Governor Mike Parson Thursday morning signed Senate Bill 1359 into law. The headline on our websites declared, “Governor signs bill impacting rural hospitals.” What that impact will be we won’t know for some time.
SB 1359 was not without controversy, and Parson heard from a lot of people about the portion of the bill that will, according to some people, allow Phelps Health an open door to compete with Salem Memorial Hospital on SMH’s turf. A lot of SMH folks felt so strongly against it they organized an online campaign to urge Parson to veto the bill.
Problem is, the portion of SB 1359 that allows Phelps Health, a county hospital based in Rolla, to openly compete with SMH in Dent County, is a miniscule part of the bill. It sailed through.
The SMH form letter read in part, “allowing larger outside health systems to enter our special hospital district poses significant risks. These entities often prioritize financial returns over patient care, which can lead to reduced services, higher costs for patients, and potential closures of unprofitable departments.”
In other words, if Phelps Health comes in to Dent County and tries to cherry pick profitable services and leaves SMH with services that don’t make profit, SMH probably wouldn’t last long. To add to the angst, SMH is already trying to survive, millions of dollars in debt and battling issues too numerous to list here.
I spent part of Friday talking to Tara Peters (R-Rolla) and Ron Copeland (R-Salem) about not only SB 1359, which Peters sponsored and Copeland vehemently opposed, but where health care in our communities goes from here. It isn’t going to be easy, but then again health care all over isn’t easy these days. We need to quit talking about SB 1359 and start talking about all of our health-care entities working together.
I am encouraged. Peters and Copeland – though they aren’t exactly seeing eye to eye right now – both agree that the most important thing going forward is not what impact SB 1359 might have on area health care, but how Phelps Health, SMH and all the other folks who deliver health care around these parts can get together and do what’s best for you and me.
The list of providers in Dent County seems to grow every day. Besides Phelps Health, dominant in the region when it comes to health care and already having a clinic in Salem, there are Four Rivers Community Health Center (about to build a new clinic in Salem), Mercy (has a clinic in Salem) and Dent County Health Center. The health center is on the grow, as evidenced by a listing of services on its website.
I am further encouraged from the talk I am hearing – on and off the record – from health care and community leaders. They realize what’s at stake. They realize that if I have a heart attack in my rural Dent County home this weekend, I will likely need care long before I get to Rolla. They realize some health care services pay for themselves and some don’t.
If SMH doesn’t make it financially over the next few months, maybe a year from now, and someone else has to take over and run the health-care show in Dent County, Phelps Health is the best choice. No, Phelps Health isn’t going to come in here next week or a month from now and steal enough business way from SMH to put it under. If SMH goes under, it’s because the business model for that type of hospital doesn’t work anymore. Rural hospitals are failing all over the country, and it will take lots of federal or state dollars to stop the downfall.
People need to quit blaming leadership, billing, the board, the professionals on staff or Rural Health Group – or now SB 1359 – for the demise of SMH, if that’s what happens. Good people at SMH are making a good effort to succeed.
But.
If SMH affiliates, sells or combines – or whatever they want to call it – with Phelps Health, there will be a hospital in Salem and Dent County for a long time to come.
If SMH continues to go it alone and tries to overcome the financial hardships, difficulty in recruiting and maintaining staff and the near impossible task of having enough left over for capital improvements, they might make it. Or they might not. It’s a gamble, and the stakes are a hospital – a matter of life and death, really – for people in Dent County and communities south and east of the county that depend on SMH. If SMH gets too deep into red ink, there is a chance no one will take it over.
Simply put, you have pretty close to a sure thing with a Phelps Health/SMH combined effort and a long shot with SMH going it alone.
I’d like to say I have tremendous insight, and all of what I just wrote is a result of my keen awareness of health care and the finances involved in making it work. But that’s not the case. I have talked to people – lots of people who know about health-care finances, laws and structure – over the past few months. Most all of them say the same thing when it comes to the future of a hospital in Dent County.
Over the past seven years, since we started the Phelps County Focus, I have had the privilege to work closely with the good folks at SMH and Phelps Health. You would have to go a long way to find people who care more about providing good health care to their communities than the staffs at those two places.
The prospect of the two combining in some fashion might give us the best of both health-care worlds and ensure there is a hospital in Dent County tomorrow and beyond. No doubt Phelps Health has the ability to recruit health-care professionals, the expertise to collect bills and pay bills, keep up with laws and technology, make capital improvements and do all the things it takes to have first-class health care in the community. Any community.
Phelps Health is county-owned, non-tax supported and is overseen by a five-member elected board. Ironically, three of the five have some sort of tie to Salem and Dent County. One of those three, doctor Tony Kaczmarek of Rolla, is a Salem native. Phelps Health employs almost 2,000 people, including 100-plus providers. The hospital is licensed for 240 patient beds, with clinics in Salem, St. James, Vienna and Waynesville. When it comes to picking somebody to help you out, you can’t get much more local or knowledgeable than Phelps Health.
Back to SB 1359.
“The rumor is that we're trying to close local hospitals,” Peters said a few weeks ago when the furor over SB 1359 came to light. “That is not true. This bill helps rural hospitals. All of my legislation this year is actually to promote (rural hospitals).”
As far as SB 1359, Peters went on to say there are safeguards in the statute that will not change, saying there are two hurdles for county hospitals with intentions of building in a community: county commissioner approval and a certificate of need.
SB 1359 got the headlines around here for obvious reasons, but another bill will impact rural hospitals.
A bill favoring Missouri pharmacies and health care providers in a national dispute with drugmakers became law July 7 without Parson’s signature, according to a story by the Missouri Independent.
The legislation bars pharmaceutical manufacturers from limiting where they will deliver drugs purchased at a discount under a federal program intended to help providers serving people in rural and high-poverty areas or with specialized health needs, according to the story.
It allows medical providers qualifying for the program, known as the 340B Drug Pricing Program for the section of federal law where it is found, to enter contracts with an unlimited number of pharmacies to dispense the drugs to their patients.
The bill is “flawed,” Parson wrote in a letter explaining his action, but ultimately is better for patient access and affordability than if he vetoed it. He had 45 days – until July 7 – to make his decisions and any bill not signed and not vetoed becomes law as if he had signed it. Parson did not veto any bills.
The Missouri Hospital Association, in a statement following Parson’s action, said the legislation will maintain access to essential medications.
The program is essential for keeping rural providers open and giving patients access to prescriptions near their homes, Joe Pierle, executive director of the Missouri Primary Care Association, told Missouri Independent.
“This whole contract pharmacy (issue) is really about allowing us to contract with local pharmacies so that patients in the Mark Twain National Forest can drive a mile or two to pick up a prescription instead of having to traverse the hills and mountains down there, which are difficult to navigate, to sometimes go to a different county to get the drugs,” Pierle said.
SB 1359 and the pharmaceutical bill are getting headlines now, and lawmakers and a bunch of lawyers and judges will no doubt sort it all out in the future. Meanwhile, we continue to play a health-care version of musical chairs with the viability of Salem Memorial Hospital.
One thing is for certain, and that is the best way forward for health care in our region is not to get into an Old West-style financial shootout among those who provide it, but for everyone to come to the table and determine what’s best for the people in our communities. I truly believe that is what’s going to happen.
