Health Care

Baucus and Health Officials Discuss Struggles in Rural Montana

By Greg Lemon, 2-21-08

Complexities in Medicare and lack of federal funding put pressure on rural health providers, said Sen. Max Baucus, D-Montana, at a lunch forum in Hamilton Thursday.

Baucus spoke to about 80 local citizens and health care professionals for about an hour at Marcus Daly Memorial Hospital. Baucus, chairman of the powerful Senate Finance Committee told the crowd that Montana was lucky.

“All of you are fortunate in a sense,” he said. “This is the first time we’ve had a Montanan chair this committee.”

Baucus has served in the Senate for 29 years and his currently running for a sixth term.

Montana’s concerns about rural health care are shared by other states and with Baucus’s position in the Senate, those concerns will certainly be addressed, he said.

The current health care system makes it easier for urban health centers to qualify for money, Baucus said. But the system does allow for rural hospitals, like Marcus Daly, to be identified as critical access hospitals. This designation makes more funding available, and is essential because the small hospitals are crucial in rural areas, he said.

Out of the 55 hospitals in Montana, 47 are designated critical access, said John Bartos, Marcus Daly CEO.

However, proposals are coming forward in Congress that would freeze the increase in funding for rural hospitals. Baucus plans to fight those proposals.

“I don’t think it’s right that Montana hospitals (face) a $10 million cut over the next three years,” he said. “My main goal back there is to get them to understand that rural areas must have a hospital.”

What he would rather see is a simplification of the Medicare system, which he said is plagued with “fat and waste.” This drives up costs of health care by complicating the system. 

“We spend twice as much per capita (for health care) as the next most expensive country,” he said. “We spend 18 percent of all our health care dollars on administrative costs. We have a very complex system and it’s unnecessarily complex.”

Nearly 47 million Americans don’t have health care. The system is broken and Baucus sees a change coming with the next administration.

“In 2009, we’ll see a major health care proposal for this country,” he said.

Brian Kelleher, an emergency room doctor at Marcus Daly spoke about the advantages of being a critical access hospital. The designation has allowed Marcus Daly to fund a major expansion to the emergency room facilities, Kelleher said.

Still, doctors are seeing a cut in the their Medicare reimbursements, which could limit the number of Medicare patients they see, he said.

Also, the hospital is strained by the increase in mental health patients and the lack of long-term mental health facilities in the state. Often the emergency room is the place where patients with a psychiatry emergency are brought, Kelleher said. These patients often need long-term care, but none is available. So they’re released back into the community only to be admitted again when another emergency arises.

“Resources for further care both inpatient and intensive out-patient is somewhat lacking,” he said.

Bartos suggested Baucus help Montana establish a mental health residency program, which could bring more mental health doctors to the state and provide them with experience while providing the services Montana sorely needs.

Baucus also addressed the problem of retaining family doctors, which has become a problem of late because of Medicare reimbursement. Medical students understand they can make more money as a specialist, because they get more of a reimbursement for Medicare patients, he said.

He pledged to address the reimbursement problem “to make sure we get a bigger bump in the reimbursement for family practice ... I have a hunch we can do a little better.”

The fact is the current health care system is nearing the point of crisis, Baucus said. This crisis will necessitate changes. These changes will need bipartisan support, which will hopefully come from the next president.

“If whoever is elected president is really non-partisan about this issue, that will go a long, long way,” he said.

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