Natl. Rural Health Assn. president, at UK, says rural health cuts won't save money or help communities but will eliminate jobs

Speaking about President Obama's proposed cuts to rural health care Wednesday, Susan Starling was frank about her feelings: "As a CEO of a critical access hospital, I'm very nervous. What do I need to do as a hospital administrator?" she asked Alan Morgan, chief executive officer of the National Rural Health Association.

"If at all possible, invite your legislator into your facility," Morgan replied. "When they see what you're doing for your community, that's what will turn the tide on this."

The conversation was part of the Healthcare Spotlight Series at University of Kentucky Albert B. Chandler Hospital in Lexington and put on by The Health Enterprises Network in partnership with Hall Render. Morgan was the keynote speaker and Starling, CEO of Marcum & Wallace Memorial Hospital in Irvine, moderated the subsequent discussion. They spoke at length about President's Obama's recent call to reduce reimbursement payments for critical-access hospitals as well as eliminate the CAH designation for those within 10 miles of another hospital.

Morgan, whose association has 21,000 members, said there has been discussion about making cuts to rural health facilities for the past year, starting when the Congressional Budget Office released its proposals for potential savings in March and proposed eliminating CAHs. "Once you put something like that on the table, it stays on the table," Morgan said. The Medicare Payment Advisory Commission followed suit, suggesting the same cuts Obama ultimately called for in September.

Morgan said the proposal runs counter to efforts to create jobs, saying closing CAHs and reducing reimbursement — which he said would force many to close — will eliminate far more jobs than it creates. "We have a hard time communicating to policymakers that if the health care system is not the largest employer in a rural community, it's second only to the school system," he said. "Health care is about the economy."

While cuts may be on the table and the health-reform law is not perfect, Morgan said, it does allocate a "tremendous amount of federal resources" to rural health, most in the form of grants and special programs. But Morgan said much remains to be decided about the law. "If someone tells you it's great, they don't know if it's great. If someone tells you it's bad, they don't know that either," he said. "They just don't know yet. Until the regulations come out on most of this we just don't know."

That being said, Morgan does not feel the act will "fix rural America" since "there is no silver bullet." But he pointed to good things about rural health, such as studies showing that rural facilities outperform their urban counterparts in primary care, safety and preventive services. "As a nation, as rural advocates, we need to be proud of what we do when it comes to quality, when it comes to innovation," he said. "What makes rural great is a strong sense of community, which allows you the ability to network . . . to try innovative approaches."

But doing that takes money, Starling and Morgan agreed. "Just by cutting, we're not changing the system," Starling said. "If we close hospitals in rural America, we're not saving money. We're shifting it to urban. It's actually spending more."