The National Rural Health Association takes issue with your Jan. 11 editorial, "Lobbyists, quit yer bellyaching" (p. 44), which cites the Medicare Payment Advisory Commission's report of solid hospital inpatient margins.
The same report shows that the Medicare inpatient hospital margin for small, rural hospitals is nearly half that being experienced by urban hospitals. Rural hospitals with fewer than 50 beds are projected to have experienced an 8.9% Medicare hospital inpatient margin in 1997 compared with urban hospitals, which are projected to have had a 17.2% margin. At the same time, a recent report by the Rural Policy Research Institute states that "constraining Medicare spending by imposing continuing and significant reductions on small, rural providers could jeopardize access to care for rural beneficiaries."
The editorial fails to mention that at a time when Congress and HCFA are promoting Medicare managed care, 70% of the plans that left the Medicare+Choice program were serving rural beneficiaries. Members of the NRHA believe it is "dazzling double talk" (to quote your editorial) to tell rural Medicare beneficiaries they now have choice in healthcare benefits.
Do not fault lobbyists or associations for communicating the realities of the Balanced Budget Act of 1997 and other policy reforms that are having a severe impact on providers' ability to deliver quality healthcare. If members of Congress and HCFA don't seriously consider the impact many recent Medicare reforms will have on rural providers, some rural hospitals, community health centers, clinics and physician practices will be forced to close, leaving countless rural Medicare beneficiaries without access to any healthcare.
Government affairs director
National Rural Health Association
Kansas City, Mo.