Louisiana Officials Tell Their Stories to Obama Cabinet

When Hurricane Gustav blew through Louisiana last August, Mary Ellen Pratt got to say what several other health facility CEOs in the region couldn't.

The new generator serving their new St. James Parish Hospital, a 20-bed critical access facility in the town of Lutcher along the Mississippi River, didn't stop working.

Pratt got the rare opportunity to tell that success story and several others this week to five top Obama Administration officials, including Health and Human Services Secretary Kathleen Sebelius, who conducted what many said was the first rural health tour of its kind.

And many rural healthcare officials believe that the tour, one in a series of trips Washington officials will make to rural settings this summer, and last week's nomination of Regina Benjamin, MD, of Bayou La Batra, signals a new day when rural healthcare is finally getting a front seat at the federal banquet.

As part of the tour Monday, Sebelius, (who is from the largely rural state of Kansas) joined a forum down the road, in the town of Reserve in adjacent St. John the Baptist Parish, with three other administration secretaries: Tom Vilsack of the Department of Agriculture, Hilda Solis of the Department of Labor, and Eric Shinseki of the Department of Veteran's Affairs. Also along was Mary Wakefield, administrator of the Health Resources and Services Administration. They wanted to see and hear first hand the challenges rural providers face.

The officials listened during a 90-minute community forum as those in a standing-room-only audience relayed their fears about growing older with no insurance, no money, chronic conditions, and poor access to care.

In turn, the administrators discussed their hope that many of the problems and disadvantages of providing health care in rural settings will be softened if key provisions in health reform proposal can ever be passed.

There should be money for telemedicine installation, so patients would have the benefit of specialists without having to travel long distances.

Hospitals and doctors and clinics should have electronic medical records.

In St. John the Baptist Parish, the Cabinet officials heard that one family practitioner is the only doctor to serve the entire town, and he was said to be 80 years old, Wakefield recalled.

So there will be about $500 million in recovery money to greatly increase the size of the National Health Service Corps to encourage physicians to set up practices in rural towns they otherwise would ignore.

Wakefield, former director of the University of North Dakota's Center for Rural Health, says the tour "reinforced for me the importance of this administration's commitment to rural health."

What the Cabinet officials heard and saw in conversations with the providers is the fragile nature of the rural health care workforce, she says. The need for mental health, dental health and primary care providers became much more real "up close and personal."

Sebelius and Wakefield took a side trip to Pratt's hospital, spoke with several patients and talked about how telemedicine might one day bring specialty services much closer to their patients' bedsides. And Pratt says, they listened to stories from patients about how dedicated nurses sometimes travel to their hospitalized patients' homes to take care of their pets until the patients are discharged.

Pratt says that several years ago, hospital officials decided it would be cheaper to rebuild the facility than to repair and upgrade it. Of the $19.5 million cost, $18 million came from a direct loan from the Department of Agriculture.

"The issues that our hospital faces is typical of any rural community," Pratt says. "But our demographics tend to be more challenging than in urban areas, with higher levels of poverty and lower levels of education. All that leads usually to challenging health care status."

Other issues involve the difficulty in keeping good quality staff, although the newer building has made recruitment far easier than it was before, she said.

But there is fear about what health reform might bring to hospitals such as St. James, Pratt says. "With health reform, there are going to be some radical changes going on. And everyone involved in health care is uncertain about how this is going to affect us," Pratt says.

What she was referring to is the fear that Medicare will slice disproportionate share reimbursements to rural hospitals, money that pays for care for people with no insurance, supplemental funding St. James depends on to provide care. The idea is that a public option would provide coverage that would, in effect replace that. But the disproportionate share money may go away long before the patients have a chance to be enrolled in a public plan, Pratt says.

"I have concerns that the money for uncompensated care will be removed before everyone is in a health insurance product," Pratt says. "There's going to be a time lag between the plan's offering, and when we get folks with no insurance onboard. But how do we handle that in-between stage, and till make sure our hospitals remain whole."

But those are problems, she said, she has confidence that Sebelius and other Cabinet-level officials appreciate, perhaps much more than in previous administrations.

"In prior administrations, there were always lots of cuts to rural health," Pratt says. "There were cuts to the Flex (Medicare Rural Hospital Flexibility Grant) and several other programs that supported rural health efforts.

"And although it was always reinstated, and we didn't actually get cut, it sent a message were not that valuable to that administration. We always felt vulnerable."

Time will tell whether she's right.