Today’s story

Ryan Johnson at the Herald and I teamed up for this story, which would impact hospitals across the state.

MAYVILLE, N.D. – A proposed Medicare change is “ill-advised” and could force rural hospitals in North Dakota and across the country to cut services, Rep. Earl Pomeroy, D-N.D., said Wednesday.

The new rule would require a doctor to be present for outpatient therapeutic services, including blood transfusions, which now can be performed by other medical professionals who follow guidelines set by doctors.

Pomeroy was joined by Jonathan Blum, deputy administrator for the Centers for Medicare and Medicaid, as he toured the Sanford Medical Center in Mayville to see how the new rule could hurt North Dakota’s hospitals.

Dr. Jeff Anderson said he can understand setting a national guideline, but said the new rule also needs to make sense for rural hospitals with smaller staffs.

“We really couldn’t increase our staff any more, so if there were more requirements for staff, we don’t have a staff and, ultimately, we end up limiting services,” he said.

Pomeroy said it was important for Blum to get a firsthand look at rural hospitals so he could understand how the change could hurt health care quality.

“Some might think it’s always going to be better if you have a physician right there,” he said. “But if you’re taking the physician away from something else, it may not be better.”

Blum said he’s heard similar concerns from critical-access hospitals, institutions that provide essential medical services to rural communities and are reimbursed by Medicare.

“I think in terms of the program’s perspective, we have to set up rules on a national basis,” he said. “But at the same time, we have to be flexible for differences in health care across the country.”

Pomeroy said the proposal is set to go into effect in 2011 if there isn’t a change soon. The final decision could be made in November, which means now is “an extremely important time” in the process, he said.

But he’s hopeful that Blum’s only visit to rural hospitals to learn more about the potential impact will get the message across.

“North Dakota is going to be making the demonstration not just on behalf of our state but rural areas throughout the country because it all would be affected by this rule change,” Pomeroy said.

‘The right balance’

Earlier in the day, Pomeroy and Blum met in Bismarck with about 30 hospital officials from across the state.

The proposed physician supervision rule “will devastate us,” said Dan Kelly, CEO of McKenzie County Healthcare Systems in Watford City.

At least 19 North Dakota critical-access hospitals are trying to recruit 25 physicians, 12 nurse practitioners and seven physician assistants. Many hospitals will find it difficult – if not impossible – to meet the supervision requirements, he said.

“It’s a matter that I’ve got to have a provider 24/7, 365 to basically stand by,” Kelly said.

This is “quite frankly going to close a number of our facilities,” he said, adding that physicians will quit and hospitals can’t financially bear the burden.

Outpatient therapeutic services are within the scope of practice for licensed, skilled professionals, Kelly said. If something happens, physicians can be called and arrive within minutes.

Cooperstown Medical Center CEO Greg Stomp said it’s difficult enough to recruit physicians and their families to rural areas without a physician never able to be home “because they’re sitting there watching the nurse give somebody an IV.”

“It just doesn’t make sense,” he said of the regulation.

The purpose of health care reform was to lower costs, expand access and improve quality, said Chris Jones of Catholic Health Initiatives in Fargo.

“With this policy by itself, I think we can demonstrate beyond a reasonable doubt that the cost will go up significantly and, if you can’t get the physicians, we’re going to reduce access significantly, which in turn has that ripple effect down to quality,” Jones said.

Blum said it was valuable to hear the strong feelings on the issue and see people affected.

Blum said the comment that the regulation would undermine the goals of health care reform “really strikes home to me.”

The Centers for Medicare and Medicaid is still in the phase of taking comments on the issue, so it’s too soon to discuss final policies, Blum said.

“We’re generally interested in trying to find the right balance,” he said.