“Iowa is known for having high-quality care,” said Grassley, a Republican who also hosted a town hall meeting at SMCH as part of his 99-county tour. “I want to help you maintain what you have here in Lake City so you don’t lose your doctors.”

During his tour of SMCH, Grassley asked Cindy Carstens, SMCH’s CEO/administrator, about a variety of topics, including average number of inpatients at the hospital, reimbursement for telemedicine services and more. Grassley supports the Rural Emergency Acute Care Hospital (REACH) Act. This proposed legislation is designed to help rural hospitals stay open while meeting the needs of rural residents for emergency room care and outpatient services.

“A car accident or a heart attack is dangerous under the best of circumstances, but it’s a lot more dangerous for someone who’s far away from an emergency room,” Grassley said. “When a rural hospital closes, its emergency room closes with it. This proposal will fill a pressing need, help keep hospital doors open and offer hospital services where and when people need them most.”

Under Medicare, many rural hospitals like SMCH are designated as critical access hospitals, meaning they have to maintain a certain amount of inpatient beds, as well as an emergency room. Many hospitals struggle to attract enough inpatients to keep their Critical Access Hospital status. When they close their doors, it often means a community loses its emergency services. Studies show that proximity to an emergency room often means the difference between life and death, Grassley noted.

-Messenger photo by Darcy Dougherty Maulsby
U.S. Sen. Charles Grassley, R-Iowa, left, stands in a treatment room at Stewart Memorial Community Hospital Wednesday afternoon during a tour of the Lake City facility. Cindy Carstens, right, the hospital’s chief executive officer and administrator, updated him on the plans for a roughly $30 million building project.

The REACH Act would create a new rural emergency hospital classification under Medicare. The hospital would have an emergency room and outpatient services. It would not have the inpatient beds that many hospitals are struggling to maintain. The bill wouldn’t force any new requirements on hospitals, however, Grassley added. It simply would offer them a new option.

SMCH plans renovations, expansion

More than 120 rural hospitals nationwide have gone out of business since 2005, and the trend has been accelerating since 2010, according to the North Carolina Rural Health Research and Policy Analysis Center.

Many of the closures in recent years have affected critical access hospitals. Most of the hospitals that shut down were plagued by financial woes related to upkeep for leaking roofs, antiquated power supplies and aging clinical equipment.Other complicating factors include insufficient patient populations, high rates of uninsured patients, dwindling cash flow and physician shortages.

SMCH has been a community cornerstone for Calhoun County for nearly 70 years. Now it’s time for an upgrade–and the community agrees, Carstens said.

“Over the past year, we have talked to the community to get their input on our renovation and expansion plans and now we are in a position to move forward on this exciting vision,” she said.

The hospital will have extensive design changes, including improved emergency and therapy departments, dramatically enhanced patient privacy and improved security. The overall cost for the entire project is estimated at $31 million. To date more than $1.1 million has been committed to the project.

The majority of the funding will be in U.S. Department of Agriculture long-term financing. Another $2.25 million needs to be raised through private contributions. The goal is to begin construction in the spring of 2020.

“The support we have received already is really incredible,” said Jim Henkenius, chief financial officer of SMCH. “We are so grateful for the support of our friends and neighbors who know the difference these enhanced facilities will make in the quality of care that we will be able to provide to Lake City and the surrounding area.”

Grassley speaks out against free college tuition

Henkenius updated Grassley on this building project as the senator toured the hospital and clinic. During the town hall meeting, other SMCH team members and community residents asked Grassley questions about the soaring cost of health insurance for self-employed people like farmers. Others brought up the challenges facing rural hospitals as some of their new employees right out of college struggle with student loan debts as high as $100,000 to $200,000.

“First, I don’t think we should provide free college tuition for everyone,” Grassley said. “Students need to have skin in the game.”

While student loans serve a purpose, Grassley advises students against borrowing every penny they can.

“In addition, I support ‘know before you owe,’ where you look into career opportunities with different college degrees,” he said. ”I run into people who get a bachelor’s degree but then go back to community college to get a different degree where they can actually make a living.”

Grassley emphasized that keeping rural Iowa strong remains a key focus for him.

“Preserving rural healthcare and supporting rural broadband need to be priorities at the federal level,” he said.