Three of Northern New England’s health care leaders met at Dartmouth Regional Medical Center for a forum on rural health care Monday. The trio discussed the economic and health challenges they face in a rural environment.
The CEOs of the UVM Health Network, Dartmouth Health and MaineHealth met with Bipartisan Policy Center Senior Vice President Bill Hoagland to discuss three key areas of rural health care: what it entails, its unique challenges and potential solutions.
UVM Health Network President and CEO Sunny Eappen noted that millions of people live in rural areas that need health care services.
“I don’t think most people realize probably about 50 million Americans, 45 to 50 million Americans, live in what would be considered rural America from the CDC,” Eappen said. “If you look at the top five reasons that people die in America: heart disease, stroke, pulmonary disease like COPD, unintentional car accidents, shootings or cancer, all five of those are all higher in the rural parts of America for a variety of reasons. So not only do we have to provide care at that very high level, but we’ve got to provide it in a very broad geographical area as well.”
The three medical networks are also academic training centers. MaineHealth CEO Andrew Mueller says a critical focus is not only training new physicians but finding ways to keep them in rural communities.
“One of the things about being a rural academic health care system is the ability to train medical students, residents and nurses in a rural setting,” Mueller said. “And many times that encourages them to stay and continue to practice in that rural setting. So we have a huge obligation to continue to train the next generation of care givers, not just at the academic center, but also in the rural communities that really deserve good care. And so we’re constantly thinking about how we can ensure that there’s a pipeline of all the clinical specialties and disciplines required to deliver good care in rural communities.”
Mueller notes that the northern New England health networks face a number of challenges including workforce shortages and competition with large metropolitan hospitals in the Northeast.
“The reality is, is that virtually two-thirds of our costs as health care systems are our front-line workers. It’s their salaries and wages,” Mueller said. “And so we’ve tried to remain competitive. And even though the three of us in northern New England are in rural communities, we’re still close enough to big metropolitan areas, Boston, and areas of Connecticut and close to New York City, that we’re still forced to compete with some of the city rates that put additional pressure on us as rural health care systems. Housing I think has become a universal challenge. One of the other unique challenges to northern New England is, because of the rural nature, it means that it really is travelling by hours as opposed to miles.”
A submitted question on the potential impact of federal leaders failing to reach a deal on the debt limit led to an extended discussion. Dartmouth Health CEO Joanne Conroy is incoming president of the American Hospital Association. She noted that their biggest payers are the government health plans Medicare and the state supported Medicaid.
“If they decide they can’t pay us we go further and further into our cash reserves, which have been under a tremendous amount of strain over the last 18 months, two years, to actually keep the doors open until they are able to pay us. It is a significant impact,” said Conroy.
Conroy responded to a follow-up asking what implications there might be if a deal includes changes to Medicare or Medicaid.
“Even though they say Medicare is off the table, it doesn’t mean cuts to providers are off the table. And we’re already being paid about 80 percent of the costs of delivering care to Medicare patients. And the language does not say that they won’t cut support for providers,” Conroy said. “That is one of our major concerns.”
MaineHealth’s Mueller added:
“This could be devastating to us for sure if we continue to see the payments that we do get at the present time continuing to decline,” Mueller said. “And the big secondary impact of that is not lost on any of us that we’re our states’ largest private employers. We also run the risk of really damaging some of our rural communities economically.”
The three medical systems employ about 55,000 people across northern New England and northern New York.