Buchanan and Rural Health


October 26, 2022


Dear Editor,

After having the pleasure of serving in rural communities as a healthcare administrator for over 37 years, 25 of which were spent in Glasgow, MT, I have a keen interest in the health of rural communities and the organizations that serve to meet the healthcare needs of those communities. Nationally, access to health care in rural communities faces a crisis situation as rural hospital closures increase. According to the Center for Quality and Payment Reform (CQPR), over 150 rural hospitals closed between 2005 and 2019. Another 19 rural hospital closures occurred in 2020 alone, the highest number of rural hospital closure in a single year over the previous decade. In addition, another 600 (30 percent of all rural hospitals) are at risk of closure because of poor reimbursement from third party payers and increased cost of operations partly driven by workforce shortages and the resulting increase in wages, salaries, and benefits. In Montana, twelve (12) rural hospitals are at risk of closure. It is, therefore, disappointing when a member of our Congressional delegation votes against legislation that seeks to address Federal policy which can help alleviate the pressures on access to healthcare in Montana.

The Critical Access Hospital program which, in part, originated out of a Montana based demonstration project, came into existence through the Balanced Budget Act of 1997, and served for a long time, to provide some stability to rural hospital operations throughout the country by providing a separate Medicare reimbursement formula for Critical Access Hospitals. Essentially, Critical Access Hospitals were afforded payment at 101 percent of the cost of providing care to Medicare beneficiaries. This helped stabilize operations of rural Critical Access Hospitals and provided assistance in acquiring and deploying the ever-changing technological advances the public expects. The program isn't a panacea, but with most rural hospitals serving a disproportionate number of Medicare patients, the Critical Access Hospital designation served as a great support to operations. This support was essentially eliminated with the advent of sequestration which took effect in 2013 and reduced Medicare payment to hospitals, including Critical Access Hospitals, by two percent thereby reverting Critical Access Hospitals to being paid at a rate lower than what it cost to care for Medicare patients.

There was a legislative effort to eliminate sequestration of Medicare payment though the Protecting Medicare and American Farmers from Sequester Cuts Act of 2021. Fortunately, the act passed and was eventually signed into law, but unfortunately, it did so without the support of Representative Matt Rosendale.

In a day and age when politics on all sides have become too polarized, Montana needs common sense representation that puts Montana's interest ahead of the agenda of the representative's political party. That is why I am supporting Gary Buchanan who I believe is best suited to represent the needs of all Montanans.


Randall G. Holom


Corvalis, Mont.


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