Louisiana Officials Tell Their Stories to Obama Cabinet

Cheryl Clark, for HealthLeaders Media , July 22, 2009

Sebelius and Wakefield took a side trip to Pratt's hospital, spoke with several patients and talked about how telemedicine might one day bring specialty services much closer to their patients' bedsides. And Pratt says, they listened to stories from patients about how dedicated nurses sometimes travel to their hospitalized patients' homes to take care of their pets until the patients are discharged.

Pratt says that several years ago, hospital officials decided it would be cheaper to rebuild the facility than to repair and upgrade it. Of the $19.5 million cost, $18 million came from a direct loan from the Department of Agriculture.

"The issues that our hospital faces is typical of any rural community," Pratt says. "But our demographics tend to be more challenging than in urban areas, with higher levels of poverty and lower levels of education. All that leads usually to challenging health care status."

Other issues involve the difficulty in keeping good quality staff, although the newer building has made recruitment far easier than it was before, she said.

But there is fear about what health reform might bring to hospitals such as St. James, Pratt says. "With health reform, there are going to be some radical changes going on. And everyone involved in health care is uncertain about how this is going to affect us," Pratt says.

What she was referring to is the fear that Medicare will slice disproportionate share reimbursements to rural hospitals, money that pays for care for people with no insurance, supplemental funding St. James depends on to provide care. The idea is that a public option would provide coverage that would, in effect replace that. But the disproportionate share money may go away long before the patients have a chance to be enrolled in a public plan, Pratt says.

"I have concerns that the money for uncompensated care will be removed before everyone is in a health insurance product," Pratt says. "There's going to be a time lag between the plan's offering, and when we get folks with no insurance onboard. But how do we handle that in-between stage, and till make sure our hospitals remain whole."

But those are problems, she said, she has confidence that Sebelius and other Cabinet-level officials appreciate, perhaps much more than in previous administrations.

"In prior administrations, there were always lots of cuts to rural health," Pratt says. "There were cuts to the Flex (Medicare Rural Hospital Flexibility Grant) and several other programs that supported rural health efforts.

"And although it was always reinstated, and we didn't actually get cut, it sent a message were not that valuable to that administration. We always felt vulnerable."

Time will tell whether she's right.

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