Columnist points out rural America's heavy reliance on Social Security, Medicare and Medicaid

The latest offering from syndicated agricultural columnist Alan Guebert, right, delves directly into politics, starting with Mitt Romney's choice of U.S. Rep. Paul Ryan as a running mate. The Wisconsin Republican's "biggest reform ideas take dead aim at America’s three costliest social programs, Medicare, Medicaid and Social Security," Guebert writes. "Any change in either or all will have profound effects across farm country because rural America relies more heavily on all three than the nation’s urban areas. According to a November 2011 study by the National Academy of Social Insurance, 9.3 percent of 'total personal income' in rural counties comes from Social Security. By contrast, Social Security is just 5 percent of total personal income in urban America.

"Moreover," Guebert notes, "Social Security is the economic lifeblood of many rural counties. For example, Orangeburg County, S.C., gained $232 million of income -- or about $1 billion in overall economic activity -- in 2009 through Social Security. The story is the same for Medicare and Medicaid’s impact on farm and ranch country. While one in six, or 49 million, Americans, receive Medicare benefits, 12 million -- or one in four of those beneficiaries -- live in rural America. And that number is growing; 15 percent of rural America is 65 years old or more while just 12 percent of urban Americans are senior citizens."

Medicaid covers 16 percent of all rural residents and 35 percent of all rural children up to 18. The urban numbers, respectively, are 13 percent and 28 percent. Six out of 10 rural nursing home residents receive some form of Medicaid, and it is estimated that 56 percent of all rural physician income and 60 percent of all rural hospital cash flow is tied to Medicare and Medicaid. (To see all the documents used in this story, go here.)

Rural hospitals urge Congress to save two Medicare programs that help them

A coalition of rural hospitals are lobbying Congress to keep two Medicare programs that the National Rural Health Association says are vital to keep hundreds of smaller hospitals going. The Medicare Dependent Hospital designation and the Low-Volume Hospital Adjuster, which date to the 1980s, help keep low-volume rural hospitals' doors open with the Medicare payment adjustments they provide, according to the NRHA.

Both programs could end Oct. 1 without Congressional action. "Rural facilities do not have the financial background to weather all of these cuts," said Lance Keilers, NRHA president and administrator of Ballinger Memorial Hospital in San Angelo, Tex., told Brendon Nafziger of DOTmed News, an online magazine serving the medical and medical equipment industry.

More than 200 hospitals have the Medicare Dependent designation. To qualify, a hospital must have fewer than 100 beds and Medicare patients must make up 60 percent of its inpatient days or discharges. Low-volume hospitals must be at least 15 miles from another hospital and provide care for fewer than 1,600 Medicare beneficiaries a year. (Read more)

Safety-net hospitals could get hit hardest when Medicare reimbursement changes in October

When hospitals start getting paid based on the quality of care they provide to their Medicare patients, so-called "safety net" hospitals, a last resort for the poor, could be the losers in the equation. That's because a main way of measuring quality will be patient experience ratings, and safety-net hospitals tend to get poorer marks from patients, according ta new study published in the Archives of Internal Medicine.

Since hospitals have had to publicly report their patient experience ratings, the gap between how patients rated these facilities and the scores that other hospitals got widened. "We found that [safety-net hospitals] performed more poorly than other hospitals on nearly every measure of patient experience and that gaps in performance were sizeable and persistent over time," the authors write.

When the Centers for Medicare and Medicaid Services agency starts using the scores to hand out bonuses and penalties, safety-net hospitals could be at a disadvantage, especially since penalties could mean a 2 percent cut on regular Medicare payments. Starting in October, patient experience scores will determine 30 percent of a facility's bonus. "The hospitals that perform best will gain money, while those that lag in scores and improvement over time will end up with less," reports Jordan Rau for Kaiser Health News. (Read more)

Rural health advocates object to federal report that suggested ending special payments to rural hospitals

The National Rural Health Association and a coalition of Medicare-dependent rural hospitals say a recent report that found payments to rural doctors are "at least as adequate as those made to urban physicians"and "some special payments to rural hospitals should not be continued" is inaccurate and "harmful to rural Americans," the Daily Yonder reports.

The report came from the Medicare Payment Advisory Commission, "an independent congressional agency given the job of reporting on functioning of Medicare." The groups say 77 percent of rural counties are defined by the Rural Health Research Center as having a shortage of health professionals, and 164 counties have no primary-care physician. And they point to a 2011 federal report which found that “Rural areas have higher rates of poverty, chronic disease, and uninsurance, and millions of rural Americans have limited access to a primary health care provider.” Moreover, the groups say that a recent study found that 35 percent of all rural hospitals lose money.

Alan Morgan, CEO of NRHA, said “Rural patients and providers will ultimately pay the price as rural hospitals will be forced to eliminate services or close their doors if this report is enacted." (Read more)

Study finds rural health care only a notch behind, with certain advantages over urban care

A new report has found a narrow gap between the quality of health care in rural and urban settings, but the study does recognize the "significant differences" differences between urban and rural care.

The report is an update to "Rural Relevance Under Healthcare Reform: A Tracking Study," by iVantage Health Analytics, and evaluates performance measures across physician, outpatient, hospital and emergency room settings. According to a press release, the report reveals that in Medicare could save about $7.2 billion if costs per patient were the same in rural and urban settings. The report also finds that for rural patients, physician payments are 18 percent lower and hospital payments are 2 percent lower than in urban areas, but outpatient payments are 14 percent higher. The overall cost per Medicare patient is 3.7 percent lower for rural patients.

Rural emergency care is faster overall than urban emergency room care, with rural patients seeing a doctor 30 percent faster (once the patient gets to the hospital, we should add). This results in fewer hospital admissions. The full report can be accessed here.