Nebraska rural health care roadmap aims to bolster, strength rural health

LINCOLN — A joint collaboration between the Nebraska Hospital Association and Nebraska Rural Health Association announced a roadmap Monday aimed to improve rural health care.

Jeremy Nordquist, president of the hospital association, and Jed Hansen, executive director of the rural health association, announced the “Roadmap to Strong Rural Health Care” along with three medical center CEOs from Wahoo, Falls City and York.

“This roadmap is a guide for state and federal public officials on actions that are needed to protect rural health care services in rural communities across Nebraska,” Nordquist said.

‘At risk’

Nordquist said rural health care is at risk and suffering — like other industries — because of  inflation and workforce challenges.

However, rural health care has been hit especially hard by the COVID-19 pandemic in recruitment and retention, Nordquist said, even as hospitals supported more than one in every 12 rural jobs nationwide in 2020.

“Simply put, investment in rural health care is an investment in the future of Nebraska,” Nordquist said.

Hansen said rural health systems experienced a 20% increase operationally in per-patient costs, an “unsustainable” increase in unfavorable financial environments.

Health care workers also must contend with an aging population, he continued, as well as struggles with treating mental health and with transportation costs.

“Ultimately, the goal of the rural roadmap is to provide relief now and to work towards stability and sustainability of our state’s rural health care systems now and in the future,” Hansen said.

‘Not sustainable’

Julie Rezac, CEO of Saunders Medical Center in Wahoo, said a lack of behavioral health and substance abuse professionals on top of a nursing shortage — expected to reach 5,435 nurses by 2025 — requires a sufficient workforce boost.

Rezac pointed to three specific bills in the Legislature that would accomplish this: Legislative Bill 586 by State Sen. Jana Hughes of Seward to expand clinical training sites for nurses across the state, Legislative Bill 610 by State Sen. Loren Lippincott of Central City to fund career and technical education programs for the State Department of Education and Legislative Bill 128 by State Sen. Myron Dorn of Adams to increase reimbursement rates for inpatient and outpatient hospital services.

Nordquist said Dorn’s legislation would increase rates by 9.6% in the next fiscal year and 7.7% the following year. This is the largest increase the associations have asked for with a 20-year average increase ask at 1.56%.

“We don’t come to make this ask lightly,” Nordquist said. “We ask because we’ve seen these costs explode, and our bottom lines just are not sustainable.”

Nordquist also pointed to Legislative Bill 149 by State Sen. Mike Jacobson of North Platte to support behavioral health capacity and previous legislation passed by State Sen. John Lowe of Kearney for a new rural health complex between the University of Nebraska at Kearney and University of Nebraska Medical Center.

Taking care of rural America

Ryan Larsen, CEO of Community Medical Center in Falls City, emphasized the need for oversight of Medicare Advantage plans so hospitals and doctors can be fairly reimbursed and patients understand what they’re getting.

“I love rural America. I love rural Nebraska,” Larsen said. “I want to make sure we are all around to take care of our rural citizens.”

Jim Ulrich, CEO of York General in York, added that without additional support, hospitals have to make difficult financial decisions, which can come at the cost of cutting services.

Larsen detailed his center’s decision to end labor and delivery services at the end of 2019, which means mothers may have to decide to cross the border into Kansas (where Nebraska Medicaid may not always work well, he said) or a one- or two-hour drive to Nebraska City or Lincoln, respectively.

‘Strong rural Nebraska’

Hansen said 14% of total employment is tied to health care directly or indirectly, with every dollar spent in rural hospitals bringing an additional $2.30 to the global economy.

By addressing the challenges in the industry and minimizing the miles needed to bring life-saving care to farmers, ranchers, educators, business owners and other Nebraskans in rural parts of the state, Hansen said the whole state will benefit.

“Strong rural health equals a strong rural Nebraska,” Hansen said.