Georgia tries new, small step for rural health care

mlee@macon.comApril 29, 2014 

ATLANTA -- In what looks like a novel tack to prop open the doors of rural emergency rooms in Georgia, a state regulator has voted to allow hospitals to create tiny, standalone triage centers in certain country communities.

The next step is finding some money.

Georgia’s move for freestanding, rural ERs would be “the first ... in the country, as I understand it,” said Department of Community Health Commissioner Clyde Reese just ahead of his board’s unanimous vote Tuesday on the new rule.

The new type of license “would allow facilities who maybe are in danger of closing due to financial difficulties or those who have closed within the last 12 months to offer a lesser set of services and to enable them to maintain some sort of health care infrastructure in their community,” Reese said.

The Flint River Hospital in Montezuma scaled back operations last year and may be a fit for the program. Attempts to speak to hospital management there were unsuccessful Tuesday.

The new rule requires that would-be stabilization centers be open to handle emergencies 24 hours a day, seven days a week to provide triage before sending patients to a general hospital. Each center would have a handful of beds and the option to also offer elective outpatient procedures and basic obstetrics and gynecology that don’t require an overnight stay.

Reese said DCH will fast track any applications for this new type of facility license.

But it’s not so much rules that close hospitals. It’s money -- or the lack thereof. And the rules say tiny ERs would have to take everyone regardless of their ability to pay.

Small but ‘major’

“I think we would agree this is a major first step,” Jimmy Lewis, CEO of Hometown Health, a network of rural hospitals, said during an earlier DCH hearing. But he listed several financial obstacles between the rule edit and a triage bed.

Besides the cost of care for people with no insurance or means to pay, by his reading the ERs “would be limited to provider-type reimbursement” from Medicaid, the federal- and state-funded health insurance for low-income Americans. That is to say, because the ERs are not hospitals, they could not send Medicaid as large a bill as a hospital could.

The new rule is part of a plan outlined by Republican Gov. Nathan Deal in March meant to address heath care shortfalls in rural communities. The push originated earlier in the year with state Sen. David Lucas, D-Macon, who wanted to do something similar to what DCH has now approved. Lucas was defeated in part by the complexity of doing so via legislation.

“We’ve got to explore the things that will try to bring rural Georgia into the 21st century as far as health care,” Lucas said.

“The problem is the sales tax base in the smaller communities is not big enough” to support hospitals, he said. And another is that it’s hard to attract doctors to work out in the country.

Georgia would do better to expand Medicaid to more uninsured Georgians, which would help the bottom lines of rural health care providers, said a letter by Timothy Sweeney, head health policy researcher at the nonprofit Georgia Budget and Policy Institute.

“Rather than advancing a policy that could potentially lead to reduced services being delivered by hospitals in rural communities, the Department (of Community Health) should examine proposals that increase access to health coverage among Georgians who are currently uninsured,” his letter reads.

The power to expand Medicaid is split between the executive branch and the Legislature. Deal has rejected any expansion and the Legislature, just finished with its annual session, made no moves in that direction.

Some policy ideas may come out of a new Rural Hospital Stabilization Committee, another of the governor’s initiatives. The 15-member committee is supposed to investigate the needs of rural hospitals and recommend solutions.

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