Congress is working on legislation that would better reimburse New Hampshire's rural hospitals for treating Medicare patients.
Medicare currently reimburses rural health care providers at a lower rate than their counterparts in urban areas.
But provisions in the medicare prescription drug bill currently in conference committee would give rural providers some relief.
NHPR's Washington Correspondent Judith Smelser reports.
SFX: HOSPITAL SOUND
At THE Androscoggin Valley Hospital in Berlin, a nurse tends to an elderly patient.
SOUND UP
Like in many rural areas Berlin's population is aging.
YOUNG PEOPLE MOVE to the cities to find work.
Consequently, 65 percent of THIS HOSPITAL?S patients are on Medicare.
Hospital Administrator Russel Keene says MEDICARE REIMBURSEMENT RATES SOMETIMES DON?T COVER THE COSTS OF TREATING THE ELDERLY.
AND FEES FROM THE OTHER 35% OF THE HOSPITAL?S PATIENTS DON?T MAKE UP THE DIFFERENCE.
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"I think we have been able to maintain a majority of the services, but obviously it's affected our ability to continue to upgrade plant - upgrade from a technological standpoint. And some of the things that we would've done probably in a more expedient fashion we've had to look at and problably stretch those out a little bit over a longer period of time than we would've liked."
THE ANDROSCOGGIN HOSPITAL IS NOT ALONE.
Rural hospitals across the country face the same problem.
For some medical procedures, Medicare pays these facilites roughly half as much as IT PAYS CITY OR SUBURBAN HOSPITALS.
MEDICARE ALSO PAYS Private physicians IN RURAL AREAS at a lower rate.
AND New Hampshire Congressman Charles Bass says that's simply not fair.
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"You have, for example, reimbursement rates in northern Massacuhsetts, right next to my district, that are in some instances double - this is for doctors now - than they are in immediately adjoining county in New Hampshire where they have the same costs, the same kinds of people, the same issues, and so forth. That's wrong."
The disparity exists because of a complicated formula put in place when Medicare was created nearly 40 years ago.
The reasoning was that many of the costs associated with providing health care - from malpractice premiums to office rent to labor costs - were lower in rural areas.
But New Hampshire's freshman Senator, John Sununu, says that argument is no longer valid.
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"With today's modern health care infrastructure, I don't think that it's fair to say that it's much more expensive to provide health care in Newton, Massachusetts than it is in Manchester, New Hampshire or Berlin, New Hampshire, or Lebanon, New Hampshire. I don't think you have the same disparities that might've existed nearly 40 years ago."
Rural health care advocates agree.
They note, for example, that many rural hospitals have had to raise salaries to attract and retain quality staff.
A number of little-known provisions in the celebrated Medicare prescription drug bill CURRENTLY BEFORE CONGRESS would give rural providers some relief.
The dollar amounts are still being hammered out in conference committee.
BUT the bills passed by the House and Senate provide somewhere in the neighborhood of 30 billion dollars to help reduce the rural-urban gap.
Both versions would raise the base rate rural hospitals receive to the same level as urban facilities.
They would also adjust the wage index used for calculating rural reimbursement payments.
New Hampshire Congressmen Charles Bass and Jeb Bradley actively support those provisions.
AND THEY both voted for the House version of the Medicare bill.
New Hampshire Senators John Sununu and Judd Gregg voted against the Senate version.
Their opposition stemmed from problems they saw with the bill's main component - the prescription drug benefit.
Some rural HEALTH CARE advocates fear the whole bill may fall victim to differences over that central issue.
If agreement on the drug benefit can't be reached, Congressman Bradley says he'll work to make sure the rural increases are addressed in a separate bill.
FADE IN HOSPITAL SOUNDS
Back at Androscoggin Valley Hospital in Berlin, Russell Keene welcomes the rural provisions in the Medicare bill.
But he says this is just the beginning of what needs to be done.
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"I think it's just one step. We're certainly hopeful but some of the work that a great many of the senators have done, as well as the house of represenatives, there's a greater awareness of the need, espeically in rural areas. And hopefully this is just one step and will eventually continue in subsequent bills that will help us stabilize financially."
Many lawmakers agree.
Congressman Bass and Senator Judd Gregg both say they'd like to see the reimbursement issue addressed as part of a fundamental overhaul of the Medicare program.
For now, though, rural providers are hoping Congress will give them a little breathing room before the end of the year.
For NHPR News, this is JS in Washington.
