Rural hospital advocates are hopeful that a bill introduced in Congress earlier this month will take some pressure off small, rural facilities that often are paid less than their urban counterparts. Under the legislation supported by a bipartisan group of lawmakers in the House and Senate, Medicare's base payment rate to urban and rural hospitals would be permanently equalized.
Many lobbyists and Capitol Hill aides said they expect the bill to become part of more sweeping Medicare reform legislation later this year. The bill also would create an add-on payment for rural hospitals that serve fewer than 2,000 patients per year and change wage-index calculations that hurt rural hospitals by not accurately reflecting what they pay workers, backers said.
"Rural hospitals have been on life support for some time," Sen. Kent Conrad (D-N.D.), one of the bill's lead sponsors, told reporters. "Our bill would take them off the critical list."
The rural hospital legislation, which would cost from $17 billion to $19 billion over 10 years, would make permanent a provision in a 2003 budget bill that somewhat equalized hospital payments through the end of this fiscal year. Conrad said the money could come from $400 billion that House and Senate budget proposals have set aside to add a drug benefit to Medicare.
The American Hospital Association and other lobbying groups voiced strong support for the legislation, as did rural hospital administrators.
"This bill would do wonderful things for our community and wonderful things for our hospital," said Cliff Park, chief executive officer of 42-bed Evanston (Wyo.) Regional Hospital.
"We see this bill as a placeholder for some very key rural hospital provisions that we'd like to see enacted," Alan Morgan, vice president of government affairs for the National Rural Health Association, said last week.
Some of those provisions include extending reimbursements to nurses, physician assistants and clinical nurse specialists on call for critical-access hospitals, and creating a capital infrastructure loan program that would give rural facilities $5 million to improve buildings.
Other sponsors of the bill include Sens. Charles Grassley (R-Iowa) and Blanche Lincoln (D-Ark.) and Rep. Jerry Moran (R-Kan.). The lawmakers expressed optimism that their bill, unlike similar ones introduced in previous sessions, would advance because it is likely to become part of a broader Medicare reform effort now under way in Congress.
Conrad and others said urban hospitals would not be affected by any changes to rural reimbursement. Not everyone was convinced the legislation faces a bright future. "Until we see everything that's being introduced and where all the money is coming from to pay for all this, be careful of the devil in the detail," said Larry Goldberg, director of the national healthcare practice at Deloitte & Touche in Washington.
"When you look at rural provisions, there isn't a lot of opposition," Morgan said. "There is a general understanding (in Congress) that additional assistance needs to be provided to rural hospitals."