Sebelius stopped at St. John's Hospital-Aurora on Monday to participate in a forum on rural health care services, as part of the ongoing work of the new White House Rural Council. After stopping in Joplin in the morning and visiting with Governor Jay Nixon about the ongoing recovery from the May 22 tornado, Sebelius hosted a roundtable discussion in Aurora about delivery of healthcare in rural areas.
Doug Stroemel, St. John's West Region president over the Aurora and Cassville hospitals, served as host. He introduced Sebelius as heading an office that daily impacts the quality of life around the nation.
New initiatives, such as a coordinated effort by the National Health Services Corporation working with businesses, encouraging providers to work in underserved areas and converting records to an electronic format to make them more available all improve the delivery system, she said.
A number of leaders in the field were present to participate in the discussion. Sebelius introduced Judy Baker, the HHS regional director based in Kansas City. Several local healthcare professionals were present as well, including St. John's physicians Brad Garner, Connie Butler and Jaime Zengotita, who were introduced by David Barbe, president of the Mercy system which includes the St. John's hospitals.
Barbe said rural areas face a greater impact from an aging population and a challenging economic situation where a higher proportion of the population lives in poverty. Both factors result in southwest Missouri having a higher population on Medicaid than other parts of the state. Factors, such as obesity and diabetes, have a higher impact on such a population, he said.
Rural hospitals provide access to care, Barbe said, and many small rural health clinics get higher reimbursement rates from Medicaid. While new physicians still face a debt load of $150,000 to $200,000 coming out of school, unlike any other profession, debt forgiveness for working in rural areas would improve service delivery.
Kay Kahre, a lifelong Aurora resident who has used local hospital services from minor surgeries to cardiac rehabilitation, spoke about the value of having such resources close by to her.
Tim McBride, with the Rural Policy Research Institute in St. Louis, said Institute's health panel has conducted a non-partisan analysis of health services. With quality of life issues such as higher poverty rates, rural areas have a great deal in common with inner cities, including higher insurance rates.
McBride said the economic downturn has decreased employment generally, but at the same time, healthcare employment has risen by 1 million people or 7 percent. Provisions of the Affordable Care Act are helping to bring more healthcare providers to rural areas. The proportion of physician-to-population numbers will be coming down to one for every 1,800 people in rural areas, compared to one for every 900 in urban areas.
"The Affordable Health Care Act is doing a lot to help rural America," McBride said.
Tina Reeves, from Access Family Care in Cassville, spoke about the challenges of providing for the underserved. Keeping people healthy often requires follow-up care, which is difficult to provide for those without insurance or on Medicaid. Providing dental care has been particularly challenging, she added.
David Sater, 68th District state representative from Cassville, asked Sebelius how the state was going to be able to afford managing an increase of 200,000 to 250,000 more people on Medicaid without more federal support.
Sebelius acknowledged that federal support for Medicaid will decline by 10 percent a year, beginning in 2014. The cost, however, comes from people with no insurance going to emergency rooms, a cost kicked on to taxpayers that totals $8 billion nationwide. The lack of preventative care also contributes. Changing the system will ultimately relieve the expense, which is critical to do now, when 12 million baby boomers each year are reaching retirement, she said.
Sebelius cited two ways to address healthcare costs. The first has been shifting the expense from the federal government, leaving someone else to pay. A better solution, she said, is looking at the underlying costs. HHS has set higher quality standards for hospitals to reduce infections. Instead of simply paying for tests, quality outcomes will be tracked. The Medicare and Medicaid pay systems will be used to reward better outcomes.
"We pay little over twice as much as any other country in the world [for healthcare], and we don't have health outcomes that are very good," Sebelius said. "Doctors can be doctors again, not clerks. There are practices that have lower costs and better outcomes. We think better outcomes is the way to go."
Sebelius said seven out of 10 deaths are related to chronic disease. Strategies, such as lowering smoking, through new regulations on targeted tobacco advertising and reformatting school lunch programs to target obesity, are multi-year efforts that will have long-term benefits.
"We are providing tools to make better choices," Sebelius said.
Sebelius plans to travel the nation looking at innovations that will improve the healthcare system and enhance rural care in particular.