Chuck Grassley

United States Senator from Iowa





Grassley Describes Rural Hospital Bill, Other Initiatives to National Rural Health Association

Feb 03, 2016

Remarks of Sen. Chuck Grassley
National Rural Health Association
Wednesday, February 3, 2016

I want to thank you, the National Rural Health Association, for inviting me to speak with you.
Hospital closures and payment issues impact Iowans and the nation at large.
As a senator from a rural state, I have been a long-time advocate of rural hospitals.
These hospitals provide needed care close to home. 
A tractor accident is dangerous under the best of circumstances.
But it can be fatal for someone who’s far away from an emergency room.
Following a traumatic injury, patients have a small window of time to reach services before they are in trouble.
The distance to an emergency room often means the difference between life and death.
Emergency room professionals use the term “Golden Hour.” 
Rural communities deserve access to that Golden Hour of emergency care.
In the past five years, 65 rural hospitals have closed their doors. 
Last year, 17 rural hospitals closed.
Those hospitals that haven’t closed are struggling to keep the doors open.
When a rural hospital closes, its emergency room closes with it.
When emergency rooms close, patients must travel longer distances to receive life-saving care.
This wastes precious minutes of that Golden Hour.
These closures are creating a health care crisis for hundreds of thousands of Americans across the country. 
Take, for example, Portia Gibbs from North Carolina. 
At 48, Portia suffered a heart attack 75 miles away from the nearest emergency room. 
She later died while waiting for a helicopter to make it to Virginia where the closest hospital was located. 
If Portia’s heart attack had occurred just one week earlier, Portia would have been transported to a hospital in Belhaven, North Carolina, just 30 miles away. 

Unfortunately, the facility in Belhaven had closed just six days before Portia’s heart attack because of financial struggles.
But rural hospital closures extend beyond the loss of emergency services.
There are economic consequences for these communities when the local hospital closes.
If we care about rural communities, as I do, we must change this trend of closing rural hospitals.
One area where we can change this trend is to improve the way rural hospitals are compensated for the lifesaving care they provide.
Today, the Medicare payment structure for hospitals is focused on inpatient volume. 
This must change. 
Researchers at the University of North Carolina found many of the at-risk rural hospitals around the country have an average of two or fewer inpatients on any given day.
In a Critical Access Hospital with 25 beds and only 2 inpatients per day, that is an 8% utilization rate.
It doesn’t take an economist to figure out that is not sustainable.
Instead of letting these facilities close, why not let go of the under-utilized inpatient services.
So, along with Senators Gardner and Lankford I have introduced S 1648, the Rural Emergency Acute Care Hospital Act, also called the REACH Act.
I understand that Senator Lankford mentioned this yesterday.
The topic is so important, it deserves two speeches.
The REACH Act will provide a voluntary path forward for rural hospitals to eliminate their underutilized inpatient services and ensure patients access to emergency medical care.
The REACH Act will create a new Rural Emergency Hospital classification under Medicare.
A qualifying hospital will have an emergency room and outpatient services.
It would not have the inpatient bed requirement that so many hospitals are struggling with.
This legislation will not force any new requirements on hospitals.
It will simply offer them a new option.
With this new designation, these facilities will have protocols in place to transfer patients who require a higher level of care.
The value of the Rural Emergency Hospitals is their ability stabilize a patient before they are transferred to a higher level of care.
In addition to providing life-saving emergency care, Rural Emergency Hospitals will have the flexibility to provide a wide array of outpatient services.
These services can include observation care, skilled nursing facility care, infusion services, dialysis, home health, hospice, nursing home care, population health, as well as telemedicine services. 
This is not all inclusive, but just a sample of the outpatient services that could be provided.
The door is left open for Rural Emergency Hospitals to design their outpatient services to match the needs of their communities.
The REACH Act is one part of the solution to stop rural hospital closures.
We have a lot of work to do, but we can also celebrate some wins.
My legislation, S. 332, the Rural Hospital Access Act, made the Medicare-dependent hospital and the Medicare low-volume hospital programs permanent.
This was signed into law early last year.
Now those hospitals have some predictability so that they can plan for the future.
 S. 607, the Rural Community Hospital Demonstration Extension Act, is another one of my bills.
It was recently passed in the Senate.
Everyone agrees it should be done.
This legislation provides cost-based payments for eligible hospitals within some of the 20 most sparsely populated states.
Currently, there are 23 hospitals participating in this program, and we want them to continue to keep their doors open.
I think we all agree it is better to keep 23 rural hospitals open rather than close 23 rural hospitals.
Now comes your part.
We need grass roots efforts to weigh in with the House of Representatives, particularly the Ways and Means Committee.
We need them to move S. 607 quickly to the President’s desk.