A Rural Health Roundtable held at the Cass County Memorial Hospital in Atlantic, Friday, gave area health care providers a chance to speak about issues affecting how they do their jobs and how the Obama administration’s new initiatives might affect them.

Dr. John Bigelow

One of those who spoke was Dr. John Bigelow, Executive Director of the Southwest Iowa Mental Health Clinic in Atlantic. Bigelow mentioned  the Behavioral Health Unit (BHU) which is in danger of  closing because a lack of reimbursement from Medicaid and Medicare has cost the hospital nearly $500-million dollars. He said the Affordable Care Act policies are looking to make behavioral health care part of primary care, which is important, because many of the patients he treats have significant health issues. He says statistics show there are a significant number of people who are dealing with depression and anxiety disorders, due in-part to the economy. The economy he says also creates a hardship for those who have to travel about 40-miles or more to receive the limited amount of services they BHU can provide.

A number of surrounding counties he says, don’t have community mental health centers because they weren’t being funded appropriately. Bigelow says the SWIMC is doing better than similar facilities because of Medicaid cost reimbursement, but that only covers about 35% of the clients they serve. CCMH he says, has provided cash flow during times of financial shortage, and the County subsidizes services to individuals who don’t have insurance, but some policies have high deductibles or don’t cover mental health. Bigelow said he was pleased to learn the Health and Human Services Administration (HRSA) has expanded eligibility of the National Health Corps, because it should help to attract mental health professionals to rural communities. He says it took more than seven months to fill the last two positions in his department, because some applicants weren’t qualified to take advantage of financial programs which would allow them to work and repay their loans.

Ed Friedman, a rural health Physician’s Assistant (P.A.) at the Redfield Medical Clinic and an administrator for 26-years, said good legislation, along with reasonable enforcement of those regulations andreimbursement are critical to the delivery of rural health care.  Friedman said the funding of a P.A. education  program by HRSA has made a big difference in bringing licensed P-A’s to Iowa. He says 40-years ago, there were none, now there are 800. Rural Health Clinics he says, have also made a huge difference. Still, he says RHC’s and Community Health Centers need guidance from HRSA on how to collaborate on policies which are confusing, and out-of-date, and those policies need to be integrated into the Affordable Care Act.

P.A. Ed Friedman