Rural health options shrinking

mlee@macon.comMarch 20, 2013 

ATLANTA -- The tiny Stewart-Webster Hospital in Richland, about 90 miles southwest of Macon, is suspending operations this week. It’s the latest chapter in a long story of poor rural access to health care, a story that advocates say is only getting worse.

“Rural Georgians are less healthy than those living in urban areas. They are more likely to be underinsured or uninsured,” Matt Caseman, executive director of the Georgia Rural Health Association, said Wednesday in a presentation to the state Legislature’s Rural Caucus. There’s more diabetes, obesity, heart disease and cancer among rural populations, and country residents are more likely than those living in the city to die in traumatic accidents, he said.

Six of Georgia’s 159 counties lack a family physician, according to 2013 state numbers. The picture for specialists is worse: 63 counties lack a pediatrician and 79 lack an OB/GYN.

Crawford, Peach, Twiggs and Macon counties are underserved by primary health professionals, according to the State Office of Rural Health, generally meaning more than 3,000 people per doctor. Bibb, Houston, Monroe, Wilkinson and Baldwin counties have pockets of underserved populations.

“The shortage of primary care is off the chart and getting worse,” said Denise Kornegay, program director at the statewide Area Health Education Centers network. In partnership with the Medical College of Georgia and the Mercer University School of Medicine, AHEC aims to introduce young students to medical careers, channel older ones into rural training and help with continuing education for rural professionals.

Research shows medical professionals tend to practice within about 30 to 60 miles of where they received most of their training, Kornegay said. One thing AHEC does is help fund housing and transportation to allow health professions students to leave campus and spend time in community-based training.

According to AHEC statistics, 669 AHEC-supported students graduated in the fiscal year that ended last June and stayed in Georgia to practice.

Kornegay said the state needs about 400 primary care residencies, which would cost about $26 million, though Medicare would pick up a lot of that after a few years. The state budget provides about one-tenth of that amount, she said.

Georgia is even looking abroad for doctors. Bibb and several other midstate counties are served by foreign doctors who can practice in the U.S. under a federal visa program.

Kornegay advocates doing more, at least in the short term, to keep the state’s would-be primary care physicians in Georgia, such as school loan forgiveness, preferred medical school admission or even salary subsidies.

“This is getting very, very critical,” Kornegay said.

The availability of providers clearly is a problem, said Pamela A. Keene, spokeswoman with the Georgia Department of Community Health, parent agency of the State Office of Rural Health.

“Poverty, level of education attainment, appropriate utilization of local services and patient compliance are critical elements” as well, she said.

Some rural hospitals also are struggling.

Less than a month before the Richland hospital stopped operations, Calhoun Memorial Hospital in the southwest Georgia town of Arlington closed.

“Uncompensated care is what’s killing the hospitals,” Caseman said.

The bundle of federal budget cuts called sequestration may make things worse.

The national Rural Health Association, parent of Caseman’s organization, recently sent a delegation to Washington to ask that rural health care be carved out of sequestration.

That didn’t happen.

Pretty much every lawmaker’s office, said Caseman, “said it was going to happen and there’s nothing we can do.”

Sequestration will push about 63 rural hospitals nationwide into the red, he said.

The State Office of Rural Health spent about $7 million in combined federal and state funds in fiscal 2010 on grants.

Among other places, their grants go to Federally Qualified Health Centers such as First Choice Primary Care of Macon and to Community Health Care Systems, which serves Jones, Laurens and Washington counties. They also help hospitals with financial management and quality assurance. Peach Regional and Monroe County Hospital both are beneficiaries.

“When it comes to economic development, if you don’t have a hospital, that’s almost like saying you don’t have a school,” said state Rep. Jay Shaw, R-Lakeland, chairman of the Rural Caucus.

Not having a hospital drives away potential investors, he said, also pointing out that in many communities, the hospital is the biggest or one of the biggest employers.

Demand for health care is projected to rise as more people get insurance and seek medical care under the federal Affordable Care Act.

“If we provide access, that’s a fabulous thing,” Kornegay said. “But if there’s no one to go to, there is no access.”

To contact writer Maggie Lee, e-mail mlee@macon.com.

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