Grassley visits West Union for roundtable on healthcare

Grassley visits West Union for roundtable on healthcare

As part of his annual tour of Iowa's 99 counties, Sen. Chuck Grassley made a stop in West Union on May 27 for a tour and roundtable discussion at Emplify Health by Gundersen West Union Hospital.

During his one-hour visit, the president pro tempore of the United States Senate learned about the many services this rural hospital offers, as well as some of the challenges it faces, especially when it comes to physician recruitment and how it's reimbursed for the care it provides.

Following a short tour of the hospital, which included a stop in the labor and delivery unit, a rarity in rural healthcare, Grassley met with a group of hospital workers and members of the Iowa Hospital Association, where they discussed a variety of topics, including the various federal funding mechanisms that support hospitals.

Patrice Kuenen, administrator at Emplify Health by Gundersen West Union Hospital, stressed the importance of the Hospital Direct Payment Program (DPP), which allows states to direct Medicaid managed care plans to pay hospitals according to specific methodologies. This plan has been in place in Iowa since 2024.

"That we have those funds, it's been very much a benefit to be able to continue with community services," Kuenen said.

According to the Iowa Hospital Association, more than 693,000 Iowans - 21 percent of the state's population - are Medicaid beneficiaries.

Grassley noted that in 2028, the statewide DPP benefit is going to phase down roughly $110 million each year from its current level of $1.09 billion until 2033 when reimbursements reach Medicare level of $640 million. According to the hospital association, the cumulative net loss from 2029-2033 will be $1.55 billion.

"We set it to go into effect in 2028, so if there are some things that are a real hardship, we can step in before it's too late," Grassley said. "It doesn't make sense to the average taxpayer that you're going to allow a state legislature to raise the cost on hospitals and nursing homes just because the federal government is going to kick in 63 cents out of every dollar.

"It's kind of a scheme that probably shouldn't have got started, but it got started, and once it gets started, people get used to it," he added.

Erin Cubit, a lobbyist for the IHA, thanked Grassley for the runway provided for the phaseout of the program.

"It does help hospitals to be able to have that time to make decisions that they need to," she said, though adding, "We are definitely concerned about sustainability. Prior to the state's Direct to Payment Program starting, we had a majority of hospitals in Iowa with a negative operating margin."

With the DPP program, that number of hospitals with a sustainable operating margin has increased dramatically, she said. She's hoping Grassley will consider an extension of the timeline outlined in the phaseout.

"It does help ensure that the service lines that hospitals have remain intact," Cubit said.

Kuenen said she appreciates Grassley's support for rural communities, but she underscored the challenges the hospital is facing recruiting nurses and physicians. The use of agency nurses and contracted physicians comes at an extraordinary cost, "but we'll do it because we want to provide that service to the community," she said. The West Union hospital currently has 11 advanced practice clinicians (nurse practitioners and physician assistants) and two physicians on staff.

"Family medicine providers are so important because they see and care for the entire lifespan," Koenen said. "Right now, we're going to look a little bit harder outside the state to create a pipeline to get some family medicine residents or physicians that want to do OB in rural communities."

Grassley said a program set up 1,000 residents in the state three years ago, and 10 percent work in rural areas. He said the idea is that if residents practice in a certain area, chances are they'll remain in that area. And a provision that keeps the residents at their assigned facility for five years helps that embeddedness.

Grassley was asked if rural healthcare will come into focus in the Senate in the months ahead, to which he replied that programs that are due to sunset this year will likely get extended. He also plans to focus on making the work of pharmacy benefit managers (PBMs) more transparent, so consumers know more about why the prescription drugs they take cost what they do.

"We want to save the taxpayer some money if we can," he said, adding that he has a bill in the works that deals with PBMs transparency. "For me, transparency brings accountability."

Grassley noted that no changes are expected with Medicaid other than the work to eliminate fraud in the program so people who aren't eligible for the assistance aren't getting it, which will leave more funding for those who do need it.