In the Trenches: Rural Health Care and Indiana

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Rural Indiana: the thought conjures up visions of bucolic agricultural scenes, red barns painted to advertise Mail Pouch tobacco, summertime fairs and generally a slower pace of living.

Living here is a heritage for most rural Hoosiers. It is for me. I am raising my family on farm land that my father and his father before him have worked and will work for years to come. I chose it as much as it chose me. My career has taken me all over this country, working from the east coast to the west coast.  But I am a Millennial - albeit an older one - so moving home was about wanting to live here, not about working here. I moved for the place, not the job.

I happened to find an excellent job at a hospital that has come to mean more to me than just a pay check or another line on my resume.  I am the Chief Executive Officer of Greene County General Hospital, a place where my vocational passion and personal pride have taken root. This is a Critical Access Hospital, serving a high-poverty, rural population. It is the only place within 35 miles for people to get to emergency care. It is also providing a full line of services with state-of-the-art equipment and providers.  3D mammogram? We can do that.  Labor and Deliver services with a Board-Certified OB-GYN? We have that too.

25 beds. 350 employees. $62 million dollars a year into the local economy. Open and independent in defiance of national trends.

But none of that matters. 

What matters is the lives we are saving and improving. What matters is James, a heart attack victim who is still smiling at us every day in the cafeteria thanks to our ER. What matters is the baby and mother whose lives were saved during a troubled labor and they could not make it any farther. What matters is the wife and mom who is back in action because our physical therapy department helped her reclaim her life from chronic pain.

These stories and countless others like them are happening in rural Indiana because we have taken extreme measures to be disciplined and wise.  We have established a Human Resources program that has received statewide recognition through the Department of Workforce Development. We have added fitness programs that are making Greene County a healthier place to live.  We have provided services close to home that are not available to many rural Americans – chemotherapy, physical and occupational therapy, labor and delivery, surgery and intensive care, heart, lung, cancer specialists…the list goes on.

Our hospital was established over 100 years ago by our community for our community. Unfortunately, the long, steady progression of public policy has taken its toll on our hospital. Yes we are seeing more people are signing up for insurance. But the reality is that many people still cannot afford to meet their deductibles or premiums, so they are still not paying their bills.  And the government programs that provide coverage are slow to pay, if they pay.

All this is happening while the federal government is decreasing payments for hospitals like ours. In theory, more insured patients should mean less need for funding like the Disproportionate Share program, money that comes to hospitals like ours because we see a higher number of Medicare/Medicaid patients.  But the reality is that the payments have not changed. Between sequestration and decisions to reduce critical funding, we are set up to fail.  These cuts are not treatable with a band-aid. These are gaping chest-wounds reaching to the heart of rural health care and caused by the hand of government. The bleeding must stop.

I spent almost a week in Washington D.C. with the National Rural Health Association and our own Indiana Rural Health Association, walking the halls of Congress, begging for action – not more funding, just a stop to the cuts. There must be a groundswell to save rural hospitals like Greene County General Hospital.  We have done everything humanly possible on our end – with lean projects, exceptionally well-executed budgets, and a team of professionals working to be efficient and effective in every department and with every patient. It is time to acknowledge that the government must now fix what it has broken.

We talk about the haves and the have-nots, about rural entrepreneurship and broadband access.  None of that matters if we cannot get a handle on rural health care.  Communities like ours would lose not just their primary employer and investor, but their primary draw for future economic development – not to mention the incredible, deadly impact of losing quick access to exceptional health care.

This is a crisis no one is talking about.

On the federal level, we must ask our Congressional delegation to sponsor the Save Rural Hospitals Act.  It has been introduced in the House, but the Senate has not yet taken action on it.  Why not? On the state level, we must be vigilant to make sure that people are not just signing up for coverage, but that the organizations providing that coverage are meeting their obligations on claims.

The solutions for entitlement reform will not be found in this death by a thousand cuts. All it will do is kill the prosperity and potential we have all worked so hard to bring to rural Indiana. The cure cannot kill the patient.

If you think rural Indiana – keep thinking about those gorgeous fields of corn and the small town main streets we love.  But connect that charm to the economic engine helping preserve the beauty.  Think rural health care, and think about how you can help us fight to save it.

Brenda Reetz is the CEO of Greene County General Hospital in Linton, Indiana.

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