[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.
____________________