In rural regions, health facilities fight to survive

Issue Date: February 17, 2010

By Christine Souza
Assistant Editor

Jose Antonio Guzman, who works as a farm employee in Solano County, is examined by Dr. William Davis at the medical clinic of the Winters Healthcare Foundation Inc. in downtown Winters.

As the debate over national health care plays out in Washington, D.C., many smaller, cash-strapped medical facilities in rural communities say they face a series of challenges that could force some to close.

"It is really hard for small hospitals. We struggle every day here and we need every type of funding we can get," said Wanda Grove, administrator for Surprise Valley Community Hospital in Cedarville. "Our employees are working a 36-hour week right now because we are trying to save money. Our people are all underpaid compared to other hospitals."

Surprise Valley serves a community of about 1,500 people and sees between 350-400 patients each month. Grove said her medical facility is the smallest hospital in California and has the capacity of only four acute-care beds and 22 long-term care beds, and staffs one full-time physician and one part-time physician.

A hospital's lack of operating funds directly affects a patient's access to physicians and services and/or special procedures. Although Surprise Valley offers interim obstetrics services, Grove said, the facility does not deliver babies except for emergencies, because it does not employ a full-time anesthesiologist.

"A lot of little hospitals don't deliver babies anymore, which is very sad. So our ladies have to go to Lakeview, Ore.; Klamath Falls, Ore.; or to Fall River Mills in California, between here and Redding," she said.

Following the national health care debate carefully, Grove said she believes overhauling the entire system would be a mistake.

"We don't want them to revamp the whole system all at once; we would prefer it if they would go through it slowly and step by step," Grove said. "I also don't want them to take funds away from Medicare or Medi-Cal, because then we would have more patients with no insurance. It would make it even harder than it already is."

As at many other rural facilities, most patients are low-income and are either on Medicare, Medi-Cal or are uninsured, though some patients have private insurance.

According to the California HealthCare Association, hospitals are absorbing more than $11.3 billion in uncompensated care to provide services to the uninsured and underinsured in California.

Jan Emerson, vice president of external affairs for the California Hospital Association, said in 2009 California hospitals lost $4.2 billion in Medi-Cal funding and another $3.5 billion from Medicare. Of the 69 hospitals in California designated as rural, 75 percent operate in the red and of all hospitals statewide, 50 percent do, she said.

Jose Antonio Guzman has his blood pressure taken by Ana Bermudez, a medical assistant at the Winters Healthcare Foundation Inc. medical clinic.

Whether a hospital is urban or rural, another impact to the quality and access that patients have to health care is the lack of funding in the California state budget. California Farm Bureau Federation Rural Health and Safety Chair Joe Valente, who manages a diversified farming operation in San Joaquin County, said a lack of state funding could be devastating for county hospitals that depend on that money to survive.

"In San Joaquin County, we have a general hospital and they were estimating to be $11 million over budget and now it looks like they are going to be $20 million over budget," Valente said. "If the county was forced to close this hospital, this would place an even bigger burden on the other hospitals in the area and become a greater problem as more people become unemployed."

In Winters, the Winters Healthcare Foundation Inc., a non-profit community health care center, serves a local population of about 7,000, including farm employees and their families. Founded in 2000, the facility offers a variety of medical services and a dental clinic.

Due to the slumping economy, more patients seen at the medical clinic in recent months are uninsured, said Christopher Kelsch, the foundation's executive director.

"Although we see a mix of insurance types, our uninsured rate has grown over the last two years from 20 percent to about 33 percent," Kelsch said. "It is not just folks who have never had insurance; it is folks that had insurance and have either been laid off or their insurance has been cut off."

Foundation president and founder Joe Martinez, who also serves as president of the Solano County Farm Bureau, said that it is important for people to receive medical care. As an employer in the community, he said, he wants healthy employees.

"A happy, healthy employee is more productive and a better all-round employee at the ranch. There are fewer chances that they are going to be in an accident or get injured," he said.

Through federal grants and local and matching grants, the foundation uses a sliding fee schedule for patients, "so if they cannot pay the cost of the visit, then it is prorated, which is especially effective," Martinez said.

Kelsch said the foundation will continue doing what it can to maintain and expand services, but added that costs increase each year and a shortage of physicians further complicates the situation.

"In California alone, we are going to be thousands of primary care doctors short. In rural areas, we will be inordinately affected in the next 10 years," he said.

Throughout the health care debate, In communications with Congress Farm Bureau has stressed big picture issues such as determining how large of a role the federal government should have in health care decisions, to a narrower focus that answers what will the legislation do to the delivery of health care in rural areas, and what mandates will be placed on farmers and ranchers as employers.

"There is a lot riding on what Congress decides. We recognize the need to improve our health care system, but we favor a more incremental approach," said Jack King, CFBF National Affairs Division manager. "Whatever happens, we want to boost rural services, not witness its further decline. There's already an inequity in Medicare re-imbursement rates to rural health care providers, so how can we close that gap and also create incentives for health care professionals to serve in rural areas?"

In communications with Congress, Farm Bureau has encouraged investments in wellness programs, opportunities for individuals to exercise greater control over their health care expenditures, discourage defensive medicine by reining-in malpractice lawsuits, while opposing a public health care option, King said.

The national health care debate came to a halt in January with the election of Republican Scott Brown to the U.S. Senate seat in Massachusetts left vacant by the death of Sen. Edward Kennedy, a Democrat. As a result, Brown swept away the Democrats' filibuster-proof, 60-vote majority, adding uncertainty to the debate.

"This has stopped everything in its tracks for the foreseeable future," said Bryan Little, CFBF director of labor affairs. "I don't see them being willing to risk the wrath of the public. The Brown election seems to mean that the public is so upset with them that they need to be really careful about everything that they do."

President Obama and the Democrats are reaching out to Republicans, offering to work together to find common ground on the health care issue.

"At this point, I think the federal bill is probably dead, except for some lowest-common-denominator things they can all vote for, like forbidding insurance companies from denying insurance to people with pre-existing conditions," Little said.

(Christine Souza is an assistant editor of Ag Alert. She may be contacted at csouza@cfbf.com.)

Permission for use is granted, however, credit must be made to the California Farm Bureau Federation when reprinting this item. Top