Preparing for Future Healthcare Stressors

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Learn more at evenrealities dot com and see how everyday smart classes keep helpful information in sight so you can stay productive and hands free throughout the workday Add the even Ring one or even clip to your even G two order and get ten percent off with code Marketplace. evenvenrealities. com code Marketplace Hi everyone, it's Kimberly Adams. I'm back in your Make Me Smart podcast feed here to share some of the reporting that I've done as part of my new job hosting the Marketplace Morning Report We traveled to Alabama about a month ago to report on the challenges facing rural healthcare Many of them are long standing, but they're becoming more intense and more pervasive because of policy decisions at the national level thingsings like the big Republican tax and spending bill from last year, including changes to Affordable Care Act coverage. So as those changes kick in, we wanted to better understand what this will mean for communities all around the country Here's what we learned in Alabama, starting with how hard a hospital closure can hit a community. So this is whyild there's still the paper on the exam chair. It's almost as if we're walking through just early in the morning before it's about to open This is the Thomasville Regional Medical Center, or perhaps we should say was, because right now, the bright reception areas, brand new surgery facilities, and the only in house MRI machine for dozens of miles are all empty. morning, mister May nice to meet you. Thank you so much for meeting us today. Ireciate. Sheldon Day, the mayayor of Thomasville is our tour guide We're about an hour and a half north of Mobile, in Alabama's seventh congressional district, an area with some of the lowest life expectancies in the entire country, which is why Day says Thomasville needs its hospital. We have a Primary care clinic care, with all the bells and whistles, we were the only hospital in the region that did three D digital mammograms The only thing you're missing Patience The medical center closed in twenty twenty four less than five years after it opened. The COVID nineteen pandemic was a major factor. Like so many hospitals around the country, Thomasville Regional shut down elective and non essential care, which the mayor says made up something like seventy five percent of the patient volume here When the hospital was open There were also patients like this one We had a young lady who had a a heart condition B to one of her. I order it our and they brought her here. An other hospital would not have been able to see what we saw, because our advanced diagnostics They had a surgery team waiting on her as soon as she got to a facility moobile and her life was saved Today, she's got two children active family here in our community, business owners in our community. And that's just one example. If she had had that last month while this hospital was closed, she would have died I'm sorry to ask this, but how many members of your community do you think you may have lost because of this It's hard to tell We've done the best we could do. Mayor Day has given dozens of tours to prospective buyers and media over the last couple of years trying to get the hospital reopened The financial headwinds facing rural healthca in the U. S are made up of more than just the lingering impact of COVID And those headwinds are getting more intense because of recent federal policy decisions, cuts to Medicaid, increased work requirements, disappearing subsidies In Alabama, the State Hospital Association says more than eighty percent of rural hospitals are operating at a loss Many of the buyers that looked at the facility They absolutely were foaming at the mouth to buy it. and then they go work the numbers and they go I don't think we got to do it Despite the tough math facing rural hospitals everywhere, Mayor Day does have a solid sales pitch. It's ready to go. I mean, that's one thing I think that is attractive to people who are looking and considering purchase a facility here. Everything is so new. I see the hand sanitizers and soap is still stocked. They've put probably in the neighborhood about one hundred thousand dollars a month to maintain the facilities. Plus the hospital is a bargain. The mayor says the price tag is around a fifth of what it would cost to build and open a similar facility today, about twelve million dollars instead of something like sixty millionllars Thomasville is being veryer careful about finding the right buyer There are a lot of folks going around Basically bottom feeders are trying to, you know collect up a bunch of rural hospitals and many of them are buying them, converting them to rural emergency hospitals. which they get a better reimbursement, but you do not have the same level of care. And reopening also means reiring. The mayor says more than a hundred jobs were lost when the hospital closed Many of the folks who were here want to come back. We talked about the other facilities in our area beginning to convert to rural emergency hospital, where that means they're not doing med surge anymore. Some of those nurses will want to come here. We had people that worked here for three weeks without a salary because they wanted to make a difference here. And the need clearly remains The facilities manager told us sometimes people still drive up to the hospital during emergencies before the signs on the locked doors to the ER inform them they have to take their crisis somewhere else. Anywhere I go, the number one question is, tellell me about the hospital, any progress. The multiple stories that I have or people who Hey, we're thinking about moving back home But we need he care for Halma Yeah We just recently had a minister in our community her husband has a lot of health issues. T number one reason they're leaving is because they gota have access to a higher level of care for him Thomasville is a town of about three thousand five hundred people in southwestern Alabama Next, what happens to that local community and a local economy when the only hospital in town closes? Look around for a minute and let me get you some chairs. On the main street of downtown Thomasville, there's a bakery, a movie theater currently under innovation, and This is the Hall of Fame. and they put me in the Hall of Fame about six, eight months ago, weren't y? Congratulation. That's recently inducted member, Jimmy Duncan, a college football national champion in nineteen seventy one But after his playing days, Duncan worked at the nearby paper mill his dad helped open. See these knees right here That That wasn't from playing football. That was from running up down that floor that seeent floor. But the paper mill is pretty tough work, but it wass the highest paying job in the area. They were right, Charlie. That's correct. Charlie Anderson was born and raised in Thomasville and brought this Hall of Fame to life a dozen years ago But we weren't just visiting to relive the Glory Days. We also wanted to talk about healthcare and the lack thereof in the area thirty minutes in any direction you want to go. They're paper mill or wood products industries Jimmy can tell you accidents that happened at Mills You haven't got two hours sometimes to drive somebody. So when the hospital shuts down, like it did here in Thomasville, there's a hit to community health and to financial health. Alabama hospitals generate about thirty billion dollars a year in economic activity, according to the state's Hospital Association. I would think it probably also affects Do people looking at loocated in a place like Thomasville, think about If I don't have good healthca, I might not want to go there This is something that towns across America have to reckon with as rising healthcare costs and policies at the federal level put the squeeze on healthcare My name is Amy Brrescott and you' at our bakery is called Half baked. Just across the street from the Thomasville Sports Hall of Fame She and one of her daughters opened the bakery a year ago Presscott remembers well when the local hospital opened back in twenty twenty. At the time, she was director of the local Chamber of Commerce. It was a huge effect on getting more businesses in here as far as larger industries and stuff like that, because that's one thing that they look for, like if we have an incident, where's the closest place to take someone. When we visited, another one of Prescott's daughters was about a week away from having a baby, so their family was keenly feeling the effect of that hospital's closure in twenty twenty four. Now for her prenatal care, it's a journey We were at the doctor yesterday in Mobile making sure we weren't ready to deliver a baby. And she has to travel weekly down to Mobile. It's also like half a day out of your work day. Y when you have to do that. So if you don't have somebody to run your business while you're gone, you have to run to the doctor you just have to close the doors Angie Newsom also stopped by the bakery. She owns and operates the local radio station. It's WJDB. It's on the south end town. ninety five point five Newsom is also the coordinator for the town Museum at the library less than a block away. My dad called me one Saturday night right for the Alabama, Texas game And I could hear my mother screaming we take her to the Thomasville Hospital. The doctor came back in after the MRI and said I've called for the helicopter Your mother has a tumor on her spinal cord. And now we have to travel to Birmingham Every three or four months to see her cancer doctors. So I mean, this is what I've been hearing from lots of folks is that now you just have to basically take an entire day off of. Absolutely, abbsolutely. We all want to be independent and nobody wants to just worry someone to death asking them, oh, I need you to take me to the doctor knowing that it's a day wages that are lost Poul Stinson is director at the public Library in Thomasville, which also serves as a career readiness center. While visiting, I asked her what it was like when the hospital was still open It was great. I know this facility My youngest son, it came in handy when he had an emergency He was probably I think too. and he's actually in there So the Hema office I' tellld you to not Easton He. Dake care called. He just orered to in a fever and I needed to come get him. So I immediately left, went and got him His favorite was r rising Got him in the car seat We were headed back home. And I noticed H eyes were open, but he was not responsive because I was trying to talk to him, make sure he was okay. So I immediately did a U turn, went straight to the hospital, and that was probably one of the scariest things because he was not I can tell you're shakaking a little bit just retelling the story that must have been terrifying. It was That was probably one of the hardest things I've ever done is carry his lp body into the They are So so And he was in that seizure for over forty five minutes even after the medicine that they gave him took him out of it. Did they tell you what might have happened if you'd had to delay care We didn't talk about that. Didn't want to know. Because it was already Yeah, It was already very stressful Well, I'm glad that the hospital was there then. Me too. Your friends, family members who've needed emergency care since then, what have you heard from them so A lot of what we do is you end up calling somebody or texting somebody that is a nurse. And so actually one of my employees, he's a minor, but his dad is a nurse and his dad I have called him to stitch us up when we think something is wrong, and that's pretty common. one of the local nurse practitioners. I text him. anytime there's a somethingomet a little bit more serious And they've kind of stepped up. That's wild though. It's sort of like at home health carere. Yeah. which I mean, they're not, I guess advertising it. but yeah when They are there for their friends and family As you hear there, many people we spoke with had very personal stories about health carere access There was another thing that kept coming up in almost every conversation we had is our low reimbursement. They are extraordinarily low. Our reimbursement rate for insurance is a lot less. They can get a job there and make so much more money because they have such a better reimbursement rate. In Alabama, we got the lowest reimbursement rate in the nation. lowest in the nation That last voice was Sheldon Day, mayayor of Thomasville. If you look at the deemograph of Brswick Geordg, you look at the demograph of Thomasvill Vy simo Isolated rural areas. Project Georgeia gets ninety cents On the dollar reimbursement we get sixty five Why is that I'm glad you asked that question because that's the question I keep asking Why is the formula Slanted that badly Thirty years ago, pretty much every hospital in our region were deliing babies. Now there are zero. Zero And in my opinion, lot of the costs have escalated because of the way we reimburse from a national level. Hospital insurance reimbursement is very technical, and we're not going to get too deep into the details. But the simple version is that for older Americans on Medicare, the federal government decides how much it will pay for medical services based on essentially wages in a given area Wages are pretty low in Alabama compared to elsewhere in the country, so the Medicare reimbursement rates are relatively low as well Liz Walker is executive Director for teelemedicine and rural Initiatives at the University of South Alabama Health System in Mobile It's almost like kind of the origin story of then how your commercial rates are set off your Medicare rates So when you startart with a low number Everything progresses from there Private insurance, Medicaid, the childildren's Health insurance program The low reimbursement rates in Alabama shape how much doctors and nurses get paid, and how much money hospitals and clinics can make Walker says one reason it's so hard to fix this system is that it's effectively a zero sum game It's a set amount of money that the federal government is going to towards this number. If our wage index goes up Someone else's is going down We met dor. Marsha Rowlerson, a pediatrician of more than forty years in Bruton, Alabama, an hour and a half or more. O a lunch of catfish, grits, and fried green tomatoes, she expressed similar frustrations about the low reimbursement rates. It has to do with some formula that I don't understand at all. It has to do with the makeup of your state But it doesn't make sense anymore So what are the solutions? There is money set aside for rural hospitals in the big tax and spending law President Trump signed last year, and Alabama is getting just over two hundred million dollars It's not going to boost the rates or even shore up the operating costs for rural hospitals. I don't want to disparage it But it's pie in the sky Did anyone talk about how important it is that we get paid fairly from Medicare patients Did anyone talk about the fact that so many people don't have insurance and don't come in until they're really, really sick Is there anything in this document that's going to change that Those are our problems Over the decades, Rowlerson has seen firsthand how rising costs and changing policy shape individual health carere choices She keeps a list of cases where she says patients' lack of access to or ability to afford care their lives short Fty seven year old died with congestive heart failure related to chronic kidney disease and type two diabetes. He was forty seven Those are a lot of L term neglected chronic diseases. Plus He's part of our workforce, right? He's forty seven. He's part of our future. He's a father, maybe even a grandfather. And now he's forty seven and he's not with us anymore. And it's a loss not only to his family, hisis children, but to the community According to health Policy nonprofit KFF, changes from the One Big Beautiful Bill Act will lead to an almost one hundred forty billion dollars hit to rural Medicaid funding over the next ten years. Layer that on top of the expiration of COVID air subsidies for affordable Care actct coverage and you end up with lots more uninsured or underinsured people Rollerson says the private market won't be much of a safety net for the people in her community So if you get insurance from 're company you work for You may have a thousand dollars deductible. For each family member So People just don't get care But if they show up sick in the ER, hospitals still have an obligation to treat them That translates into more than six hundred ninety million dollars in uncompensated care in the state every year, according to the Alabama Hospital Association We mentioned earlier how the One Big Beautiful Bill Act does include funding specifically for rural healthcare I think that it's a great idea and that healthcare transformation is certainly what is needed Liz Walker again at University of South Alabama Health and Mobile But that money won't go towards plugging the funding holes for hospital operations It is incredibly difficult And it's difficult to transform all the complex operations that go into providing care Nevertheless, Walker and her team did submit ideas for how to use this money and are waiting to hear back Meanwhile, they're coming up with other solutions. partartnerships are going to be really important moving forward because these small independent hospitals, they really don't have the leverage that larger organizations have. And so any way that we can partner to create that leverage for them is going to make them more sustainable those are some of the bigger system wide changes that can help healthcare survive in rural communities. But in many parts of rural America, those solutions are lacking, and more and more communities are facing hospital closures or reductions in the type of care available So what do you do if you live far from an emergency room What agency do you have over getting the health carere you need Ppose this question to doror Lawanda Grzette, Chief of cardiology at University of South Alabama Health and Mobile for someone who has a chronic condition, be helpful to try to game planned if I had to go somewhere Where would I go? try to arrange to have a visit at that place and establish a care relationship with that place that you might end up going if you got into trouble. so that there is some records and there's some physician or a nurse practitioner or physician's assistant who knows you Oh this makes a lot of sense. For example, if you know you have diabetes or high blood pressure, you go in advance to the closest hospital to you and just say, hey, here are my medical records just in case I get brought here in an emergency. Yeah and try try to have a relationship there. Have a visit. H a visit if you have diabetes and see a primary care doctor or an endocrinologist H asthma, COPDC, a pulmonologist, you have heart disease, seeee a cardiologist or a primary care so that you are somehow known to that system You mentioned that you're seeing people make really challenging choices around Health insurance and health care. It's been going up for everybody, peopleople on the exchanges, people off the exchanges. Can you talk a little bit more about what you've seen in that regard? A lot of times in medicine, we talk about compliance How often patients? Do what we say and follow through, follow through with our recommendations, prescriptions and so forth And I'm seeing more patients that are having issues with compliance. that are financial Hm So you know, sort of in the past it might have been, well, I couldn't tolerate that medication or sometimes I didn't think I needed it And I'm seeing more non compplliance because Well, I went to the pharmacy and they told me how much it was and I really couldn't afford that or I am planning to get that But I have to borrow some money first to get it in this Someone's gonna help me We just heard about another seven million people dropping their ACA coverage. A lot of people are about to lose Medicaid because of new work requirements and other things. So what does that look like I think that health carere has been stressed and stretch for whileile now I think the COVID pandemic was a huge dresser. This is going to be another huge stressor. that I feel we're probably even But last night prepared for I mean, you know, sort of the wave of under insurance. under insurance I think it looks like a lot of people with chronic diseases showing up to the few hospitals that have them emergency rooms and those emergency rooms being overwhelmed How will lawmakers respond when this wave of underinsured Americans, as doctor Grizette calls it, comes crashing down. What can local healthcare networks do to look out for communities And how will the provisions of the One Big Beautiful Bill Act, some of which kick in after the midterm elections this year, change things I put those questions to Liz Walker and her colleague at the University of South Alabama, Nathan Tudor I don't think we' fully realized all the cuts. I don't think so yet It's kind of wild to me that you two are top experts on these things in the area And we're getting pretty close to these changes actually kicking in