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Reimbursement top issue for rural health care

Every seat was full at the Rural Health Care Roundtable hosted by Rep. Wes Breckenridge, D-Newton and Rep. Timi Brown-Powers, D-Waterloo Thursday at MercyOne Newton. Representatives from the sheriff’s department, fire department, public health, local clinics and hospitals, senior healthcare facilities and many more offered feedback to legislators on obstacles in rural health care and where they feel the state house should focus efforts in the upcoming session.

“Healthcare, whether it is mental health or Medicade, healthcare in general is still the number one issues I receive calls and contacts to assist with as a state legislator,” Breckenridge said.

During her time at the state house, Brown-Powers said a lot of legislation, unfunded mandates and ideas are handed out without actually going to the public and seeing if they make sense in real life. A big problem she has found is they tend to be very focused in Des Moines and the urban areas in the state and don’t always pay enough attention to rural Iowa.

“My charge was to start moving across Iowa and meeting in as many rural areas as we can. Our charge is to collect information from all of you,” Brown-Powers said.

After driving across Iowa, she said she has a different perspective on rural areas. From the volunteers putting their lives on the line for communities to providers trying to figure out how to budget in murky funding waters, rural health care has a host of obstacles standing between it and the public.

“I look at a beautiful farm house and think, ‘How long does it take for emergency services to get here,’ so I look at things differently just from listening to Iowans,” Brown-Powers said.

MercyOne Newton CEO Laurie Conner said several issues frequently plague the hospital including reimbursement numbers, behavior health issues and staffing. She told the group in about the last six years the staff has gone from 429 employees to just 186.

“We have all but one nurse that is a contracted staff for our emergency department. We cannot find staff that want to work in the ED where they are seeing a higher population of behavior health and the high number of violence we are seeing,” Conner said. “They are being abused and it has added additional financial burden to us that we have to have more security here.”

She said they call all over the state to find a bed for a patient in need of behavior health care but because of how the current legislation is written, even if facilities have open beds, they do not have to reveal the openings.

Jasper County Sheriff John Halferty went even further asking the representatives to make it mandatory to show there are beds available. 

“We have had ugly conversations, we’ve had disagreements and we want a good relationship with MercyOne here and unfortunately sometimes I have to dig my heels in and they have to dig their heels in,” Halferty said. “The problem is if we could just get them to a bed or a resource and not have to tie up their ER room for three, four, five days. Make it mandatory.”

Another area Halferty was passionate about is volunteers in rural fire and EMS departments. 

“It is absolute slap in the face to these first responders, and I am one, a volunteer fire firefighter and EMT, that the legislature refuses to give them, or they even want to argue $50. The first responders have to meet the same requirements that a career department does ... and to argue a $50 or $100 tax credit, and in fact, I think there was an argument to take it away. I was like, are you kidding me.”

He also praised Jasper County for its efforts to address people in crisis through the Mobile Crisis Unit and the coalitions that have formed to take the issue head on.

As each organization representative took their turn sharing their top issue, reimbursement continued to lead the list as major concern. Kirk Norris, CEO/President of the Iowa Hospital Association, said they are currently working on proposals to present to Senator Chuck Grassley on the national level.

“Three out of the top four issues are reimbursement. The fourth issue is staffing,” Norris said. “Our proposal, what we are saying is, let the smallest providers move to a new category, let the people like MercyOne Newton move into the category those people are leaving (and the allow them to use programs) like the 340B, so that financially they can get on sounder footing.”

Program 340B is a national drug pricing program that can substantially help medical facilities financially if they are allowed to participate. Currently, MercyOne Newton does not qualify.

Norris said they are working at pace to get the priorities before congress before the 2020 election season.

In Iowa, the local legislature resumes after the first of the year and Brown-Powers wants to be ready when the gavel hits.

“Our goal is to, when we get back in January to have a really good idea of what is going on in rural Iowa, what is working, what is not working and where some of our gaps are,” Brown-Powers said. “Then the charge for us is to look at legislation that actually makes sense for the rural areas and help rural Iowans.”

Contact Jamee A. Pierson at 641-792-3121 ext. 6534 or

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