Tuscaloosa, Ala. -- Helena Smith, and her husband Neal, drove nearly two hours one-way from Wilcox County to Tuscaloosa to see their cardiologist.
“We both have problems with our eyesight, Smith said. “When it’s raining really hard, or it’s icy, it’s difficult.”
Nada Memon, M.D., who specializes in cardiac electrophysiology, has been Helena’s doctor for several years here at DCH Regional Medical Center. Dr. Memon often sees patients from rural areas. She often checks in with them by phone and maximizes what’s done during each appointment. Scheduling is important, too. Helena needed to come in early.
“Strategically planned visits,” Dr. Memon said. “They’re earlier in the day so she can get here, get taken care of, and go home before it gets dark out.”
The John Paul Jones Hospital is in Camden, in Wilcox County, where the Smith’s live. It’s one of the poorest counties in America. The hospital is a 23-minute drive from the Smith’s home. It almost closed before a one-cent sales tax increase helped save it. The hospital now has a management agreement with the UAB Health System. But, it still doesn’t have a cardiologist.
“You feel that good healthcare should be available for everyone,” Smith said.
Specialists tend to work in larger cities. The patient volume and specialized equipment is there to support their practices. But there’s another problem facing rural areas.
88% of rural Alabama hospitals are losing money
According to the Alabama Hospital Association, seven rural Alabama counties don’t have a hospital, six rural hospitals have closed in the state since 2011, and 88 percent of rural hospitals are losing money.
One of the reasons: Rural Alabama hospitals receive the lowest Medicare reimbursement rates in the country. That’s due to a federal wage index formula that’s based on differences in hospital labor costs nationally.
According to the Alabama Hospital Association, Medicare is paying hospitals in states like California nearly three times as much for providing the same care as Alabama’s rural hospitals.
“For our rural hospitals, we are standing on a precipice. And unless we get relief, we’re going to get a number of closures over a year to two years,” said Dr. Donald Williamson, M.D., chief executive officer of the Alabama Hospital Association.
Despite the limited healthcare services available to her, Helena has no plans to move to a larger city.
“To me, a simpler way of life offers so much more. So, much more to a person than living in a city. I just don’t care for it,” said Smith.
It will literally take an Act of Congress to fix Medicare’s wage index issue.
And even if that happens, it would take at least a year for Alabama’s rural hospitals to receive higher Medicare reimbursement rates.
Meantime, the Alabama Hospital Association says Medicaid expansion would be the lifeline that would keep rural hospitals open while the Medicare wage index issue is addressed.
Look for discussions about that to come up in Montgomery over the next few months.