I wish to comment on Stuart Katz's letter "Rural hospitals are penalized for service" (Sept. 6, p. 50), which responded to your story "Rural hospitals are winners under PPS" (Aug. 9, p. 6).
I agree with Katz that significant unjustified payment disparities exist across the nation. The largest disparities occur in New York state.
Hospitals in rural areas of New York and those in small metropolitan statistical areas (MSAs) in western New York receive Medicare payments that are far less than those of our urban counterparts. In fact, Brooks Memorial Hospital's 1998 Medicare payment rate was $3,406 (unadjusted for disproportionate share, case mix and capital), and the Medicare managed-care payment for our MSA in 1998 was $367. Both of these rates are among the lowest in the nation, and they are significantly less than Katz reported as the average payment received by hospitals in Iowa.
I agree with Katz that if the dramatic payment disparities continue between large urban areas and smaller, lower-cost community hospitals, regardless of their geographic location, it will threaten the viability of our community-based healthcare system.
President and chief executive officer
Brooks Memorial Hospital