Far too often, we hear stories about the federal government wasting millions of dollars on projects with questionable outcomes. So it's at once reassuring to hear about a federal program that is truly making a positive difference in the lives of Americans for a comparatively small amount of money but also distressing that this program would be cut under the president's fiscal 2005 budget proposal.
The Medicare Rural Hospital Flexibility Program, also known as Flex, is one such example. This program provides small and rural hospitals with technical assistance for conversion to critical-access hospital status and assistance to other rural hospitals. However, this is only part of what the program does. What is more significant, once a hospital converts to critical-access status, the Flex program encourages the development of "rural-centric health networks" and offers grants to strengthen the rural healthcare infrastructure.
What does "rural-centric health network" mean? In Pennsylvania, Flex funds have been used to develop a model telemedicine network with the Susquehanna Valley Rural Health Partnership. This is a rural health network consisting of three critical-access hospitals and Williamsport (Pa.) Hospital & Medical Center, which many consider to be one of the most wired hospitals in the nation. These funds are bringing the best of our nation's technology into rural America, proving that rural need doesn't mean second-class care.
In Illinois, practical workshops that permit individual improvement, innovation, exchange of ideas and collaborative efforts have emerged through the Flex program. I have personally been involved with these through my experience with the Illinois Hospital Association, the Illinois Critical Access Hospital Network and the Illinois Department of Public Health's Center for Rural Health.
In North Carolina, the Flex program provides needed resources to purchase software and hire staff for a new countywide-billing and trip-reporting system for emergency medical services. This system improved collection rates for emergency medical services and established a more collaborative approach among independent EMS squads.
Other states, including Alaska, Maryland, North Dakota, South Dakota and Wyoming, are also using Flex dollars to improve billing by purchasing computers and billing software.
Many states, including Florida, Idaho, Texas and Wisconsin, have used Flex dollars to conduct EMS need assessments and create programs to address the needs identified. The resulting solutions have included training programs in rural communities as well as through distance learning to help ensure that rural areas have qualified EMS personnel.
The Flex program has fostered and strengthened working relationships among state offices of rural health, state hospital associations, medical associations, peer-review organizations, regulatory and billing agencies, third-party payers, EMS, state and local policymakers, trade organizations and rural providers.
In many states, planning groups are formed to steer and advise their state's Flex programs. These working relationships have proved successful in improving communication and collaboration between these stakeholders and in establishing a workgroup to monitor and respond to future rural health policy issues.
In North Carolina, Flex dollars were used to develop an on-call system staffed by registered nurses. The service was opened up to area physicians for use in their practices.
These are real cases, real people and real success stories. These stories are only a snapshot of a much larger picture of what the Flex program means to small rural hospitals and their communities for the annual appropriation of $25 million. That sum helps hundreds of hospitals and millions of people in rural America. The return on this small investment is immeasurable in lives helped, and literally saved, by preserving access to care and shoring up the healthcare infrastructure of rural America.
Not surprisingly, I was shocked and dismayed to learn that President Bush's fiscal 2005 budget calls for a 70% cut in the Health Resources and Services Administration rural-specific programs. This includes the elimination of the Flex program.
I understand small grant programs with small constituencies are easy marks for funding cuts. The Flex program represents why we entered the healthcare field-to improve people's lives and to promote healthy communities.
The Flex program is an example of good government, and a program that should be modeled in other areas of healthcare, not eliminated for short-term political gain.
Congress has expressed significant interest in preserving and enhancing healthcare for all Americans and recognizes the uniqueness of rural health service access and delivery. It is more than political rhetoric. It is substantiated with appropriations.
Our role and obligation in this effort is to be good stewards of the limited resources, and we have clearly demonstrated, not by word but by deed, that we have fulfilled our part. We have the opportunity and accept the challenge to bring about a true system of care in rural America. Continuation of the Flex program will provide us with the tools to carry out the challenge.
We must share our thoughts with our elected officials, or the best examples of good government, such as the Flex program, could face elimination if our elected officials are not fully informed.
D. David Sniff is president of the Kansas City, Mo.-based National Rural Health Association