Q&A: Rural Pa. hospital CEO talks about how Medicaid cuts would pinch healthcare system
Bethany Rodgers- Republican lawmakers are considering cuts to Medicaid, which could impact rural hospitals in Pennsylvania.
- Fulton County Medical Center, a rural hospital in Pennsylvania, relies on Medicaid for about 25% of its revenue.
- The hospital's CEO fears that cuts to Medicaid could force them to scale back services and potentially close the attached nursing home.
GOP lawmakers in are hunting for ways to slash federal spending, a process that could mean cuts to Medicaid programs that support more than 3.1 million Pennsylvanians.
Health advocates and Democratic lawmakers in the Keystone State have warned that cutting Medicaid could have serious consequences, among them the potential impact on rural hospitals. Many of these rural hospitals are already operating in the red, and federal funding reductions could further erode their revenues.
Mike Makosky, president and CEO of the Fulton County Medical Center, spoke to the USA TODAY Network about how the loss of federal dollars might undermine his hospital's ability to provide health care in this rural southcentral Pennsylvania community. The interview has been edited for length and clarity.
Question: How significant are Medicaid revenues for your hospital?
Makosky: Well, they're pretty significant. I would say that Medicaid is probably about 25% of our payer mix, with Medicare being about 50(%) or so, and the rest being insurance or self-pay.
What are some of the financial challenges you face at Fulton County Medical Center?
Of course, payment is a challenge. Being a small, rural hospital, we do our own billing, and we have to fight with the insurance companies for payments. Medicaid and Medicare payments being cut doesn't help us because inflation drives up the cost, but yet we only get paid whatever our payer contracts are. And our payer contracts typically don't go up every year.
And with the Medicaid, we get about 74 cents reimbursement for every dollar we spend to care for a Medicaid patient. ... And if Medicaid does get cut, then it's going to go even less than the 74 cents that we're getting paid now.
We also have a long-term care nursing home attached to the hospital that we operate, and long-term care is very Medicaid-dependent. We have a 67-bed nursing home, but we only have 50 right now because we don't have the staff to bring our census back up to our full capacity. So if that Medicaid payment drops any more … we may have to make some decisions about our nursing home, too. Hopefully, it doesn't come to that.
How closely have you been following what’s going on in D.C. with Medicaid? And how would cuts impact your hospital?
Well, I try not to look at too much of it, because it is kind of depressing and you can lose yourself in it, to tell you the truth. But we’ve calculated about 15% less revenue or less dollars (if the cuts were passed). So it would definitely make an impact on us.
And of course … if inflation, salaries, wages, cost of medication, those things keep going up and up and up, a 15% cut to (Medicaid revenue) would really make a difference.
If the cuts go through, how do you think you would absorb that?
We probably would have to scale back some of our clinical services.
Can you talk about the importance of your hospital to your community and the availability of other services?
There's a lot of farm country around us — cattle and corn and that kind of thing. … We're about 35 to about 65 miles from the closest larger hospital. … We're a trauma center IV, which means that we keep a lot of the services readily available 24-hours-a-day in case a trauma comes in. It is very important in a rural hospital to have an emergency room that's competent and stays staffed.
Like, for instance, almost a year ago, we had a farmer that came in that got caught in the machinery and ended up in really bad shape with his leg. We just so happened to have a lot of our specialists here that morning. They were able to stabilize the patient … and get him up on the helicopter to a higher level of care. And really save that patient's life.
Those things happen quite often, and if we weren't here and that patient had to drive 35 to 75 miles away to another emergency room, they wouldn't have made it.
Without us being here, then, there’d be a very much higher mortality rate in our area. Our service areas is not big — it's about 15,000 lives. But when we’re needed, we’re needed.
Based on your experience, how do you feel about the future of rural hospitals?
That’s a tough question. I hope that there are solutions.
I really fear, though, that the bigger healthcare organizations are going to eventually take up all of the small rural hospitals. Not only in the state, but everywhere. And we're going to see the rural hospitals really a shell of themselves in the future, because the resources are going to be at the larger hospitals.
People in rural areas, they're not really going to want to travel to the city to see a urologist or to a cardiologist. … You come to our hospital today — we don't have a parking garage. It's an easy walk from our parking lot to the main entrance. You walk right in, and services are right there.
A lot of people in rural areas, they don't want to travel to the congestion of the city. … I just fear that if small rural hospitals aren’t vibrant like most of us are today, then we're going to see deterioration of people’s health in the future.
Bethany Rodgers is a USA TODAY Network Pennsylvania investigative journalist.