IN RURAL COMMUNITIES ACCESS TO ADEQUATE HEALTH CARE CAN BE
DIFFICULT . THIS MONTH IT GOT HARDER FOR
THOSE LIVING IN THE TOWN OF FLORENCE WHERE THE HOSPITAL
CLOSED DOWN FOR FINANCIAL REASONS.
DR. DANIEL DIRKSON OVERSEES THE RURAL AIR FOR HEALTHY IN ARIZONA
AND UNDERSTANDS THE CHALLENGES FOR HEALTH CARE PROVIDERS AND
PATIENTS. >> ACROSS THE COUNTRY THERE'S
BEEN 85 REAL HOSPITAL CLOSURES SINCE 2010.
SO WE'RE NOT THE ONLY STATE THAT HAS HAD SOME TROUBLE WITH REAL
HOSPITAL CLOSE YOURS. HOSPITAL CLOSURES.
MANY OF THE RURAL HOSPITALS IN OUR STATE AND OTHER STATES ARE
REALLY VERY CLOSE TO NEGATIVE MARGINS.
>> FINANCIAL MARGINS. >> RIGHT.
SO THEY DEPEND VERY MUCH ON MEDICARE AND MEDICAID FOR
COVERAGE BUT ALSO PAYING FOR THEIR HEALTH SERVICES AND IF
THEY HAVE TO ABSORB A LOT OF UNCOMPENSATED CARE OR WHAT'S
CALLED CHARITY CARE THEY OFTEN HAVE DIFFICULTY STAYING OPEN
BECAUSE THEIR FINANCES WON'T SUPPORT THEIR OPERATIONS.
IN ARIZONA I'D SAY OUR MOST VULNERABLE HOSPITALS ARE THE
SMALLER HOSPITALS WITH THE FEDERAL DESIGNATION OF CRITICAL
ACCESS HOSPITAL, 25 BEDS OR LESS OR 35 MILES OR MORE FROM ANOTHER
FACILITY. THEY HAVE TO HAVE AS PART OF
THAT FEDERAL DESIGNATION A 24 HOUR DAY 7 DAY A WEEK EMERGENCY
DEPARTMENT. SO THESE OFTEN FORM THE CRITICAL
INFRASTRUCTURE IN OUR SMALLEST MORE RURAL COMMUNITIES IN
ARIZONA. THERE'S 14 RIGHT NOW RURAL
CRITICAL ACCESS HOSPITALS IN ARIZONA, THERE'S ANOTHER TWO
THAT ARE IN THE PROCESS OF OBTAINING FEDERAL DESIGNATION
FOR CRITICAL ACCESS HOSPITAL. >> WHAT ARE THE HEALTH
IMPLICATIONS OR HEALTH CONSEQUENCES OF CLOSURES ON THE
COMMUNITIES THEY'RE SERVING. >> SO IF THE CRITICAL ACCESS
HOSPITAL CLOSES OFTEN IT EFFECTS THE PHARMACY IN THE AREA, IT
MIGHT EFFECT THE NURSING HOME IN THE AREA AND ANY SERVE LIKE
LABORATORY, X-RAY, OTHER TYPES OF THINGS THAT MIGHT BE
AVAILABLE FOR THAT. SO PEOPLE ARE OFTEN FORCED TO
DRIVE LONGER DISTANCES OR GO WITHOUT CARE.
>> YOU MENTIONED OF COURSE THE WAY MEDICARE AND MEDICAID
COMPENSATE HOSPITALS, WHAT ARE SOME OF THE FACTORS THAT HAVE
CHANGED THAT WOULD LEAD TO A HOSPITAL CLOSE SNG.
>> SO MEDICAID RESTORATION EXPANSION IN ARIZONA HAS BEEN
THE SINGLE MOST IMPORTANT FACTOR IN CREATING POSITIVE MARGINS,
HEALTHIER MARGINS, EVEN WITH THOSE CHANGES, IF MEDICARE FOR
QUALITY REASONS OR OTHER REASONS STOPS PAYING A RURAL HOSPITAL
OFTEN THEIR DAYS CASH ON HAND THAT ALLOW THEM TO CONTINUE
OPERATING DESPITE THE FLUCTUATIONS IN BILLING AND
COLLECTIONS, IF THE COLLECTIONS LAG TOO LONG THEY MAY NOT HAVE
ENOUGH ON THOOND KEEP THE DOORS OPEN AND KEEP PAYING THEIR
PERSONNEL. >> ARE THERE ANY STEPS YOU'D
LIKE TO SEE THE STATE OF ARIZONA TAKING TO SUPPORT RURAL HEALTH
CARE PROVIDERS MORE. >> THERE'S PROBABLY TWO MAIN
THINGS, ONE IS IN EVEN HEALTH POLICY AT TIMES YOU'RE FORCED
INTO PLAYING DEFENSE. RIGHT NOW WE'RE TRYING TO
SUSTAIN AND BUILD ON THE GAINS MADE AND THERE'S EFFORTS AT THE
NATIONAL LEVEL TO REDUCE MEDICAID FUNDING.
MEDICAID COVERS ABOUT 2 MILLION OF THE 7 MILLION IN OUR
POPULATION. IT'S CRITICAL.
SECOND PART IS WE COULD DO A LOT TO MAKE SURE OUR SERVICES IN
RURAL AREAS ARE STRENGTHENED WE'VE DONE THAT IN CRITICAL
HOSPITAL POOL IN THE PAST WHICH IS KIND OF OUR STATE VERSION OF
DISPROPORTIONATE SHARE PAYMENTS AT THE FEDERAL LEVEL.
THE COMBINATION OF DISPROPORTIONATE SHARE PAYMENTS
FROM THE FEDERAL LEVEL WENT DOWN AS MORE PEOPLE WERE COVERED BUT
ALSO THE CRITICAL ACCESS HOSPITAL POOL THE STATE HAS DONE
THOSE TWO I THINK NEED TO BE STRENGTH EDGED AND IF
STRENGTHENED STRENGTHENED.
AND IF I COULD ADD A THIRD ONE IF WE HAVE MUCH HEALTH
PROFESSIONALS, AND HELP HEALTH PROFESSIONALS DURING THEIR
TRAINING PROGRAM IN RURAL AREAS, IT'S A PREDICT ABLE EFFECT ON
GETTING THEM TO PRACTICE IN THOSE AREA WHEN THEY GRADUATE
FROM WHATEVER PROGRAM THEY HAVE GONE THROUGH.