Rural Hospitals Innovate To Fight Off Closure; Iodine Industry Wants Disposal Well Changes
Proposed cuts to Oklahoma’s Medicaid reimbursement rate that could be as high as 25 percent are threatening the services offered by rural hospitals across the state.
As we’ve reported, dozens of hospitals in Oklahoma are vulnerable to closure. These rural patients tend to be poorer, and rely more on Medicaid and Medicare to pay for care. Many of the buildings are more than 50 years old, which means they’re not cheap to maintain. But a new designation could help them keep their doors open, The Journal Record’s Sarah Terry-Cobo reports:
[Oklahoma Hospital Association] Vice President of Rural Health Andy Fosmire said he’s worked with several state industry trade associations to create an alternative business plan, dubbed the 24-hour outpatient model. The proposal would close in-patient services and emphasize outpatient services, including primary care, physical therapy and behavioral health, based on what the community could support. Those outpatient services would help offset the cost of emergency departments, which typically lose money, he said. Hospitals would have minimal staff during the overnight shift. Under the plan, a physician, physician assistant or nurse practitioner on call must be able to arrive within 20 minutes, while a registered nurse would triage patients in need, using a videoconference service to consult with a physician while the on-call provider is en route.
The federal Medicaid and Medicare systems reimburses these facilities based on what kind of hospital they are, and the federal system doesn’t have a designation for this rate yet, says The Journal Record’s managing editor Adam Brooks.
“It's also hard for hospitals because it's not proven. Nobody's done it. It means cutting staff, which is a hard choice for anybody,” Brooks said. “And it means maybe people have to drive hours to get their care. But to keep the doors open, that could be worth it for communities.”
Few hospitals have moved to this so-called 24-hour outpatient model, so there’s not a lot of evidence it will work. Hospitals are also skeptical of trying something so drastic, Terry-Cobo writes:
Jahni Tapley, the McCurtain Memorial Hospital CEO said it would be too costly to transfer patients, because she’s nearly two hours from the closest Oklahoma hospital. The nearest treatment centers are in Texarkana and Paris, Texas. But those facilities won’t accept Oklahoma’s Medicaid, she said. She’s sustained $10.2 million in federal cuts to Medicare, and 26 percent of patients don’t pay for services. Since 2013, she’s laid off staff, consolidated departments and furloughed employees one-half day every two weeks to save money. As long as she doesn’t have any major equipment purchases, they can continue running on thin margins. But if a $250,000 machine broke down, they wouldn’t be able to replace it.
In northwest Oklahoma, the Woodward Iodine Corporation wants the Oklahoma Corporation Commission to ease disposal well restrictions to make their operations more efficient.
“They use the petroleum formations to get iodine. Then they have to dispose of wastewater. They don't use oil and gas, but they still have to dispose in similar wells,” Brooks said. “Because of the volume of the wells, the iodine company we talked to has annual monitoring, and that costs them workdays and then even more time if there are problems with the wells.”
The company has asked the OCC to lower the permitted volume on several of these wells in order to limit the interruptions to their operation.
Any well that’s rated for more than 25,000 barrels a day must conduct integrity tests every year. The well is shut down, and pressure equipment is attached. As long as no issues are found, the disposal well is out of service for a day or two, he said. The company has at least 12 injection wells, according to Oklahoma Corporation Commission records. [Woodward Iodine Corp. president and CEO Leroy] Goodman requested that the OCC lower the permitted volumes on six disposal wells to less than 20,000 barrels per day. A well only has to be tested every five years at that level. He has received permission on some of those wells, but not all, he said.
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