Archive for the ‘Advocacy’ Category

AAS: Rural Health Care Problems Won’t Stay on the Farm

Tuesday, July 30th, 2013

Posted: 7:00 p.m. Saturday, July 27, 2013

By Editorial Board / Austin American Statesman

Texas moved to town in the mid-20th century, but Texans cling to the state’s image of itself on horseback. The state became officially urban in the 1950s, when the rush toward its cities that started during World War II finally tipped the population scales.

Even so, romantic visions of Texas rural life still flood the airwaves and our imaginations. Those romantic fantasies, however, mask some unpleasant realities about the availability of health care out yonder.

A life expectancy gap between the state’s urban and rural residents will continue to grow as health care gravitates toward where a majority of Texans live, even as the need for efficient, financially accessible health care grows in the rural areas where the population is older and poorer. In fact, that rural population — usually associated with Texas past — may well yield clues about how to deal with an aged Texas population of the future.

According to a recent comptroller’s report: “By 2040, the Texas state demographer projects that the share of the population aged 65 or older in Texas will nearly double, to 18.0 percent.”

The state’s changing demographics will challenge policymakers to make choices now and in the foreseeable future as fundamental as how big a life expectancy gap is acceptable or whether to devise ways to close it. Those choices will prove expensive.

As the American-Statesman’s Andra Lim reported last week, financial hardships forced 100 rural hospitals to close in the 1980s. Back then, life expectancies of rural and urban residents were virtually the same. Now, rural males in Texas live to an average age of 74.2 years; women to an average age of 79.2 years. Urban males live to an average age of 75.1 and women to 79.8 years.

Old notions about clean air and clean living out in the country collide head on with the reality of a rural population that is older, poorer and less likely to have health insurance. Those who depend on Medicaid assistance take a direct hit when Medicaid payments — a favorite political target — can’t keep pace with increased health care costs. Not expanding Medicaid coverage effectively cuts it.

“Any further reductions in Medicaid payments will strain rural providers. A certain repercussion is decreased rural services or (fewer) providers accepting Medicaid leaving many rural Texans without health care access,” warned the Texas Rural Health Organization in 2012.

“If access to care declines, and access to emergency care declines, that could contribute to shorter life expectancies in rural areas,” Don McBeath, director of government relations at the Texas Organization for Rural & Community Hospitals, told Lim.

That decline in access to health care is compounded by the realities of rural life that challenge cherished myths about it. The National Rural Health Association — which has scheduled an October conference in Austin — reports that rural residents suffer from hypertension on a higher per capita basis than their urban counterparts. Rural residents are more likely to die following heart attacks than urban dwellers. Oh, and that notion that the slower pace of country living is safer? National Rural Health also had this: “Although only one-third of all motor vehicle accidents occur in rural areas, two-thirds of the deaths attributed to these accidents occur on rural roads.”

So much for the simple life.

Texas legislators have taken steps to increase the number of physicians in rural areas that appear to be working. The Legislature approved increased funding for a program that helps doctors repay student loans in exchange for at least four years practice in areas where physicians are in short supply. Legislators appropriated $33.8 million for 2014-15. The program made $5.7 million available in the 2012-13 budget — an amount that quickly evaporated. The Texas Higher Education Coordinating Board had been unable to accept new applications since 2011.

Legislators also authorized nurse practitioners more latitude and authority in providing health care.

But, the Legislature — following Gov. Rick Perry’s lead — refused to expand Medicaid assistance to low income people, which will aggravate problems in obtaining health care, especially in rural areas.

There is also the ongoing dilemma posed by nursing home care, regulation and availability. Nursing home owners have been pleading for years for increased reimbursements. This year, they got some relief, but a funding gap persists. “Of the more than $350 million in biennial (general revenue) we were seeking to ensure Texas seniors’ nursing home care is funded at the level actually deemed necessary by state health officials, the Legislature ultimately approved nearly $100 million — a needed step forward as we work to continue narrowing this funding gap,” said Tim Graves, President of the Texas Health Care Association, the nursing home lobby.

The quality and availability of rural health care deserves increasing focus because some of those rural problems will become urban ones — and sooner than we think.

TORCH Statement on Affordable Care Act Ruling

Saturday, June 30th, 2012

Judey Dozeto
Twitter: @torchnet

AUSTIN – Texas Organization of Rural & Community Hospitals (TORCH) released the following statement after the Supreme Court ruling on the Affordable Care Act:

Now that national health care reform through the Affordable Care Act has basically been upheld and the individual mandate is here to stay, TORCH will continue to monitor the ongoing analysis of yesterday’s Supreme Court ruling.

There are many phases of the health reform process yet to be implemented until it becomes fully effective in 2014. Therefore, we will also continue to watch for any possible negative impact on rural patients and providers.

The ruling yesterday does have one possible negative implication for hospitals. The law, as originally passed by Congress, required states to expand their Medicaid programs to cover all persons – men, women, and children – up to 133 percent of the national poverty level. This would mean a broad expansion of the number of persons in Texas being cover by Medicaid. In fact, the Texas Health and Human Services Commission had predicted that the level of uninsured in Texas could drop from 26 percent to less than 10 percent. Consequently, many more patients entering Texas hospitals would have insurance coverage.

At first blush, the ruling yesterday appears to remove the financial penalty for state’s that refuse to expand Medicaid. Given the Texas state budget situation and the general position of Governor Rick Perry and the Legislature, Texas could very well choose to decline an expansion of Medicaid.

If so, hospitals would be denied one of the real benefits of these reforms. The financial burden of dealing with high levels of uninsured patients would continue to fall upon small hospitals and local communities. Of course, some of the persons that would have been covered in a Texas Medicaid expansion might be picked up in other areas of the mandate, such as small employers of more than 50 people being required to provide coverage. The more likely scenario, however, is that many of the people that would have been covered by Medicaid expansion could remain uninsured.

As we move forward at the state level, TORCH will be watching to see how our state chooses to handle both the Medicaid expansion and insurance exchange issues.


About Texas Organization of Rural and Community Hospitals

Texas Organization of Rural and Community Hospitals (TORCH) is the voice and principal advocate for rural and community hospitals in Texas. We provide leadership in addressing the special needs and issues of these hospitals. We take aim at the struggle rural hospitals have to survive with the rigors of increasing costs, decreasing reimbursements, the added challenges of bringing new information technology into the rural landscape, dealing with a growing number of retirees and uninsured residents and functioning under a national health care system that many agree is broken. TORCH also takes a place on the national stage, serving both as a model of rural hospital organization and an effective voice in our nation’s capital for rural health care here and elsewhere. Learn more about TORCH on our web site or follow TORCH on Twitter.

HHSC Statement on Affordable Care Act Ruling

Thursday, June 28th, 2012

AUSTIN – Texas Health and Human Services Executive Commissioner Tom Suehs released the following statement after today’s Supreme Court ruling on the Affordable Care Act:

“We’ll work closely with Gov. Perry, state leaders and the Attorney to fully analyze the ruling, but I’m pleased that it gives states more ability to push back against a forced expansion of Medicaid. The court clearly recognized that the Affordable Care Act put states in the no-win situation of losing all their Medicaid funding or expanding their programs knowing that they would face billions of dollars in extra costs down the road.

I remain concerned that expanding Medicaid without reforming it only multiplies the tremendous budget pressure the program puts on states. Medicaid already consumes a quarter of the state budget in Texas, and enrollment and costs would mushroom under the Affordable Care Act.

We’ll continue to work with the Legislature to improve the Texas Medicaid program so that it delivers better results at a lower cost. The reforms we’re putting into place through our new transformation waiver will replace an archaic federal Medicaid funding system with one built around local solutions that rewards hospitals for patient care and innovation. This will lay the foundation for true Medicaid reform in Texas and allow us to use existing funding to improve access to care.  The best long-term solution is for Congress to grant states more flexibility to tailor solutions that best meet their needs.”

The Texas Medicaid program covers 3.4 million Texans today, including children, pregnant women, people with disabilities and those over age 65. The Affordable Care Act would have required states to expand Medicaid coverage to other low-income adults. The expansion was scheduled to take place in January 2014. The Supreme Court ruled that the federal government cannot deny Medicaid funds to states that opt not to expand their programs.
Source: HHSC press release

For more information please visit the HHSC web site.

Breaking News from TORCH – SCOTUS Decision

Thursday, June 28th, 2012

In Plain English:

The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.
Source: SCOTUSblog

Download a copy of the decision here

TORCH Representatives are on Capitol Hill Today and Tomorrow

Wednesday, June 27th, 2012

Four hospital CEOs are accompanying the TORCH staff on visits with the Texas Congressional delegation during the next two days. These meetings are intended to raise awareness on three issues. First, a recent MedPAC report surmised that rural access issues and payment inadequacies no longer exist. We intend to show that while rural providers deliver high quality, cost-effect care, that equal access and financial viability is a substantial and ongoing concern. Second, sequestration will hit on January 2013 and it will disproportionately hurt rural providers. We need Congress to consider alternatives for rural providers and to maintain their support for rural safety net programs. Lastly, we will be requesting their support for S. 2620 and HR 5943, which would extend the Medicare Dependent Hospital Program and low-volume hospital adjustment past this September when both are set to expire.

Yesterday, NRHA announced that more than 20 organizations – including TORCH – joined together to send a strong message to Congress on behalf of all the rural hospitals affected by the MDH/LVH issue, in order to prevent millions of dollars of critical federal funding cuts. These two rural hospital payments, the Medicare Dependent Hospital program and the low-volume hospital adjustment, are set to expire on Oct. 1 unless Congress intervenes.

Other supporting organizations include:
• Hospital associations of Arkansas, Florida, Illinois, Kansas, Kentucky, Missouri, North Carolina, Oklahoma, Ohio, Tennessee and Wisconsin
• American Association of Nurse Anesthetists
• Christus Health System
• Federation of American Hospitals
• LifePoint Hospitals
• Medicare Dependent Hospital Coalition
• Mississippi Rural Alliance
• Rural Hospital Coalition
• Rural Wisconsin Health Cooperative
• Southeast Kansas Rural Health Collaborative
• SSM Health Care

TORCH will be headed back to DC later this summer to continue these grassroots efforts. We strongly encourage all TORCH-member Hospitals to join us and NRHA July 30-31 for the March for Rural Hospitals. This event is free and we are hoping for a large crowd, so make plans to attend today. For more information, go to NRHA’s web site.

The joint letter to Congress is available here. More information on MedPAC’s findings can be found here.

HHSC just released more important updates concerning the 1115 Transformation Waiver

Friday, May 18th, 2012

RHP Planning Summit:
To assist RHPs develop regional plans, HHSC is organizing a two-day RHP Planning Summit tentatively scheduled for June 28-29, 2012, in Austin, Texas. At the summit, HHSC will provide technical assistance to those RHP participants responsible for contributing to an RHP Plan—including representatives from public and private hospitals, providers, local government entities, and other stakeholders. Please note that due to limited space, in-person attendance will be capped at approximately 250 attendees. HHSC will broadcast the conference online so that individuals not able to attend in-person can watch presentations, hear discussions, and submit questions through an online chat function.

Summit Survey:
To maximize attendees’ time, HHSC developed a short survey asking for RHP participants’ preferences in the design and content of this two day summit. HHSC encourages all stakeholders engaged in RHP planning to participate in this survey as this feedback will help enhance the effectiveness of this summit. This survey only takes a few minutes to complete. HHSC will only accept survey responses submitted online and the survey submission period ends promptly at 5pm Central on Friday, May 25, 2012. Please note that once a response is submitted, it cannot be revoked. Should you experience any technical difficulties with this online survey, please contact Ashley Sellers at or by phone at 717-695-1185.

Program Funding and Mechanics (PFM) Protocol:
Earlier this week, HHSC released the attached draft PFM Protocol, the State’s working document for Delivery System Reform Incentive Payment (DSRIP) requirements. The draft protocol is based on HHSC’s developing approach and is subject to change based on feedback from Texas stakeholders, HHSC leadership and CMS. CMS must approve the protocol before Texas regions can move forward with DSRIP projects. HHSC is seeking public feedback on the draft PFM Protocol by Thursday, May 31, 2012.

May 23 Webinar:
HHSC has scheduled a webinar for May 23, 2012, 3:00 pm to provide an overview of the draft Program Funding and Mechanics Protocol. To access the webinar: 1) Go to; 2) Click on Attend Meeting; 3) Enter Meeting Number: 805 606 709; and 4) Call the number that appears on screen. The participant call in number is: 1-866-861-7912

PFM Protocol Meetings:
HHSC will not have a June 7, 2012 hearing on the PFM Protocol as indicated earlier. Public comment on the draft protocol will only be accepted through the attached Feedback Form. If any additional updates on the protocol become available, HHSC will incorporate them into the June RHP Planning summit.

For updated materials and to sign up for email alerts, please refer to the waiver website. Should you have any questions, please email waiver staff.


Senators Schumer and Grassley Introduce MDH and LVH Legislation

Wednesday, May 9th, 2012

On Monday, Senators Charles Schumer and Chuck Grassley introduced a bill that would extend the Medicare Dependent Hospital (MDH) and Low-Volume Hospital (LVH) programs. Senate Bill 2620 would help avoid the pending expiration of both programs. Important new data indicates that the Federal investment in rural health has significant benefits both for the rural patient and the tax payer. In fact, small rural hospitals nationally have equal or better quality outcomes, and cost 3.7 percent less per Medicare beneficiary than their urban counterparts. These vital rural hospital programs are examples of the benefits of targeted, effective government action but will expire on October 1 if action is not taken. Their continuation is critical both to providers and the patients they serve. TORCH is requesting its members to call on their legislators in both chambers of Congress to act to protect rural hospitals.

Congress established the Medicare-dependent hospital (MDH) program in 1987. There are approximately 200 MDHs in the United States. These hospitals are paid by Medicare with a special rate to address the fact that most of their patients are Medicare patients. These payments allow MDHs greater financial stability and leave them better able to serve their communities. A hospital qualifies for the MDH program if it is located in a rural area, has no more than 100 beds, is not classified as a Sole Community Hospital, and has at least 60 percent of inpatient days or discharges covered by Medicare. This program expires September 30, 2012. Schumer’s bill will extend the program for one year.

Low volume hospitals are those that are critical to the community but may not serve a high volume of patients. Since 1988, the Medicare program has recognized that these hospitals need additional support so that they can continue to provide high quality care to rural communities. A low-volume hospital is defined as one that is more than 15 road miles from another comparable hospital and has less than 1,600 Medicare discharges are year. Medicare seeks to pay efficient providers their costs of furnishing services. However, certain factors beyond providers’ control can affect the costs of furnishing services. Patient volume is one such factor and is particularly relevant in small and isolated communities where providers frequently cannot achieve the economies of scale possible for their larger counterparts. The bill would extend the additional payments for low volume hospitals for one year. Download the bill here.

Primary Election Date Change Reopens Window for More Candidates to File

Friday, March 9th, 2012

With the change in the Texas primary date, a second filing period for candidates was opened up recently under the order of a federal court. Candidates who previously filed also had an opportunity to withdraw with a refund of their filing fee (which is not normally allowed) or file in a different district. The one week second filing window ended Friday at 6 pm, so all of Texas finally knows exactly who is running for State Representative, State Senator and U.S. Representative; and in which district. All hospitals are strongly encouraged to reach out to all candidates running for in their state rep, state senate and congressional races. Ask that all the candidates come by the hospital and even propose a candidate debate at the hospital for staff and the community. Now is an excellent time to get commitments from candidates that they will support laws and policy that protects rural hospitals. Such as approach is more important than ever given the certain cuts hospitals will continue to take.

Redistricting Moves Rural Texas Lines – Primary Election Now a “Go” for May 29

Thursday, March 8th, 2012

The upcoming Texas primary election has finally landed on a date – May 29. And, the three-judge Federal court panel in San Antonio recently issued another set of maps for Texas congressional, state rep and state senate lines. This is expected to be the final word for now as the new maps were agreed to by most of the parties associated with the litigation, including the Texas Attorney General.

The heart of the litigation argument was that the Texas Legislature had drawn the maps in a matter that violated the U.S. Voting Rights Act. It did not give minorities a shot at being elected, especially in new congressional districts, that was proportionate to the growth of minorities in Texas.

The final set of boundaries did move some lines from what the Texas Legislature set back during the session and from what the San Antonio court had originally ordered. The new set of maps was spurred when the U.S. Supreme Court overruled the San Antonio court stating the court overstepped its authority by changing lines on its own, rather its authority was to rule on the legality of the lines and then have the state and other parties revise them.

The bulk of the changes in district boundaries are in the areas between the Dallas-Fort Worth Metroplex and the Panhandle, between the Metroplex and Austin, and in the triangle region cornered by Houston, Austin, and South Texas.

An analysis of the new lines indicates that the political strength of rural areas in Texas is not severely impacted. The maps originally created by the legislature and the final set issued by the court leave rural areas with a similar number of U.S. Congress members and State Senators. The rural areas do have two less State Representatives as those slots were moved by the Legislature into urban areas. A case can be made that rural Texas even gained some U.S. House Representatives as Texas gained four congressional seats and three of those have at least one rural hospital in the district. Counter to looking at the pure numbers, there is however an indirect softening of rural representation as many of the districts continue to be a mix of urban and rural; and the urban portion of those districts has grown while the rural portion has not fostering a scenario where the urban areas of the district will elect the reps and drive their agenda.

Based on the new census numbers for Texas, lines were redrawn to balance population in all districts. Here are the target numbers:

Texas 2010 census population = 25,145,561
Ideal district population:
698,488 Texas Congress (36 districts)
811,147 State Senate (31 districts)
167,637 State House of Representatives (150 districts)
1,676,371 State Board of Education (15 districts)

(Note – the State Board of Education lines were not challenged in court)

A side-by-side analysis can be found here listing each rural hospital by city, its current Congressman, State Rep and State Senator as well as the new congressman, State Rep and Senator. People listed in the “New” column are the current holder of the seat and may not be running for reelection. If the “New” column is blank, then it is a newly created Congressional seat with no incumbent.

A look at the actual new district maps can be found here:

U.S. Congressional Districts
State Representatives
State Senators

Associated with the new lines comes an order from the federal court for Texas to hold its primary party elections on May 29. This results in considerable delay from the original March 6 date. The election will come only days after many local and school elections, which are scheduled for May 12.

CAHs Added to the List of Eligible Sites for National Health Service Corps

Thursday, March 8th, 2012

Critical Access Hospitals (CAH) have recently been added to the list of eligible sites where a National Health Service Corps participant can work. There are some other requirements, but the addition of CAHs is another recruitment opportunity for rural hospitals. The Corps has options for full time and part time participants. The full-time program offers up to $60,000 in tax-free loan repayment for two years of service and up to $170,000 for a five-year service commitment. Information can be found at National Health Service Corps.