During a stop at Dosher Memorial Hospital in Southport Monday, Gov. Roy Cooper led a roundtable discussion on rural healthcare issues to hear ideas and to also push his plan for Medicaid expansion in North Carolina.
The Democratic governor told hospital administrators and elected officials who gathered in the hospital conference room he hopes the Republican-controlled legislature can agree on a plan that would provide better access to healthcare for patients and increase reimbursement costs for critical access hospitals like Dosher.
“We can get about 3,500 more people in Brunswick County insured, but we’ve got to find a way,” said Gov. Cooper. “We can do it without additional tax dollars. Thirty-seven other states have done this.”
Gov. Cooper said approving Medicaid expansion would give the state an additional $4 billion in federal dollars to insure the “working poor,” people in the gap who now make too much for Medicaid but who do not qualify for subsidies under the Affordable Care Act.
He said expansion would also create about 250 healthcare-related jobs in Brunswick County and improve Dosher’s bottom line. About 40 percent of hospitals in rural North Carolina are operating in the red, Gov. Cooper said.
Dosher CEO and President Tom Siemers said Dosher is also unique – it is the only independent critical access hospital in the state that is not corporate owned and is also the only township hospital.
“We don’t have access to capital and reserves that other hospitals have,” said Siemers. “If Medicaid is expanded, it’s going to help all hospitals in North Carolina.”
Yet Siemers said he understands the predicament that State. Rep. Frank Iler and State Sen. Bill Rabon find themselves in while trying to provide funding in the state budget for all types of needs, including transportation and education. Siemers said the legislators have been great friends of Dosher hospital in the past and are faced with difficult challenges every day.
The Dosher Board of Trustees has approved a resolution in support of Medicaid expansion, delivered to the governor recently. Gov. Cooper said the opioid crisis and uninsured patients are also placing a burden on rural hospital emergency departments. It’s where those who have no insurance end up, along with mental health patients. Siemers said about half of Dosher’s bad debt self-payers are patients seen at the ER.
“The easiest thing we can do right now, and the quickest, is to expand Medicaid,” said Gov. Cooper. “Here, all we’ve got to do is say one word, ‘Yes,’ to bring down federal dollars.”
The governor also listened to other healthcare issues those in attendance at Monday’s roundtable offered.
Dr. Andre Minor, who has practiced in the area since 1990, said there is a growing manpower shortage as physicians are fed up with the demands of paperwork just to prescribe generic drugs. Doctors are seeing fewer patients but are spending more hours on the job to fill out forms, he said.
“It just adds to the burden of the day, one more thing that you have to deal with that you didn’t have to do ten years ago,” said Dr. Minor.
Dosher’s Chief Medical Officer Dr. Brad Hilaman told Gov. Cooper that dramatic changes in rural health care is shutting the doors of some healthcare facilities.
“Once they close, I think reopening them is going to be very difficult,” said Dr. Hilaman. “We need to make sure everyone is monitoring our rural hospitals. I think it needs to be monitored and try to keep these facilities open.”
Gov. Cooper also mentioned that proposed changes in the State Health Plan for government employees and certificate of need process are also affecting rural hospitals.
“It’s tougher for you than it’s ever been,” said Gov. Cooper.
“Obviously, Medicaid expansion is not a cure-all but it would increase compensation for the people who come here.”
Dr. Hilaman also told Gov. Cooper recent changes at the state level that no longer place Dosher in a “physician shortage area” have affected the hospital’s ability to recruit doctors. The hospital used the program in the past to forgive student loans for doctors who chose to come to the area.
“It’s a big deal for our organization,” Siemers told Gov. Cooper. “Brunswick County is the size Rhode Island and there are two hospitals here. If your office calls them, it might make a difference.”
Dosher Chief Operating Officer Carol Northup reminded the panel that the state is also facing a nursing and clinical staff shortage. Hospitals have a difficult job hiring new staff without an educational incentive in the schools or community college.
“It’s not physicians alone,” said Northup. “It would be very important to have that for our professionals.”
Southport Mayor Jerry Dove said processing mental health patients is placing a burden on Dosher and its emergency room staff.
“We’re fortunate to have Dosher Hospital in our city, but sometimes we get overloaded with these patients,” said Dove.
Dosher trustee Robert Howard said a healthy Dosher Hospital is not just important to residents and patients but to the area’s local economy.
“It is directly related to the success of Smithville Township,” said Howard. “It’s not only medical issues, it’s an economic issue.”
Keeping Dosher strong and in good financial standing is very important, added trustee Linda Pukenas.
“It is like the soul of the community and our families,” said Pukenas. “Almost everyone in this community has been touched by Dosher in some way.”
Trustee Sherri Marshall, who has served on the board for 12 years, said she has seen a lot of changes in that time.
“It’s scary, and I hope that as this group is sitting around here, I hope another group can find the answers,” said Marshall.