On Aug. 15, the Department of Health and Human Services released a report that if fully implemented, could close hundreds of rural hospitals across the nation, endangering access to health care for millions of rural patients, and actually costing the taxpayer more money.

My reason for writing is that our hospital, Weems Memorial Hospital, is a critical access hospital (CAH) that could be impacted by actions resulting from these recommendations.  We are located in Apalachicola, and have a history of providing needed care to the citizens of Franklin County.  This is possible due to our designation as a CAH. As you know, our county is a very hardworking, yet impoverished, county with many health needs here on the bay. Our continued existence is vital to this effort.

I mention this to speak of the precarious nature of facilities such as ours which not only provide needed services to the communities we serve, but are also cornerstones of economic development. As the second largest employer in the county, we provide $4.84 million in wages to the area with a net impact of $6.34 million after a 1.31 multiplier effect. Additionally, our employees generate $1.8 million in retail sales and over $120,000 in local and state sale tax.

In particular, I am concerned about the potential decertification of CAHs such as ours based upon the distance requirement, depending on what a final mileage figure would be. If the 35-miles rule were to stand without state exemption, we would be at risk of losing our CAH certification and therefore would be threatened with closure. A more moderate 10-mile rule has been discussed and would not affect us, but I remain concerned about the erosion of healthcare in our rural areas regardless of a particular mileage requirement and therefore oppose any legislative effort to decertify CAHs.

The HHS report is wrong. Eliminating critical access hospitals does not save money. CAHs save taxpayer dollars.

·  Despite CAHs representing over 22 percent of all community hospitals, Medicare expenditures to CAHs are less than 5 percent of the Medicare hospital budget.

·  CAHs provide cost-effective primary care. In fact, in comparing identical Medicare services in a rural setting to an urban setting, the cost of care in a rural setting is on average 3.7 percent less expensive. This focus on primary care, as opposed to specialty care, saves the Medicare program approximately $2.2 billion each year.

·  It's approximately $7.2 billion in annual savings to Medicare if the average cost per urban beneficiary were equal to the average cost per rural beneficiary.

The 34-page report on critical access hospitals would eradicate individual state determinations on which small, rural hospitals are critical "necessary providers" in a state, by overriding state decisions with complete federal authority. This report seeks to kill rural health care by shutting down as many as 70 percent of a state's rural hospitals.

The HHS report would create huge voids in access to health care in rural America.

·  Under this report, using Missouri as an example, roughly 70 percent of the rural critical access hospitals in that state alone would lose their designation, and face possible closure. Does that sound rational to anyone living outside of Washington D.C.?

·  The report shows that approximately 50 percent of the CAHs that would lose their designation under this scheme would do so because they are “too close” to another CAH that would also lose its status. This will likely result in the closure of both facilities. This is the fastest way to ration care to America's most vulnerable seniors.

·  Also under this scheme, a CAH would lose its status even if the other hospital did not treat the same type of patient. In fact, 7 percent of the other facilities do not serve typical rural Medicare patients because they are psychiatric facilities, rehabilitative hospitals, children's hospitals or veteran facilities."

Even the HHS report admits that meaningful access to care is dependent on more than just distance between providers. We agree. It is important to remember:

·  77 percent of the 2,050 rural counties in the United States are designated as primary care Health Professional Shortage Areas (commonly referred to as HPSAs ).

·  Rural hospitals and clinics have a significantly harder time recruiting and retaining medical and administrative staff because of inequities in the Hospital Wage Indexes and Geographic Practice Cost Index.

·  Rural areas of the United States have fewer than half as many primary care physicians per 100,000 people as urban areas.

·  More than 50 percent of patients in rural areas of the United States travel at least 20 miles to receive specialty medical care, compared to only 6 percent of patients in urban areas of U.S.

Critical access hospitals are critical to the rural economy.

·  CAHs create approximately 138,000 jobs.

·  CAHs are often the largest or second largest employer in a rural community.

·  The average CAH creates 107 jobs and generates $4.8 million in payroll annually and can mean as much as 20 percent of a rural economy.

·  If a rural hospital closes, severe economic decline in the rural community is the result. Soon after, physicians, nurses, pharmacists and other health care providers in the community will be forced to leave. Patients will have to travel farther distances for care or will delay receiving care, resulting in poorer health outcomes.

·  Businesses, families and retirees will not relocate to a rural area if quality health care is not available.


What are critical access hospitals (CAHs)? CAHs are important health care access points for rural patients across the country.

·  Initially created by Congress in 1997 to curb the tide of rural hospital closures, CAHs are small, rural hospitals specifically designated as important access to care points for rural patients.

·  More than 62 million rural residents rely on critical access hospitals, yet much of this population is scattered over 90 percent of the nation's landmass.

·  Rural populations are vulnerable. On average this population is older, sicker and poorer than individuals in urban areas. The Department of Health and Human Services states, "rural areas have higher rates of poverty, chronic disease, and un-insurance, and millions of rural Americans have limited access to a primary care provider."

·  Twenty percent of the population lives in rural America, yet only 9 percent of physicians practice in rural areas. Seventy-seven percent of the 2,050 rural counties in the U.S. are primary care HPSAs. More than 50 percent of rural patients have to travel 60 miles or more to receive specialty care.

·  Critical access hospitals achieve high levels of performance, according to stands for quality, patient satisfaction and operational efficiency, for the types of care most relevant to rural communities.

·  Most CAHs struggle financially. In fact, more than 41 percent of CAHs operate at a financial loss.

I urge the citizens of Franklin County to contact our state and federal legislators urging them to oppose legislation or rule making that would target CAHs for elimination or reduction in reimbursement and instead to seek ways of strengthening healthcare in rural Florida.

Ray Brownsworth is the CEO of Weems Memorial Hospital.