Getting health care in rural Connecticut isn’t always easy, especially because of transportation, staffing and revenue issues, according to industry leaders, advocates and state officials who gathered at the University of Connecticut in Storrs on Monday to discuss barriers to care.
“One of the biggest issues around equity is that people think that most of the problems in health care are in urban areas,” said Lynne Ide, a director at Universal Health Care Foundation of CT.
Ide noted that many people in the state government don’t understand the issues facing rural residents.
“There are many low-income people in the northeast corner of the state. And we have some of the highest comorbidities of any region in the state,” she told the group of roughly 30 officials.
Over the two-hour discussion, transportation, workforce and reimbursement rates surfaced repeatedly as key issues affecting health care delivery.
“The transportation piece is gigantic,” said Kyle Kramer, chief executive officer of Day Kimball Healthcare in Putnam and the surrounding area.
Kramer explained that public transportation in the northeastern part of the state is inadequate. “While it is available, it is not reliable,” he said, also noting that the availability of taxis, Uber and Lyft is extremely limited.
Several participants also raised the issue of staffing, a challenge that has only been exacerbated by the pandemic. John Brady, executive vice president of AFT CT, said the union is working with the legislature to improve the situation.
“We are losing staff, especially nurses, because of working conditions,” said Brady, adding that nurses feel overwhelmed by the number of patients in their care and are anxious that they cannot provide adequate care. He added that by improving those conditions, Connecticut could not only improve retention of nurses that already work here but also attract talent from other states.
John O’Keefe, chief nursing officer with Day Kimball, also raised the issue of travel nursing, which has significantly increased competition for talent facing hospitals. Travel nursing allows nurses more location flexibility but can also offer triple or quadruple the salary that a permanent position at a hospital would pay.
“They’re talking significant salary changes,” said O’Keefe, calling travel staffing agencies the competitors “in our own backyard.”
Low Medicaid reimbursement rates, an issue that the legislature is attempting to tackle this session, also came up.
Kramer, Day Kimball’s chief executive officer, said that 70% of the hospital’s patient revenue comes from Medicare and Medicaid.
“Sixty percent of that is Medicare, which we, generally speaking, break even on, and then the rest is Medicaid, which we lose 40 to 60 cents on the dollar,” Kramer told the group.
A measure included in the Appropriations Committee’s proposed budget would bump the Medicaid reimbursement rates for specialists up to 65% of Medicare rates as of Jan. 1, 2024, up from the current level of 57.5% of 2007 Medicare rates. If passed, it would provide the broadest increase to Medicaid reimbursement rates since 2007.
[RELATED: Connecticut is weighing several changes to Medicaid. Here’s a look at some of them]
In addition to the three major topics, people repeatedly brought up the importance of primary care and the consolidation of labor and delivery services.
What does ‘rural’ mean in Connecticut?
Participants also wrestled with the definition of “rural” in Connecticut, where the challenges look different than in other parts of the country, where rural residents must drive multiple hours to access care.
“I think that is a challenge for us because, while we may not be ‘rural’ by federal definition, we do face some of those same challenges,” said Rep. Cristin McCarthy Vahey, D-Fairfield.
Lori Fedewa, director at the Connecticut Office of Rural Healthcare, explained that, in addition to the federal definition, each state can come up with its own definition of rural.
Fedewa’s office developed a definition for Connecticut, where a rural town is one that has 10,000 people or fewer and 500 people or fewer per square mile. According to that definition, 68 of the state’s 169 towns qualify as rural.
What comes next?
This meeting marks the second health care forum hosted by Comptroller Sean Scanlon. The first was held last month in New Haven and focused on urban health care. Scanlon said he saw several similarities in the broad issues raised but that the approaches to solving them will look different based on the setting.
“Part of the reason I did these two back-to-back is to show that there are strikingly similar challenges, but there are differences, right?” said Scanlon. “The differences in lack of transportation within a city versus within a county are quite different.”
Scanlon said there is a need for an entity that can take stock of the health care issues facing the state and play the role of coordinating the solutions across different systems, including government and nonprofits.
“Part of what I hope this work will lead to is maybe the creation of that. Or the empowerment of something that already exists to change in a way to do this kind of work,” said Scanlon. “After two roundtables, I don’t think we have the answer to that yet. But I definitely see after two roundtables that there is a need for it.”