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Issues: Rural Health“Without basic services such as health care, rural areas cannot hope to attract new residents or retain existing residents. That is why I have worked to improve access to health care in rural areas by ensuring that rural hospitals and providers have the resources they need to keep their doors open.”
As a member of the Senate Rural Health Caucus in this 110th Congress, Senator Nelson has co-sponsored the Craig Thomas Rural Hospital and Provider Equity Act of 2007, S. 1605, to end Medicare's historic discrimination against states that do more with less. Rural hospitals are more dependent on Medicare payments as part of their total revenue; Medicare accounts for almost 70 percent of total revenue for small, rural hospitals. Rural hospitals have lower patient volumes, but must compete nationally to recruit providers due to the nursing and health professional workforce shortages. Medicare's complex funding formula penalized rural states such as Nebraska for practicing cost-effective medicine by reimbursing them at a lower rate. Health care providers and hospitals in Nebraska received a lower reimbursement for the same procedure performed in New York. This practice created a disincentive for doctors and nurses to stay in rural areas and hurt hospitals that were already struggling financially. The legislation Senator Nelson supported helped equalize the reimbursement rate between urban and rural America. When the federal bureaucracy arbitrarily lowered the reimbursement rate for rural hospital lab services for less than its cost, Senator Nelson introduced the Critical Access to Clinical Lab Services Act of 2007, S. 1277, to overturn the regulation. The regulation stated that lab services would not be reimbursed by CMS unless the patient is at the facility where testing will occur. This change jeopardizes rural Nebraskans' access to care by imposing an additional burden on the frail elderly by requiring them to visit the hospital to get simple lab tests done. The additional time and expense incurred by the patient is unnecessary if a Critical Access Hospital (CAH) is willing and able to conduct tests at the point of patient care and transport it back to the hospital for analysis. Sixty-one rural hospitals in Nebraska were impacted by the regulation, costing some of these facilities hundreds of thousands of dollars. Many rural hospitals are too large to qualify for critical access hospital status, yet they are too small to benefit from the high volume of patients that larger hospitals enjoy. Senator Nelson worked with Senator Brownback (R-KS) to introduce legislation to create a new designation of “rural community hospital” for hospitals between 25 and 30 beds. Because of their work, this proposal was included as a pilot program in the Medicare Modernization Act of 2003, and 15 rural community hospitals received cost-based Medicare reimbursements, allowing them to recoup their costs of providing care as well as to maintain their facilities by making necessary improvements. Senator Nelson worked with Brownback again to introduce the Rural Community Hospital Assistance Act of 2005 to make this designation a routine part of how the Centers for Medicare and Medicaid Services deal with rural hospitals. The National Rural Health Association recognized Senator Nelson as one of the top legislators for 2004 for his work on rural health care issues. Updated: 1.29.08 Related Links: |
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As a native of McCook, Senator Nelson understands how important health care is to the survival of rural communities. Without basic services such as health care, rural areas cannot hope to attract new residents or retain existing residents. That is why Nebraska's Senator Ben Nelson has worked to improve access to health care in rural areas by ensuring that rural hospitals and providers have the resources they need to keep their doors open. Rural hospitals are a lifeline for many Nebraska communities. Unfortunately, many of these rural hospitals are facing a financial crisis. Currently, the amount hospitals receive from Medicare is pre-set by bureaucrats in Washington without regard to the special circumstances facing rural hospitals.
