Rural Health Foundation Blog

Welcome !!

The Rural Health Foundation (RHF) was formed in 2010 as a 501(c)(3) nonprofit corporation.  RHF raises charitable funds to support patient services in  Sublette County.  Funds raised by the RHF are used for projects that improve healthcare throughout the county.

All aspects of health care are of interest to the Foundation.  The purpose of this blog is to encourage ongoing communication of current topics and an open exchange of thoughts and ideas.

 

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“A hospital will take away business from the Sublette Center.”

We rate this:  Mostlyfalse  

The purpose of the hospital is to provide beds for people whose healthcare needs are more critical than what can be provided by the Sublette Center. The laws governing CAH’s also dictate that the average patient stay at a CAH must be less than 96 hours.  Medicare and private insurance companies also have limits on the amount of time patients can stay in a hospital, which is more expensive than a rehabilitation center.  As a result, there is an incentive for doctors to move their patients over to the Sublette Center following procedures as quickly as possible.    Having the hospital may actually increase business for the Sublette Center because if patients receive an operation at the CAH that requires a long recuperation period, the Sublette Center is the closest rehabilitation center.  Today, a surgeon at University of Utah Hospital might recommend his or her patient recover at the U of U rehabilitation center after discharge from the hospital rather than putting the patient into an ambulance for a four hour drive to Pinedale.  There will be some patients who fall into a grey area where they could be in the hospital or in the Sublette Center, but we believe the impact will be minimal and possibly even very positive for the Sublette Center.

*** Researched by Susan Barney

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“Poor healthcare in Sublette County could further degrade the county’s economic situation, making it harder to attract and keep businesses, workers and tourists.”

We rate this TRUE

Dangerous accidents happen in oil & gas fields, when working cattle and when enjoying leisure activities like snowmobiling or skiing.  When companies in the oil & gas industry evaluate where to expand their businesses, access to nearby quality healthcare is a factor they consider.  If the national news gets ahold of one story where a tourist in Sublette County looses their life because emergency services were not timely enough or available at all, it could seriously degrade efforts to build up the Sublette County tourist industry for decades to come.

*** Researched by Susan Barney

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“If we don’t obtain the hospital designation, the quality and availability of healthcare in Sublette County will decline, leading to higher mortality (death) rates and lower life expectancies.”

We rate this TRUE

If we don’t obtain the CAH designation, then the Sublette County Rural Healthcare District will begin drawing down on its reverses in 2019 and completely run out of reserves by 2022.  The only way to keep the clinics open and maintain emergency services would be for the County to allocate a higher portion of county tax revenues to the SCRHD and to find places to cut costs.  EMS services are the largest expense, so emergency services in Pinedale may be dropped from 24/7 to business hours only.  Emergency services in Marbleton/Big Piney could be dropped from business hours only to no services.  The Marbleton clinic may also need to be shut down entirely.

Impact:  Higher Mortality Rates and Shorter Life Expectancies

Numerous studies have correlated the time it takes to gain access to healthcare to higher mortality rates, both in terms of the number of minutes it takes for an ambulance to arrive and in terms of the number of days patients need to wait to obtain an appointment with a doctor, physician’s assistant (PA) or licensed nurse practitioner (LPN). [1] [2] [3]  In cases of cardiac arrest, which is a leading cause of death in the US, increasing response times by ten minutes can increase survival rates by nearly 100%.[4]

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955366/

[2] http://www.naemsp.org/Documents/LLSA%20Articles/Emergency%20Medical%20Services%20response%20time%20and%20mortality%20in%20an%20urban%20setting.pdf

[3][3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC32251/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC32251/

*** Researched by Susan Barney

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“Critical Access Hospitals are going out of business across the country, so it is not a wise decision to obtain the CAH designation now.”

We rate this FALSE

Although a number of Critical Access Hospitals have closed or are at risk of closing, most of the factors causing the hospitals to close do not apply to Sublette County. Studies by  the Kaiser Family Foundation, Rural Health Research Gateway  and iVantage have determined that the main reasons CAH’s are at risk or have closed include the following:  1) they are too close to other hospitals, 2) more profitable patients with private insurance choose to use nearby healthcare providers outside of the system and 3) the CAH’s are in states that have not expanded Medicaid.[1] [2]   A Kaiser Family Foundation study found that the CAH’s that closed had two other hospitals within 22 miles of them, which put them in competition with too many other healthcare providers. [3]

Impact on Sublette County:  Neutral to Positive.

Although we do live in a state which has not extended Medicaid, we lack the competition from other nearby hospitals and healthcare providers which would draw away seniors and more profitable patients.  Our financial projections indicate we will be able to operate with a cash flow surplus without the Medicaid expansion.  If Medicaid expansion occurs, or the funds are transferred to the states, it would improve our financial position above current forecasts.

[1]  http://kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

[2] http://www.healthcarefinancenews.com/news/select-medical-holdings-corporation-subsidiary-partners-virginias-riverside-health-hospital

[3]  http://kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

*** Researched by Susan Barney

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“Sublette County can’t afford millions of dollars to convert a clinic into a hospital.  Where are we going to get the money?

We rate this FALSE

Where we get the money:  The majority of the money may come from a low-interest rate loan from the US Department of Agriculture (USDA) with the rest coming from grants approved by the town of  Pinedale as well as Sublette County.  Even if the grants from local and county government fall through, we obtain a low interest rate loan from the USDA.  Although some believe that the money should come from raising the mill tax levy, Sublette County residents voted against this measure.

How we pay the money back:  The money to repay the loan will come from a combination of higher reimbursements from Medicare and revenue from additional service Sublette County residents are already receiving, but need to drive to Jackson, Rock Springs or Salt Lake City to obtain.  We estimate that we will receive an additional $3 million annually from Medicare because of legislation in the Balanced Budget Act of 1997 which mandated that Medicare reimburse rural hospitals with the CAH designation 101% of actual costs, which is significantly higher than current reimbursements.  We also expect to receive an additional $2 million in annual revenue from other services, such as respiratory therapy, cardiac and pulmonary rehabilitation and certain types of surgeries.   These are services that Sublette County residents are already receiving, but that they need to drive out of the county to receive.     These two additional income streams are projected to bring the Healthcare district from an estimated $1.1 million cash flow shortfall in fiscal 2017 to a $1.8 million cash flow surplus in fiscal 2020 after loan payments are made.

[1] http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

[1] https://www.fool.com/retirement/2016/12/03/is-paul-ryans-medicare-privatization-proposal-good.aspx

[1] http://www.cbpp.org/research/health/medicare-is-not-bankrupt

*** Researched by Susan Barney

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“Congress will privatize Medicare to cover shortfalls, so the hospital would not be profitable and end up costing the county money.”

We rate this:  MOSTLY FALSE

Medicare privatization is one of numerous options to cover the Medicare cash flow shortfall, and not the best one because Medicare is actually highly efficient at delivering health insurance relative to private insurance companies.  (Medicare administrative costs are 2% of income, vs. an average of 17% for private insurance companies).[1] [2]  Other better options exist, including a combination of raising revenues and slowing the growth in costs.   Increasing the Medicare payroll tax from the current rate of 1.45% to 1.8% would cover the shortfall and only cost a person making $35,000 an extra $122.50 per year/$10.21 per month. [3]

We rate the impact: Neutral to Positive.

Even if Medicare is privatized, private insurance companies reimburse up to 300% more to hospitals than to clinics, which is more than double what Medicare reimburses.  Private insurance companies also have higher amounts that they allow for services than Medicare does.

[1] http://healthaffairs.org/blog/2011/09/20/medicare-is-more-efficient-than-private-insurance/

[2] https://www.fool.com/retirement/2016/12/03/is-paul-ryans-medicare-privatization-proposal-good.aspx

[3] http://www.cbpp.org/research/health/medicare-is-not-bankrupt

*** Researched by Susan Barney

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Fact or Fiction – “Medicare is going broke so the hospital won’t be profitable and will end up costing the county money.”

We rate this MOSTLY FALSE 

Medicare can never “go broke” because it has a continual stream of income from Social Security taxes; although, Medicare A, the portion that reimburses hospitals, is projected to run out of reserves in 2028 and have a cash flow shortfall of 11% increasing to 20% by 2050, mainly due to Baby Boomers. After 2050, it is projected to move back to having surplus.[1] The shortfall only effects costs pertaining to people staying in the hospital (Medicare A), not physician or outpatient costs (Medicare B) or prescription drug costs (Medicare D). [2]

Impact on County Mill Levy:  Neutral. 

Assuming Congress does nothing to prevent the shortfall, under the worst case scenario where Medicare can only pay 80% of its obligations, our Critical Access Hospital would be receiving $2.4 million (vs current projections of  $3 million) more from Medicare each year than we do today, which would be enough for the CAH to cover expenses.

Probability of adverse impact:  15%

There is always the risk that Congress decides to leave millions of senior citizens vulnerable and decides not to do anything to cover the short fall, and that the assumptions used in the financial projections change, which could either increase or decrease the amount of money the CAH brings in.

[1] http://www.factcheck.org/2016/11/broke-and-because-of-aca/

[2] http://www.cbpp.org/research/health/medicare-is-not-bankrupt

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