By Tom Baxter
New challenges produce new terminology, and there was plenty of it being thrown around Monday at the first meeting of the Rural Hospital Stabilization Committee, the latest blue-ribbon panel tasked with solving a problem no one else has been able to tackle.
The committee members were briefed on the details of the newly-created Rural Freestanding Emergency Departments — RFEDs. The result of a relaxation of state licensing rules, these are emergency facilities designed for rural counties where full-service hospitals have closed. They’re intended to work with larger facilities within a 35-mile radius, treating patients on site for no more than 24 hours.
They heard glowing mention of the TeleStroke program which brings patients in contact with neurologists through the internet, one of the ideas being offered as a partial solution to the growing healthcare-delivery problems of rural areas. But Lincoln County Commission Chairman Wade Johnson, a member of the committee, warned against any notion of an easy fix for the mounting problems in rural areas. His county of fewer than 8,000 struggles to pay for the two ambulances it uses to take patients to hospitals in larger counties, he said.
“You talk about telemedicine — a lot of our people don’t even have computers,” Johnson said.
“We’re on the thinnest little branch of the tree,” said Dr. Jeff Harris, an ob/gyn from Jesup, addressing the problems rural communities have keeping the limited medical care they have. If he were to have a episode of chest pain, if his partner in the practice were in an auto accident, or if either decided to retire, his county would be without a viable ob/gyn practice.
A recent wave of hospital closings prompted Gov. Nathan Deal to create this committee, but all agreed they had no immediate solution for the problems of communities caught in an economic tailspin, unable to attract new employers because of the lack of hospitals and unable to attract new doctors.
“It’s going to be a magic act,” said committee member David Sanders of Fannin Regional Hospital. “It’s going to be more than pulling a rabbit out of the hat.”
“The attempt is to put something there that does not exist now,” another committee member said.
To speak of the rabbit is also to speak of the elephant in the room, the state’s refusal to accept the Medicaid expansion under the Affordable Care Act. Keeping the current system afloat without the influx of federal dollars which would come with the expansion will indeed be a magic act.
Jimmy Lewis of Hometown Healthcare spoke of the potential for “frequent fliers” — people with less-than-critical ailments who will use the RFEDs to get an ambulance ride to a hospital — to overwhelm the system, and Jimmy Allen, a businessman who sits on the Tift Regional Hospital Board, spoke of the burden indigent care shifts onto the backs of hard-working Georgians.
“In that respect ObamaCare was maybe positive,” in requiring a larger pool of Americans to pay at least part of the costs of their healthcare, Allen said. And that, followed by a quick comment that he’s no fan of ObamaCare, was as close as anyone came to saying anything positive about it at all.
Meanwhile, campaigning outside a mostly-closed hospital in south Georgia, Jason Carter called the committee “too little, too late.”
“It’s our money and Nathan Deal wants Washington to keep it,” Carter said, summing up his position in favor of accepting the expansion. He’s being pounded even for considering the expansion in a current ad paid for by the Republican Governor’s Association, but that’s a message aimed at the Republican base. Especially in smaller communities facing property tax increases to save their local hospitals, Carter’s argument could have a lot of appeal.
This debate is taking place against a general backdrop of fading resistance to ObamaCare nationally. It’s still not popular, but the debate has shifted away from those who want to repeal it outright. Nationally, about 10 million Americans who weren’t insured now have coverage, according to the most recent estimate by Gallup. That would make it difficult to roll back the law at this point, even if its opponents had the energy to mount another effort.
As Lewis commented to his fellow committee members, whatever solutions they come up with will have to follow the new rules set down for hospitals and medical providers under the Affordable Care Act, like it or not.
So it’s ObamaCare with the rabbit, or without.