United States Senator Richard Burr visited Bladen County Hospital on Wednesday to discuss issues facing small hospitals and medical care in general. In the visit that lasted about one hour and 40 minutes, Burr also toured the hospital's facilities.

Burr said one initiative high on his agenda is to push for Medicaid reform. He said that Medicaid can't change without changes in the way the program is handled in the 50 states.

He asked about the Medicare/Medicaid mix at Bladen County Hospital.

The hospital's chief financial officer Bruce Brooks said that about 50 percent of the hospital's business is Medicare and about 25 percent is Medicaid. He acknowledged that many of those labeled as self-pay are in reality "no pay."

Hospital Board Chair Dr. Pearly Hoskins pointed out that a major problem facing medical providers such as the hospital are the growing number of residents in the county who are uninsured, either as a result of losing their jobs or because they cannot afford the premiums of insurance available to them.

She was referring to possible options for addressing this problem.

"The challenge for us is that if we only address the uninsured and we only have resources to reimburse 90 percent on the dollar (for Medicaid costs), then where are you," said Burr.

Burr said North Carolina's Medicaid coverage is so extensive that it is threatening to undermine the system. He pointed out that the state is the only one left in the nation that passes down a portion of Medicaid costs to the local government.

He said that though the these problems with the way Medicaid is handled in the state exist, "there seems to be no will to change the system."

He asked about how the hospital deals with emergency care and the proximity of other healthcare facilities in the area.

Hoskins pointed out that the ER is often the provider for those who cannot afford healthcare elsewhere and for treatment of problems related to chronic illnesses.

Burr said that the ER is the most expensive way to treat this type of health problems.

Burr said that many larger hospitals now see emergency rooms as a profit center rather than as a financial liability, "a flip flop from 10 to 12 years ago."

He said that medical care systems must focus on the most cost efficient ways to address medical problems, while at the same time encourage healthier lifestyles in the communities they serve.

Dr. Susan Aycock and Hospital Board member William Brisson explained the planned merging of the urgent care facility of the hospital into the emergency room complex and how that would enable the hospital to send patients to the most appropriate level of care. They explained that the new service is being dubbed "Express Care."

Burr then asked if BCH is a critical access hospital.

Hoskins replied that it is.

Burr said he is trying to change the definition of "critical access facility" from a maximum of 25 beds to an average of 25 beds. He said this would be helpful in managing patient load at these facilities. (One of the criteria for hospitals to qualify as critical care facilities is that they can have no more than 25 beds. This requirement is established by federal mandate.)

He said one of the most creative models of hospital care systems he is aware of in the state is in Bertie County, where the facility was constructed to be a critical care facility. He pointed out that it and nearby Chowan County Hospital, also a critical access facility, share many specialists.

He asked if the BCH offers OB services and if so, approximately how many children are born at the hospital annually.

Aycock said that the hospital has two OB/Gyn specialists in practice as well as family practitioners who deliver babies. She said the hospital presently has about 250 births per year.

Burr said having OB services is critical to communities.

"When you eliminate OB care, you've effectively eliminated pre-natal care," he said.

Aycock added that it also seriously erodes the level of pediatric care in communities.

Burr talked about the Medicare prescription plan scheduled to become effective in January and how it can help with the cost of medications.

HealthWatch Director Joy Grady said that her department has a very active program to help those who cannot afford medications to access them through programs operated by the drug companies. She pointed out that the forms for such programs are often confusing and difficult for individuals to negotiate without assistance.

Burr asked about the various healthcare organizations in the county and how they operate together.

Aycock said that cooperation among the various healthcare entities in the county is a strength in the local communities.

Hoskins added, however, that as competition for limited resources intensifies, the level of cooperation could suffer.

"As the pie grows smaller," said Hoskins, "table manners begin to deteriorate."

In concluding, Burr said, "I'd love to tell you that something is going to change tomorrow. But the reality is that it won't."

He pointed out that he is working to find ways to improve the availability and efficiency of medical care in the nation. He said he is working on a bill to be submitted either later this year or early next year to reform Medicaid. He said he would attempt to federalize the program-perhaps increasing the federal share of the cost of the program but with a federally designed "core benefit."

After Brooks explained to Burr about a financial problem the hospital is facing because of the way cost-based reimbursement is figured, Burr acknowledged that cost-based reimbursement system can be a "double-edged sword."

Burr talked about what the CEO of Dell Corporation, a self-insured company, had done in his company to reduce the cost of medical care for those who use the most healthcare benefits. He said that statistically 20 percent of employees make up 80 percent of the costs.

He said that the company had offered monetary incentives to get those using the most medical care benefits to avail themselves of preventive measures and build healthier lifestyles. As a result, the company had realized savings of $3,200 per employee among those individuals.

He said such plans can significantly reduce the cost of chronic disease management.

He said he believes there is potentially a 20 percent savings in healthcare costs by changing how such diseases are managed and by looking for ways to provide services more efficiently.

Aycock and Hoskins thanked Burr for his proactive stance on medical care issues and his knowledge of medical issues.

"We really do appreciate the efforts you've put into it," said Aycock.

Burr then toured the main hospital, including the Emergency Department, which is undergoing a renovation.

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