by Tim Size on December 1, 2011
Wisconsin’s rural communities have faced a shortage of physicians for decades. Without changing how we train and retain our next generation of physicians, it is about to get a lot worse. New predictions show future shortages statewide, rural and urban. Urban shortages will only make it even harder to recruit to rural communities.
You can blame people my age–the fabled baby boomers. According to a new report by the Wisconsin Hospital Association (WHA), “100 New Physicians a Year: An Imperative for Wisconsin,” we will be 2,200 doctors short by the time baby boomer retirees finally slow down around the year 2030. Their complete report is available at htpp://www.wha.org .
For the next 20 years, large numbers of older physicians and other health care professionals will be retiring from work and becoming major “consumers” of health care. WHA projects an increase in the number of physicians but not enough to make up for increased demand, increased retirements and the large number of medical school students in Wisconsin that end up practicing elsewhere. [click to continue…]
by Tim Size on October 7, 2011
This is not a monthly test of your outdoor warning siren. I have worked in rural health for over thirty years. We have never faced a situation as threatening as the federal cuts that may hit rural hospitals.
Senator Tom Coburn (an Oklahoma Republican) speaks for many when he said he understands the need to be careful when scaling back government spending. As he told Fox News, “to continue to waste $350 billion a year in the federal government, that’s pure waste or fraud or duplication.”
Waste is often in the eye of the beholder. From my point of view, a strong rural health system is not “waste or fraud or duplication.” America’s rural hospitals are the foundation of health care being local, not just urban. America’s rural hospitals are often at the center of a rural community’s economy. Weakening or eliminating rural hospitals weakens or eliminates local access to health care and local jobs. [click to continue…]
by Tim Size on October 1, 2011
This Blog post is written as part of a rural advocate dialogue in how best to respond to proposals circulating in Washington to end or limit Medicare’s Critical Access Hospital (CAHs) program.
“When your house is threatened by fire, its not the time for talking about which parts to protect and which to let go.”
As my house is within walking distance of four hospitals in Madison, Wisconsin that have benefited by Medicare policies favoring urban based providers for over forty years, I am not willing to throw the “Ten Milers” (Critical Access Hospitals within ten miles of another hospital) to the wolves–we are either for CAHs or we are not. This is not the time to talk policy. [click to continue…]
by Tim Size on August 23, 2011
There is no question that Washington must get its house in order. We owe that to our children and our grandchildren. But the recent “debt ceiling deal” breaks the oldest rule in medicine. “First, do no harm.”
We all are at risk from those politicians more concerned about looking tough than solving our country’s problems. Medicare and Medicaid are on the chopping block, but it is not just the elderly and poor who may be harmed.
Washington has created a new “super committee” to find more cuts. Some call it a super Congress to remind us this is a small group given powers usually kept by Congress. Most economists say Washington needs a coherent policy for both additional cuts and additional revenue. But politics seems to have taken new revenue off the table. Most people believe the super committee will deadlock.
[click to continue…]
by Tim Size on April 12, 2011
Like many who try to understand healthcare policy, I have begun the job of getting my arms around Medicare’s proposed 429 page rule for today’s buzz word in health care, “Accountable Care Organizations (ACOs).” I need to admit to a bias upfront of having helped to develop and then sell (twice) a health insurance plan based on similar principles. Also, before reading further, you may want to watch two widely circulated brief videos that present unquestioned ACO development in a somewhat irreverent light:
http://www.youtube.com/watch?v=lF8bK7AJyL0
http://www.youtube.com/watch?v=ULy5vjcGuDc
[click to continue…]
by Tim Size on February 14, 2011
When I used Google to search on the Internet for the word “wellness,” the first response was Wellness® – Healthy Dog and Cat Food. “See what our customers say about our quality healthy dog and cat food and discover the difference WELLNESS® all natural pet food makes.”
I don’t believe that most of us care more about our pets than ourselves. If we could buy human wellness in a can once a week, we’d clean out the stores. But aging houses and bodies share the need for sweat equity. I know from experience, easier said then done.
I also am pretty sure that none of us gets out of here alive. And sooner or later all of us will face tough challenges to our health that diet and exercise and attitude will do little to change. But what we do, for most of us most of the time, makes a huge difference in how well we enjoy the trip. [click to continue…]
by Tim Size on November 8, 2010
Beyond deceit and name calling on both sides, our recent election was about jobs. For some it was about not having a job. For many more, it was about the fear of losing one.
The election was also about huge government deficits. The stage is now set for a hard tug of war between job creation and deficit reduction. As politics and policies compete after the election, we who care about rural health must speak up.
We must say more often and more powerfully: “rural health care equals rural jobs.” [click to continue…]
by Tim Size on August 1, 2010
On the way to my office, there is a very busy intersection by our local high school. It has four roads coming together at odd angles. It has no stoplight, just stop signs. In thirty years, I have only seen one fender bender. Somehow the setup works–people figure it out and the traffic keeps moving.
I hope that the health insurance exchanges required by the new federal health reform law will work as well. These virtual market places open for business in 2014. Until then there will be much speculation, pro and con. The promise is that individuals and small businesses will gain access to better health insurance. We do know a fair amount about how they will be constructed. We can only guess how individual consumers will react.
The hope is that insurance exchanges will offer more reasonably priced premiums that vary less year to year. Individuals and small employers will have a choice among health plans on a more level playing field.
Near full participation in these markets is necessary for the exchanges to work. Participation will be “encouraged” through an array of federal subsidies and penalties, that may or may not be strong enough.
But it is a mistake to focus only on the law and the expected regulations. The benefits from this health reform will not come mostly from the government’s action but from the decisions of those using the exchanges. In other words, this reform is less about stop and go lights and more about an intersection with stop signs that requires people to make a choice of when and where to go. [click to continue…]
by Tim Size on June 2, 2010
As someone with a lifetime gladly spent promoting rural health, managing the uncertainty of health care reform has all the appeal of a root canal. Add in the joys of raising teenagers and you begin to get the picture. My hair turned gray helping to raise four teenagers, so I’m not sure what I have left to let go of this time around. But I know I’ll soon find out.
Make no mistake, whether or not you call it “reform,” health care must and will change in some very basic ways. We, and our country, can’t afford not to change. I have yet to meet a healthcare leader who disagrees with this, although I am sure there is someone somewhere. We all know this, regardless of where we stand in the endless political posturing.
[click to continue…]
by Tim Size on March 21, 2010
The healthcare legislation that looks headed to the President’s desk is not ideal. It couldn’t be otherwise given our country’s deeply held and contradictory values. But the fact that tens of millions of Americans are uninsured and most of the rest of us are just one lost job from the same dilemma, drove this train. A majority in the Senate, and now the House, have decided they couldn’t lose another generation in pursuit of the perfect bill.
I studied with George Bugbee, (the American Hospital Association’s first non-physician executive director) to become a hospital administrator just a few years after the creation of Medicare and Medicaid in 1965. Assuring universal coverage for the rest of America was widely believed to be right around the corner. It has been a long corner.
It took us the greater part of twenty years to work through challenges caused but not anticipated when the Medicare Prospective Payment System began in 1983. It will take at least that long for all of us to digest this new change. From a rural perspective, here are some of the priority areas that will need our attention: [click to continue…]
