NH's Business: Health care in rural communities at further risk in wake of policy changes, shortages

BUSINESS. I’M FRED KOCHER. HEALTH CARE ACCESS AND DELIVERY IN RURAL NEW HAMPSHIRE COMMUNITIES, WHICH IS MOST OF NEW HAMPSHIRE’S LANDMASS, IS AT FURTHER RISK IN THE WAKE OF MEDICAID CHANGES, PHYSICIAN SHORTAGES AND CARE REDUCTIONS. KEY FINDINGS FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES IN NEW HAMPSHIRE REPORT ON RURAL HEALTH, PRIMARY CARE PRACTICE CONCENTRATION IS SIGNIFICANTLY LOWER IN RURAL NEW HAMPSHIRE. NEW HAMPSHIRE CAN ANTICIPATE CONTINUED REDUCTION IN PRIMARY CARE PHYSICIANS AND NEW HAMPSHIRE BEHAVIORAL HEALTH LANDSCAPE FACES. LIMITED PSYCHOLOGISTS SUPPLY NOW MEDICAID CHANGES IN 2025 FROM THE NEW HAMPSHIRE LEGISLATURE WILL AFFECT 180,000 NEW HAMPSHIRE RESIDENTS, 70,000 OLDER ADULTS, INDIVIDUALS AND FAMILIES MAY PAY MONTHLY PREMIUMS AS OF JULY 2026, AND CO-PAYS FOR PRESCRIPTIONS WILL GO UP TO $4. WORK REQUIREMENTS WILL BE IMPOSED IF A WAIVER IS GRANTED BY THE FEDS WITH ME TO DESCRIBE THE CHALLENGES OF HEALTH CARE IN RURAL, MIDSTATE AND NORTHERN PARTS OF NEW HAMPSHIRE ARE THE CEOS OF TWO HEALTH ORGANIZATIONS IN THOSE PARTS, ROBERT MACLEOD, CEO OF MIDSTATE HEALTH CENTER IN PLYMOUTH AND LITTLETON, BRISTOL, AND. EDWARD CHINCHILLA, CEO OF AMMONOOSUC COMMUNITY HEALTH SERVICES IN LITTLETON AND FRANCONIA. WARREN, WHITEFIELD AND WOODSVILLE, WELCOME. NICE TO HAVE YOU HERE. THANK YOU FOR PRONOUNCING THAT CORRECTLY. YOU DID VERY WELL. THANK YOU. OKAY. LET ME ASK YOU RIGHT OUT OF THE GATE. THIS CHANGE IN MEDICAID CHANGES AND REDUCTIONS AND THE PATIENT MIX YOU HAVE ACROSS THE MANY MILES OF RURAL NEW HAMPSHIRE. AND WHAT IS THE OUTLOOK FOR YOUR HEALTH CARE PRACTICES AND FOR YOUR PATIENTS? OF TWO WORDS, CAUTIOUS AND CONCERNING. OKAY. MOST UNPREDICTABLE I’VE EVER SEEN. I WORRY ABOUT ACCESS AND I WORRY ABOUT THE ECONOMIC IMPACT AS WELL. YEAH, AND BE MORE SPECIFIC. WHAT DO YOU REALLY MEAN? WELL, CAUTIOUS BECAUSE WE HAVE TO SEE HOW THIS ALL UNFOLDS. WE’VE WE’VE HEARD THE POLICY NOW WE HAVE TO SEE IT IN PRACTICE AND CONCERNING BECAUSE WE DON’T MAKE A LOT OF MONEY IF WE’RE LUCKY, EACH YEAR WE PROBABLY HAVE A 1% MARGIN. I WOULD AGREE WITH ROBERT. THE MARGINS HAVE ALWAYS BEEN TIGHT. OUR FEDERAL BASE GRANT HASN’T INCREASED IN A DECADE. AND WHEN WE LOOK AT THE POTENTIAL MEDICAID CUTS, IT MAKES IT MORE CHALLENGING TO HIRE PROVIDERS IN THIS UNCERTAIN ENVIRONMENT. THIS IS GOING TO AFFECT HEALTH OUTCOMES IN YOUR AREAS THAT YOU SERVE. ABSOLUTELY. PREVENTION IS THE CHEAPEST WAY TO DELIVER HEALTH SERVICES, HEALTH CARE. AND IF PEOPLE CAN’T GET IN TO SEE THE DOCTOR AND THEY DON’T HAVE MONEY TO PAY FOR IT, THAT BY THE TIME THEY GET THERE, THEY’RE FAR WORSE OFF. AND NEW HAMPSHIRE HAS THE SECOND OLDEST POPULATION OF THE STATES. AS YOU KNOW, NEW HAMPSHIRE DATA SHOWS THAT SENIORS ARE MORE ABUNDANT IN RURAL AREAS OF THE STATE. SO IS THAT IMPACT HOW YOU DELIVER HEALTH CARE? IT DOES. SO WHEN OUR PATIENTS PRESENT, THEY OFTEN PRESENT NOT ONLY WITH AN EMERGENT URGENT ISSUE. THEY MAY PRESENT WITH DIABETES, DEPRESSION, CORONARY ARTERY DISEASE, SO THAT LONGTERM ENGAGEMENT WITH THE PATIENT IS VERY IMPORTANT. AND BEING ABLE TO GET REIMBURSEMENT TO ADDRESS THAT IS IMPORTANT. AND SOME OF THE MEDICARE PATIENTS ALSO ARE MEDICARE MEDICAID PATIENTS. SO YOU HAVE ELIGIBLES. AND 1 IN 10 OF OUR VETERANS ARE ON MEDICAID AS WELL. YEAH. ROBERT, AS YOU KNOW, RURAL HOSPITALS EVERYWHERE ARE OFTEN FACED WITH OPERATING LOSSES, WORKFORCE SHORTAGES AND REDUCED CARE. IS THAT HAPPENING WITH RURAL HOSPITALS IN NEW HAMPSHIRE? I BELIEVE IT IS. THEY’RE STRUGGLING AS WE’RE STRUGGLING TO TRY TO KEEP THE SERVICES THEY HAVE AND MAKE ENDS MEET. YEAH, AND SAME QUESTION. YEAH, I THINK THE SAME IS TRUE FOR US. AND WHEN WE GET TO COOS COUNTY, IN SPECIFIC, WE HAVE ONE HOSPITAL LEFT WHO CAN DELIVER BABIES. AND IF WE’RE GOING TO GROW THE ECONOMY, PEOPLE NEED TO HAVE A PLACE TO DELIVER THEIR BABIES. ABSOLUTELY. HERE’S A STATEMENT AND YOU’LL ALL YOU’LL BOTH IDENTIFY WITH THIS. WHEN AN URBAN HOSPITAL CLOSES OR CUTS BACK PROGRAMS, YOU JUST GO TO THE OTHER HOSPITAL. IT’S FIVE MILES AWAY IN OUR COMMUNITY, YOU’RE DRIVING HOURS, AND THAT’S FROM TOM ME, CEO OF NORTH COUNTRY HEALTH. CORRECT? ABSOLUTELY CORRECT. IT’S NOT LIKE THERE’S A HOSPITAL NEXT DOOR. THERE’S NOT LIKE THERE’S A HEALTH CENTER NEXT DOOR. YEAH, I WOULD AGREE. AND THERE’S TIMELINESS. WHEN SOMEONE EXPERIENCES A STROKE AND A HEART ATTACK. WE CAN’T AFFORD TO HAVE THEM DRIVE TOO FAR. WE WILL NOT HAVE THE OUTCOMES THAT WE WANT. EXACTLY. I WANT TO THANK YOU. ROBERT MACLEOD, CEO OF MIDSTATE HEALTH, AND EDWARD CIANCIOLA, CEO OF AMMONOOSUC COMMUNITY HEALTH SERVICE. THANK YOU. NICE TO HAVE YOU HERE. APPRECIATE IT. ALL TOO SHORT, BUT GOOD INFORMATION. IF YOU MISSED PART OF THIS YOU CA