Access to health care in rural areas like Highland County is a growing problem with reimbursement cutbacks from Medicare, Medicaid and private insurance aggravating an increasing dilemma.

As previously reported, a lack clinical care hit Highland County hard in a recent Robert Wood Johnson Foundation study, which ranked the county 81st among 88 counties statewide for the availability of clinical care.

The number of doctors, dentists and mental health providers serving the population lagged behind the state average, and the county was also behind in mammography screenings and flu vaccinations.

In the recently completed Highland County Health Collaborative Community Assessment, Health Commissioner Jared Warner said his office is sorting through the data of the 598 respondents, and confirmed that the area is falling behind when it comes to health care.

“We are recognized federally as a health care provider shortage area,” Warner said. “And that’s for traditional health care and also mental health care.”

He said the calculations were made looking at how many providers are in a region compared with the overall population, saying, “we had dismal numbers when it comes to the number of patients per provider.”

Medical providers have a tough time meeting “the bottom line” in areas such as Highland County, Warner said, since the region has so many Medicare/Medicaid patients, and reimbursement rates to both doctors and medical facilities have dropped significantly in the last decade.

“It’s harder to run a business and maintain the revenue levels you need in some of the rural areas like ours,” he said. “That’s why it’s hard to get local doctor’s offices in here, and it’s not just doctors, we’re seeing other providers like ambulance services and smaller hospitals closing their doors as well.”

Earlier this year, East Ambulance in Leesburg unexpectedly ceased operations, closing all of it satellite offices including one in Hillsboro.

Five years ago, Southwest Regional Medical Center — the former Brown County Hospital in Georgetown — closed its doors with only two hour’s notice given to staff and patients, according to a report from WXIX-TV in Cincinnati.

Joe Grygiel, vice-president of base operations for Air Evac EMS, which still has a helicopter base at Georgetown, said the problem of access to rural health care has spilled over to health care via ground and air ambulances.

He said there is legislation pending in the health, education, labor and pensions committee of the U.S. Senate called The Lower Health Care Costs Act of 2019, which from his point of view continues to allow insurers to limit access to emergency air ambulance service under the guise of preventing surprise medical billing.

“If the sole intent is to eliminate surprise billing without holding the insurance companies responsible for their portion of it,” he said, “what we’re going to do is not only limit the ground ambulances like we’re seeing, we’re going to limit the hospitals and the air ambulance resources as well.”

He said Medicare covered 60 percent with Medicaid covering 35 percent of the cost, and that when dealing with services that cost thousands of dollars, that is still far below the cost of care. He pointed out that 69 percent of air ambulance trips are out of network for the privately insured.

Last year alone, he said, 32 air ambulance bases, nearly all in rural areas, closed their doors.

“Medicare and Medicaid reimbursements don’t even reimburse our actual costs,” he said. “One of the reasons we are at where we’re at today is because of a cost shift in the billing where if you look at self-pay, Medicare and Medicaid, that equals about 72 percent of the patients we fly, and those reimbursements don’t come close to what it costs us.”

He said almost half of air ambulance emergency transports are initially denied by insurers, and that when insurance companies refuse to cover or limit coverage of emergency air ambulances, customers are stuck with the bill.

For 85 million Americans, he said, air ambulances were the only means of access to a Level I or Level II trauma center.

It’s a quandary for non-profit and for-profit companies that includes health care providers, hospitals and clinics. Ultimately, Warner said, the face of the lack of rural health care comes down to money.

“Even here at the health department, we’re a non-profit so we’re not out to make a bunch of money, but we at least have to cover our costs,” he said. “That’s becomes really difficult with the lower reimbursements from both Medicare and Medicaid.”

Reach Tim Colliver at 937-402-2571.