Frontier provision riding on N.D. officials

A provision in the health care reform bill that boosts Medicare reimbursement rates for some rural states has North Dakota written all over it. Officials from a Fargo hospital conceived the plan at least five years ago to protest what many believe to be an unfair method of payments for doctors and providers. It has now been proposed by North Dakota's two Democratic senators, Kent Conrad and Byron Dorgan, both of whom claim it's a tough sell. "I can't describe to you how tough a fight this is," Conrad said. "There's 'x' amount of money on the table. You can imagine other states that don't benefit see that as taking money from them. They are pushing back very, very hard." The so-called frontier states amendment would increase Medicare reimbursement Rates for some doctors and hospitals in North Dakota, South Dakota, Utah, Montana and Wyoming. At least half of a state's counties must have a population of six people per square mile or less to qualify for changes in the average wage index. The payments would amount to $2 billion over 10 years. The question is how much support the provision will receive, even from other frontier states. Rep. Earl Pomeroy, D-N.D., said the final bill should ultimately be decided in the Senate. Utah and Wyoming both are represented by all Republican senators, who are expected to oppose the provision. South Dakota has one Republican senator, John Thune, who said of the amendment: "This is a drop of relief in a bucket of pain." Officials at Fargo's MeritCare hospital, which is now part of the largest rural health care network in the country, said none of the frontier states have more at stake than North Dakota. Hospital officials estimate that the provision could provide an additional $20 million alone in added yearly payments to MeritCare. "When you're at the bottom of the well and you get the rope, you feel pretty good about it," said Roger Gilbertson, who retired as longtime MeritCare CEO in December after the hospital merged with South Dakotabased Sanford Health. "If you're halfway up, you aren't quite as elated." The health care overhaul could paralyze MeritCare without the new reimbursement rates, Gilbertson said. "If we get the cuts without this option, we're done. It's a big deal," Gilbertson said. "We aren't trying to scare people. But I know what trouble is." About 90 MeritCare employees were laid off and 120 vacant positions were eliminated last year when the hospital said it lost $12 million. Gilbertson and Bev Adams, MeritCare's public policy officer, held a press conference over the holiday break to promote the amendment. Hospital officials from some of the other frontier states have opted to root from the sidelines. "We're definitely a cheerleader on this issue," said Cindy Morrison, Sanford's vice president of health policy. "We didn't see it coming, but it's a terrific answer to an ongoing problem," said Dave Hewitt, head of the South Dakota Association of Health Care Organizations. "Certainly North Dakota has been horribly impacted by the current policy, but we welcome it with open arms." Gilbertson said the current payment rates are based on models that were devised in the 1980s. That was before advancements in technology put the cost of health care in North Dakota on par with the rest of the country, and it also became more difficult to find doctors. MeritCare pays some specialists up to 18 percent above the national average, mostly because of the cold weather, Gilbertson said. Pomeroy said the health care bill has been mishandled in several ways, and the frontier provision would put some common sense into the reform. "I don't think there's anything absolutely guaranteed about our votes on final passage if we would start slipping back from the wins we have won for North Dakota," he said, referring to the state delegation. Gilbertson said even lawmakers from the most populous states cannot dispute the inequity in North Dakota's payments. But he said there's another factor that might trump the numbers. "They don't really care," Gilbertson said.