Painful Choices: Rural Care Pits Profits Against Access

Three companies tried to make money running the Washington County Clinic – Banner Health Care, Rose Medical Center and Colorado Plains Medical Center.

All failed, said nurse practitioner Becky Hutcheson.Hutcheson treats patients at the clinic four days a week because there is no doctor available.

“When (Colorado Plains) bailed,” said Hutcheson, “it fell to the county commissioners to take it over.”

They did so in remarkable fashion, said Denise Denton, former head of the Colorado Rural Health Center. The Washington commissioners placed a new 1.5-cent sales tax on most purchases made in their county and used the money to pay for the clinic, a nursing home and an ambulance service.

No one would dare utter the words “socialized medicine” in the Republican stronghold of Washington County. But the commissioners wanted medical facilities in the county seat of Akron and a tax increase looked like the only option.

Denton called that realization a model for other rural areas.

“At some point, we decided as a country to educate rural children and tax ourselves to pay,” said Denton, who now serves on the Colorado Rural Health Care Grants Council. “We need to do it for transportation and health.”

Hutcheson, who commutes 30 miles from Brush to work in Akron’s Washington County Clinic, agreed.

“There were doctors out here,” Hutcheson said of the mid 20th century. “This little town used to have a hospital. It’s now a nursing home. The hospital closed. People are still upset they lost their hospital.”

County leaders simply decided that they couldn’t lose their clinic. But Medicare, the government health insurance program for the elderly, and Medicaid, the government health insurance program for the poor, cover roughly 75 percent of the clinic’s patients. Reimbursement rates for both Medicare and Medicaid are so low that many private doctors refuse to accept patients covered by either program.

It gets worse. Of the roughly 25 percent of Washington County Clinic patients not covered by Medicare and Medicaid, about 15 percent have no insurance and no ability to pay for their care, Hutcheson said.

All told, just one in 10 clinic patients has private health insurance.

That’s the kiss of death for making money.

It is also a way of life in rural Colorado and remote counties across America.

The challenge, said Denton, is to own up to that fact and make changes that insure access to health care. According to Denton, Washington County did that and other rural counties are beginning to do so by forming special taxing districts whose collections pay for health care.

Doing nothing is not an option, at least as far as public health is concerned, added Clint Cresawn, the work force programs manager at the Colorado Rural Health Center.

“There are places where access to care is so limited that some people don’t get care,” he explained.

“We focus on primary care, the sort of stuff we need day-to-day.”

Hutcheson and other non-doctors have become the ones who deliver much of that care. They do a good job when the patients can actually get to them.

But statistics from the Colorado Health Institute show that in rural counties there is not only a critical shortage of doctors, but of all kinds of advanced medical professionals, such as nurse practitioners and physician’s assistants.

The health institute reports that in 2006 Jackson County had just three registered nurses. Mineral County had just five RN’s, Hinsdale County six and San Juan County eight.

None of this bodes well for the people living in rural areas.

“A really big issue,” said Denton, “is a lack of public transportation to get to care.”

No access to health care means “no access to early detection of disease,” Cresawn added. No early detection means problems that “are a lot more expensive to treat.”

“Mental health and dental care are both huge needs,” Cresawn added.

In sum, it adds up to an urgent problem with which Colorado and the rest of America wrestles as the country tries to fix its broken health care system.

“Years ago, doctors would move to town, raise families and stay,” Hutcheson said of Akron. “They don’t do that now. I don’t even know a doctor who lives in the county.”

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Jim Spencer

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