The health-care reform bill pending in Congress will help rural communities by more people having health insurance, beginning to address some rural payment inequities and continue some important protections for rural providers that were expiring.
The bill needs to be seen as only a really important first step on long over due changes for our country. This is not a criticism of Congress but a statement of reality when a country goes about trying to fundamentally improve a huge part of itself, like its healthcare system.
It will take years for healthcare providers, insurers and local communities to adapt to a complex array of new expectations, incentives and resources. In particular, those of us who care about rural health need to be nimble to address the risk of ideas developed in urban communities and frequently not tested in rural ones.
The health reform bill leaves significant challenges for future legislation and regulation and all of us to do outside of government.
No amount of “healthcare reform” can fix our own behaviors. We must work to reduce the amount of care our system needs to deliver. We must get serious about doing what we can to get and stay healthy. We need to do this as individuals, workplaces and communities.
The current system penalizes Wisconsin for the work it has already accomplished in being one of the states that stands out with high quality and relatively low costs.
Wisconsin Congressman Ron Kind was instrumental in getting into the House Bill language that requires a study about how Medicare should create incentives for value of care rather than volume of care. The study will be done by the country’s highest medical authority, the Institute of Medicine; and its recommendations will be implemented unless Congress can take action to block the changes.
Most disappointing is that Congress did not make a simple change that would have saved money and reduce headaches for rural communities. Current Medicare law limits the number of patients the typical rural hospital can see (those paid as a “Critical Access Hospital”) to a 25 bed cap. We proposed changing that to a 20 bed average to allow for seasonal spikes in the number of patients like during a flu epidemic. Maybe this will be changed in the final Bill but currently this problem remains.
Many people have praised the new Medicare Commission as a way to modernize Medicare without “good” ideas getting bogged down in Congress. But it has key Members of Congress, in both the Senate and the House that have stood up for rural health. It is unlikely that there will be a rural perspective invited into a small Commission. The Federal law that requires proportional rural representation on the current Commission, which is only advisory, has never been implemented.
Don’t underestimate the importance of unintended consequences. It took the country the greater part of 20 years to work through problems caused but not anticipated when the way Medicare pays hospitals was fundamentally changed in 1983. It will take at least that long for all of us to digest this much change.
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