates that are consistent 
with the care, needs, and capabilities of rural hospitals, but more 
importantly allowing them to remain open, keeping that critical 
emergency room service open. Now, the emergency hospital must provide 
emergency medical care and observation 24 hours a day, 7 days a week by 
onsite staff.
  So we are still providing quality care, but we are allowing them to 
overcome the fact that they have seen their inpatient services decline, 
enabling them to keep their emergency services open 24 hours a day, 7 
days a week, to make sure trauma patients can see the doctor and be 
provided the necessary medical care they need during that all-important 
golden hour.
  The bill would also establish protocols for the timely transfer of 
patients in need of a higher level of care and patient admittance. The 
Presiding Officer and I both came from rural States, where we know--
there are hospitals in our States that are facing financial challenges. 
There have been stories in newspapers in Colorado about the struggles 
some communities are having maintaining their services, keeping their 
doors open. But there are stories in each and every one of these 
communities like the story John Gardner told about those two young 
people in my hometown who otherwise would have had a terminal outcome 
but for the availability of the emergency care in rural Colorado.
  So to avoid missing out on the services necessary to keep people 
alive, to make sure rural patients have access to care during that 
critical golden hour, the REACH Act provides our hospitals with an 
opportunity to keep health services and hospitals available across 
rural America--available, open with emergency care, giving troubled 
hospitals an avenue to keep their doors open and to keep providing the 
lifesaving care we all so desperately want in each of our communities, 
rural or urban.
  I thank the Presiding Officer for the time on the floor today. I urge 
my colleagues to support the REACH Act. We are always reaching out for 
more cosponsors in a bipartisan fashion to make sure we can do the best 
job possible providing health care to rural America, to urban America, 
and to make sure we keep these hospitals open.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Maryland.

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