[Congressional Record (Bound Edition), Volume 153 (2007), Part 3]
[Senate]
[Pages 4117-4118]
[From the U.S. Government Publishing Office, www.gpo.gov]




                              HEALTH CARE

  Mr. COLEMAN. Let me focus on an issue of concern to me. I represent 
the State of Minnesota. They call it the ``flyover country.'' They may 
say the same thing about Colorado on occasion. I saw a New Yorker's 
view of the world. No offense to my colleagues from New York. It is New 
York, Florida, L.A., maybe Chicago was in between. I didn't see Denver 
or St. Paul. There are smaller towns on there, but they are on the map 
and they are important.
  William Jennings Bryan once said:

       Burn down our cities and leave our farmland and the cities 
     will rise up again like magic, but burn down our farms and 
     grass will grow up in the streets of every city in America.

  The Presiding Officer understands that. He comes from a family which 
has worked the land. He gets that. Like many great orators, there is 
some hyperbole there, but it still rings true, whether it is food, 
values, or leadership--all of America depends on what our rural 
communities produce
  So what happens in America's small towns is a big deal. I would like 
to take this time to speak on behalf of Minnesotans and other folks 
living in rural communities. These families face some daunting 
challenges when it comes to accessing health care.
  The urgency of this issue is brought home to me by the upcoming 
closure of a rural hospital in Ivanhoe, MN. The town in southwestern 
Minnesota, county seat of Lincoln County, got its name from Sir Walter 
Scott's novel. Ivanhoe is filled with hard-working people who have 
survived generations of drought, grass hoppers, blizzards, and 
unreliable farm prices and policies. This is yet another difficult 
blow. As a result, this community will lose jobs, access to health care 
and part of their community identity.
  There is an array of issues facing hospitals like Ivanhoe. For them, 
it was the declining number of admissions at the hospital and declining 
reimbursement payments that put them at a severe competitive 
disadvantage in the health care market--and ultimately led to the 
decision. Unfortunately, their story is not unique.
  About 21 percent of the population lives in rural areas, but only 
about 9 percent of doctors work there. Only 2.4 percent of specialists 
work in rural areas.
  Nearly half of all rural residents have at least one major chronic 
illness. Yet they average fewer physician contacts per year than those 
in urban communities.
  I believe that access to health care should not be dependent on where 
you live. Every person in America deserves the same quality care.
  Unfortunately, as it stands right now, many rural communities in 
Minnesota and across the country don't have the personnel capabilities, 
technology or money to provide their residents with the health care 
they need-- they are getting squeezed at every angle. For the stability 
of rural communities and the health of the Americans that live there, 
we need to find solutions.
  That is why I am taking this opportunity to introduce a package of 
bills which seek to give rural areas access to some tools they can use 
to promote the health of their communities.
  The burden of chronic illness is heavier in rural areas. Rural areas 
report higher rates of chronic diseases, including heart disease and 
cancer.
  Mental health issues are also significant. For example, a national 
study that 41 percent of rural women were depressed or anxious compared 
to less than 20 percent of urban women and that 40 percent of all 
visits to rural practitioners are due to stress.
  Providing adequate mental health care in rural communities has become 
a national problem.
  In rural areas, where specialized mental health services are scarce, 
accessing the proper mental health care is difficult. Primary care is 
often the only system for delivering mental health services and 
providers are seeing an increase in mental health issues in their 
clinics. Today I introduced the Working Together for Rural Access to 
Mental Health and Wellness for Children and Seniors Act.
  This legislation would allow Federal grants to be given to States to 
provide assistance to rural communities to conduct collaborative 
efforts to improve access to mental health care for youth, seniors, and 
families. Grants could go toward operation of mobile mental health 
services vans or telemental health.
  Rural residents face serious health care issues not only in terms of 
illness but also in terms of lack of easily accessible services. One in 
5 Americans lives in rural areas but only 1 in 10 physicians practice 
in rural areas. Forty percent of the rural population lives in a 
medically underserved area.
  Critical access hospitals are the foundation on which is built the 
health of our Nation's rural communities. I don't have the time right 
now--we are kind of pushing the envelope on morning business--but it is 
important that my colleagues understand.
  The critical access hospital program was enacted as part of the 
Balanced Budget Act of 1997 in order to preserve access to health care 
services in rural communities. Critical Access Hospitals represent a 
separate provider type with its own conditions of participation as well 
as a separate reimbursement method for Medicare.
  With 80 Critical Access Hospitals in Minnesota, the third largest 
number of Critical Access Hospitals in the Nation, this program is of 
crucial importance to the health care infrastructure of my State. 
Minnesota's Critical Access Hospitals provide care to 1.6 million 
patients a year. They are there to provide health care to their 
communities 24 hours a day, 7 days a week, 365 days a year.
  I have visited these hospitals throughout my State and have been 
impressed time and time again by their commitment to the health of 
their communities and their stewardship of the resources that they have 
been given. I appreciate the work of the Minnesota Hospital Association 
in representing their Critical Access Hospital members and for being a 
great resource in protecting this important program.
  The Critical Access Hospital program continues to make an important 
investment in the safety net of our rural communities.
  This program has been the single most important factor in helping our 
Nation's rural hospitals not only survive also provide new quality 
health care services and resources.
  Without the Critical Access Program, rural communities had been 
having a difficult time supporting a local hospital. People were 
driving hours just to receive basic health care. Just talk to Al Vogt, 
CEO of Cook Hospital & C&NC. He will tell you that the Critical Access 
Hospital program has preserved care in Cook and many other small 
communities across Minnesota. As his community ages, Al has seen many 
seniors have to choose between gas or food money. If leaving town to 
get the very basics of health care was the only option, there are a 
number of folks who would forego the needed

[[Page 4118]]

care. Seniors and others living in rural areas deserve better. Critical 
Access Hospitals provide for them.
  Despite the growing disparities in access to health care for 
Americans in rural areas, support for Critical Access Hospitals has not 
been what it should be.
  Critical Access Hospitals are not being reimbursed in a way that 
allows them to fully account for their costs of offering services. 
These health providers, already stretched thin, are being asked to 
absorb the difference.
  With that in mind, today I introduced the Rural Health Services 
Preservation Act, which ensures that Critical Access Hospitals get 
reimbursed the same amount under Medicare Advantage Programs as they 
would under Medicare.
  Right now, interim Critical Access Hospital payments reflect the 
previous year's costs--not the current year's costs. Factoring in 
inflation and the rapid growth of the medical economy, rural hospitals 
are being left to pay a bill that is much larger than their share.
  Specifically, my Rural Health Services Preservation Act ensures 
Critical Access Hospitals receive not less than 101 percent of cost for 
inpatient, swing-bed, and outpatient hospital services provided to 
Medicare patients covered under a Medicare Advantage plan.
  This bill would create certainty in terms of payments, and accurately 
reflect the true cost of health care in our Critical Access Hospitals.
  Critical Access Hospitals are important regional hubs in rural areas. 
These hospitals serve as medical homes to the folks that live nearby, 
but also provide patient care to visitors who are in town to do some 
fishing, camping or hunting. When a critical medical event occurs, it 
is crucial that the physicians who care for a patient have information 
about their medical history in order to avoid medical errors.
  Let me tell you a story I heard recently from Lori Wightman, 
president of the New Ulm Medical Center. Recently, a 55-year-old 
arrived in the New Ulm Medical Center emergency room with chest pain. 
He was having a heart attack. Within 82 minutes this same patient was 
assessed, transported, and had his heart vessel opened at a tertiary 
hospital 100 miles away.
  This situation was a success because New Ulm Medical Center had the 
ability to transmit information about the patient quickly and easily. 
Not all hospitals are fortunate enough to have this vital service.
  That's why I introduced the Critical Access to Health Information 
Technology Act to help Critical Access Hospitals compete for Federal 
health technology grants. Essentially, this bill would give smaller 
rural hospitals a competitive edge for H-I-T grants.
  Even when a situation is not immediately life-threatening, technology 
can play an important role in disease management in rural communities. 
As I mentioned earlier, rural areas are facing serious personnel 
shortages. They have around 20 percent of the population, and only 10 
percent of the docs and only 2.4 percent of the specialists.
  Remote monitoring technologies collect, analyze, and transmit 
clinical health information. These technologies are emerging to extend 
the provision of health care services to areas where there is a 
shortage of physicians or where patients are homebound. Essentially, 
these technologies allow physicians to monitor and treat patients 
without a face-to-face office visit, thereby increasing access to 
physicians for patients living in rural areas. We have the ability 
today, if you simply lift up the phone the doctor can tell what your 
blood pressure is and how you are feeling. Minnesota prides itself as 
being the center of medical technology. We have the Medronics, Boston 
Scientific, St. Jude's cardiac pacemakers--we can do a lot with remote 
access technology. We have to make sure it is in our rural communities.
  For that reason, I also introduced the Remote Monitoring Access Act, 
which would allow Medicare to cover physician services involved with 
the remote management of specific medical conditions, such as 
congestive heart failure and diabetes.
  Specifically, my bill would create a new benefit category for remote 
patient management services in the Medicare physician fee schedule. 
Under this category, Medicare would cover physician services involved 
with the remote management of specific medical conditions.
  Not only are physicians in short supply in many of rural communities, 
but other health professionals are as well. That is why I introduced 
today a bill that focuses specifically on issues related to increasing 
nursing faculty. I am told by my friends in nursing that the problem is 
not that people don't want to go into nursing, but that it is difficult 
to get nurses to leave the clinic to spend time in the classroom.
  Personnel is one piece of the puzzle and building up our health care 
institutions in rural area is another.
  The Critical Access Hospital program has provided financial stability 
to many struggling rural hospitals that are the cornerstones of their 
communities. It is essential that Congress protects this program now 
and into the future. Prior to this program, hospital closures were 
common and the rural health care system was fragile.
  Without the Critical Access Hospital program and support for rural 
providers, there would be a floodgate of small community care systems 
closing and potentially converting many small towns into ghost towns.
  Debra Boardman, president and CEO of the Riverview Healthcare 
Association in Crookston has shared her story with me:

       The Critical Access Hospital program has afforded many 
     rural hospitals the opportunity to modernize their facilities 
     and helps assure they will remain viable and accessible to 
     the residents of rural America. Prior to receiving Critical 
     Access Hospital designation in 2001, RiverView Healthcare 
     Association had not done a major building project since 1976. 
     With this designation we were able to afford to physically 
     restructure our building and update our infrastructure to 
     accommodate the way health care is provided in the 21st 
     Century.
       Since that time we have also been able to add new 
     physicians, vital new health care services and programs. As 
     the largest employer in the county, a secondary benefit of 
     the program is that it has made RiverView Healthcare 
     Association a more secure economic engine for our local rural 
     community.

  Because of the important role that Critical Access Hospitals play in 
community stability, I have introduced a bill to provide direct and 
guaranteed loans to complete the reconstruction and rehabilitation of 
the Nation's Rural Critical Access Hospitals within the 5 years covered 
by the new farm bill.
  In more ways than we can possibly measure, rural communities are the 
heart of America. They provide us with food, energy and more 
importantly the values and leadership that keep our Nation on track. 
Just as we care for our bodily heart, we need to care for our spiritual 
heart in rural America or the whole Nation will suffer.
  That is why my legislation attempts to raise the needs of our small 
town neighbors to become a national priority. I encourage all of my 
colleagues to consider joining me in ensuring that every American has 
access to the care that they need to lead healthy and productive lives. 
I invite you to cosponsor one of my seven bills aimed at doing just 
that.
  From birth, through chronic disease management, to end-of-life care 
Critical Access Hospitals meet the health-care needs of our 
communities. And our communities trust that we will continue to do so 
far into the future.
  I yield the floor and I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. BROWNBACK. Mr. President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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