Strengthening Rural Hospitals

I have the honor of representing Nebraska’s Third District, which is one of the largest and most rural districts in the country. I love rural America, but oftentimes Congress and bureaucratic agencies in Washington make decisions without fully considering how laws, rules and regulations will affect rural populations differently from other Americans.  

For example, rural Americans tend to have greater challenges accessing quality health care because hospitals and physicians are more concentrated in urban areas. To see a specialist, rural Americans often have to wait longer or travel outside of their community.

Further complicating access to care in rural communities, the Centers for Medicare and Medicaid Services (CMS), the federal agency which administers Medicare, is working to more strictly enforce a rule, which would require a physician’s presence and supervision over nearly all routine procedures administered in hospitals. This rule not only is unnecessary, but also may limit access to basic services for rural communities, especially at critical access hospitals–small, remote facilities providing 24-hour hospital care.

Critical access hospitals provide frontline care in underserved areas, frequently with very few physicians on staff. Because of the limited availability of rural providers, these small, rural hospitals historically have been given more flexibility to comply with the physician supervision rule, but are still required by CMS to have a physician on-call and available within 30 minutes at all times. Strict enforcement of this rule, which CMS intends to begin in 2014, could result in requiring a physician to be present for small, routine procedures which are regularly performed by nurses and other medical professionals. While this requirement is less of a challenge for large hospitals, it can be very problematic in areas with few doctors.

In response to public outcry, CMS agreed to allow nurse practitioners and physician assistants to oversee certain services, and the agency delayed enforcement of the rule at critical access hospitals. CMS is now in the process of deciding which procedures will require physician supervision and which will not, based on recommendations from an expert advisory panel. Unfortunately, CMS already has rejected several of the panel’s recommendations. Patients and local budgets would be better served by allowing experts to make these decisions at a local level.

Because of the importance of access to care in rural communities, I sent a letter to Acting CMS Administrator Marilyn Tavenner. In the letter I expressed my concern about the effect of stricter physician supervision requirements on rural health care. I am pleased 16 of my colleagues –Democrats and Republicans–joined me in signing this letter, and I hope CMS will continue allowing practitioners the discretion and flexibility they need to manage care for their patients.

Ensuring access to health care in Nebraska’s rural communities is a top priority for me. 

As a member of the Committee on Ways and Means, which has jurisdiction over Medicare, and as Co-chair of the Congressional Rural Caucus, I will continue to promote increased access to vital health care services.