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Congress must act to help rural hospitals

Rural America plays a vital role in the cultural and economic landscape of our country.

From the development of natural resources that keep the lights on, lower energy costs, and keep us and our allies safer, to being the home for our manufacturing base where American-made goods are produced, areas like central and northeastern Pennsylvania are indispensable to our nation’s prosperity.

Similarly, rural hospitals play a vital role in providing critical frontline care for millions of Americans. However, they continue to be at risk for consolidation and closure, resulting in fewer healthcare options for a changing demographic with unique health problems.

We cannot allow this to continue. Rural hospitals, and the residents they serve, should not be punished or reimbursed differently for performing the same services simply because they are rural. That’s why I have introduced legislation to help our rural hospitals by bringing federal reimbursement rates in line with urban hospitals.

Whether it is an aging population more reliant on Medicare coverage for inpatient services or issues with physician recruitment and the provision of emergency medical services, rural hospitals and healthcare providers continue to face a growing risk of challenges.

I commend President Donald Trump and the Centers for Medicare and Medicaid Services (CMS) for focusing on rural health with the establishment of a White House Rural Task Force. Despite incredible developments under President Trump’s leadership, rural hospitals continue to close, risking rural populations’ access to quality care.

Congress must do more.

According to the National Rural Health Association, over the last 10 years, 124 rural hospitals have closed with another 453 at risk for closure. In a rural area like Pennsylvania’s 12th Congressional District, the continued accessibility of healthcare services remains a top concern, especially in recent months as we have seen these rural facilities turn into frontline fighters of the COVID-19 pandemic.

One area of healthcare that lawmakers representing rural areas often hear about from our local providers is how declining Medicare payments, especially compared to urban or suburban hospitals, continue to hurt the future financial viability of rural hospitals, having a long-term impact on the communities they serve.

In order to help rural hospitals survive this challenge, Congress must take action to level Medicare reimbursement rates to bring about parity with urban hospitals.

Earlier this year, I sent a letter with several of my House colleagues to CMS Administrator Seema Verma asking her to re-evaluate the Medicare Severity Diagnosis Related Group (MS-DRG) classification system in the annually updated Medicare Inpatient Prospective Payment System (IPPS)–the mechanism that determines Medicare reimbursement for inpatient services at most hospitals.

The MS-DRG recalibrations have negatively impacted these types of rural hospitals over the last several years and this re-evaluation is a critical component to ensuring rural hospitals receive the appropriate Medicare reimbursement amount.

However, more can and should be done to re-evaluate all Medicare reimbursements under IPPS to immediately begin the process of saving rural hospitals.

That is why I have introduced the Reviewing Urban and Rural Adjustments to Level Hospital Expenses and Lopsided Payments Act of 2020, otherwise known as the RURAL HELP Act.

The legislation makes two changes to tackle the Medicare reimbursement parity issue.

First, it would require the U.S. Department of Health and Human Services to determine the precise level of systematic disparity that exists between urban and rural hospital payments under IPPS.

Second, it specifies that once the evaluation is completed, the Secretary shall make an adjustment to CMS payment policies to make up for the identified disparity.

This legislative model is similar to select provisions in the 2003 Medicare Prescription Drug, Improvement, and Modernization Act that applied to outpatient services, and which caused CMS to provide a 7.1 percent adjustment to reimbursement rates for certain rural hospitals.

Reflecting the importance of this measure, the RURAL HELP Act has already garnered co-sponsors from members representing rural districts across the country, including Congressman GT Thompson (R-PA), Congressman Mike Kelly (R-PA), Congressman Jim Hagedorn (R-MN), and Congressman Rick Crawford (R-AR).

That is a collective recognition of the importance of not only ensuring this re-evaluation takes place, but that Congress takes swift and decisive action to protect rural hospitals from future decline, consolidations, and closures.

Rural America faces many ongoing challenges. Among them are the need for better infrastructure to allow more commerce and greater highspeed broadband access that opens up new business, improves educational opportunities and increases access to telehealth services.

Given the critical nature of rural hospitals to a vulnerable community, and the ability to undertake this review in the short-term, re-evaluating reimbursement rates to provide parity with urban hospital settings is the step needed right now to ensure healthcare availability drops off the list of concerns for rural Americans.

U.S. Rep. Fred Keller represents the 15 counties of Pennsylvania’s 12th Congressional District. Elected to Congress in a special election in May 2019, HE Serves on the House Oversight and Reform Committee and House Education and Labor Committee.

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