STEVE INSKEEP, host:
Now let's talk about hospital care in Southern Arizona, just a few miles from the Mexican border. Bisbee, population 5,500 is in the middle of desert. And that is where one CEO is trying to run a successful hospital, despite significant budget cuts from the state. Arizona recently passed one of the most severe Medicaid cuts in the country, with 140,000 people expected to lose their coverage in the next year. Jenny Gold of our partner Kaiser Health News reports.�
JENNY GOLD: Driving through the desert toward Bisbee, one of the first things you spot is a giant letter B whitewashed into one of the craggy mountains above. For more than 100 years, Bisbee was a copper mining town. Today, the rocks are pockmarked with gaping pits and the population of the town is shrinking. It's the kind of place where you might expect to find a typical rural hospital, struggling to make ends meet.
Mr. JIM DICKSON (CEO, Copper Queen Community Hospital): We are the only thing between here and the border to about 90 miles north.�
GOLD: Jim Dickson is CEO of Copper Queen Community Hospital. He's a daunting figure, a portly man in his 60s, with crooked fingers from his days as a high school football player. Copper Queen has 15 beds and 170 fulltime employees -the second largest employer in town.
Mr. DICKSON: And it's a very rural area. It has probably the lowest population density in the country. That's what makes it such a challenge.�
GOLD: He says it's tough to make a hospital profitable in a county that's spread out over an area the size of Connecticut and Rhode Island. The region is considered medically underserved, because there aren't enough doctors to go around. Patients tend to be low income, suffer from chronic illnesses and many are uninsured.�
But against all odds, including the deep Medicaid cuts, Copper Queen Community Hospital is thriving.
Mr. DICKSON: This is our diagnostic imagining. We have ultrasound, CAT scan, dexa scan.�
GOLD: In the past few years, the hospital has had a healthy surplus - between 5 and 10 percent, which is very high for a nonprofit, rural hospital. Urban hospitals can count on a steady flow of patients. But rural hospitals often have just a slow trickle. Dickson's secret? He makes sure he has enough volume by bringing basic, primary care out to people in the surrounding towns.
Mr. DICKSON: Our thing was get it out there. Never mind sitting back and building a Taj Mahal that everybody comes to you. You must get it to them.�
GOLD: He opened three rural health clinics across the region. In one, the doctors he employs at the clinic are the only ones in town. And Dickson keeps his bottom line strong by trimming services that lose money. Recently, he closed the only labor and delivery unit in the area - an unpopular move. But sometimes, patients in this region need a lot more than primary care at a clinic.
(Soundbite of a motorcycle)
GOLD: Bisbee Mayor Jack Porter rides up on a red motorcycle, wearing all black. His hair is long under a baseball cap, and he walks with a slight limp, the last remaining sign of a frightening morning last year when he awoke with a numbness in his face.
Mayor JACK PORTER (Bisbee, Arizona): And slurred speech, weakness on my left side. It's all very confusing to me, because until this happened, I never went to a hospital at all. Then one day I just woke up and my whole life changed. I had my stroke of luck.
(Soundbite of laughter)
GOLD: The paramedics rushed him to Copper Queen emergency room. Like most rural hospitals, Copper Queen doesn't have a stroke specialist. But that didn't slow things down. Last year, Jim Dickson installed a telemedicine setup that helped Mayor Porter.
Mr. DICKSON: One of the first things they did was hook me up to the monitor to the Mayo Clinic and bring in a stroke specialist.
(Soundbite of a ring tone)
GOLD: With just a call, doctors reached a neurologist over a video link in Scottsdale, Arizona, 200 miles away. The doctor there quickly prescribed Porter tPA, a clot-busting drug that few rural hospitals give for strokes because they don't have a neurologist around to evaluate the patient.
Mayor PORTER: The right decisions were made and I'm alive and walking today.
GOLD: The result was also good for the hospital's finances. Copper Queen Community Hospital gets paid for every patient they keep instead of transferring them. Jim Dickson's boosts his revenue in other ways as well. He employs just 12 doctors, but pays each a salary competitive to those they'd earn in an urban area, making sure they're as productive as possible. Each of the rural clinics also has an X-ray, a lab and a physical therapist. Dickson says those additional services provide him an extra stream of revenue.
But despite all his successes, Dickson is anticipating hard times ahead. That's because of Arizona's recent Medicaid cuts.
Mr. DICKSON: When they do the cuts they're planning to do, it's not downsizing or trimming. It's totally going to the bone.
GOLD: In addition to a 5 percent payment cut for hospitals last April, there will be another 5 percent in October. And 140,000 people are expected to lose their Medicaid coverage altogether. Dickson says he has enough of a surplus that he'll be able to offer the same services. Other hospitals may not be so fortunate.
Mr. BRIAN BICKEL (CEO/Administrator, Southeast Arizona Medical Center): We're living paycheck to paycheck. That's the best way to describe it in terms that the common man can understand.
GOLD: Brian Bickel runs the 25-bed Southeast Arizona Medical Center in Douglas, about 20 miles East of Bisbee. From the hospital's parking lot, the only thing you can see is open desert, some yucca plants and the Mexican border. Bickel's hospital has been running a significant deficit each of the past few years. Almost half of his patients are covered by Medicaid.
Mr. BICKEL: If it gets to the point where the cuts get too much more devastating, than you have to make a decision as to what is it that you can live without.
GOLD: He says it's frustrating, because in just two years, things are likely to get easier when the federal health overhaul kicks in.
Mr. BICKEL: If what we're looking at currently is devastation, than 2014 is going to be the gravy train rolling into the station.
GOLD: If he can make it until then. Back in Bisbee, Dickson says he's prepared. If Bickel's hospital closes, those patients will travel the extra 25 minutes to Copper Queen. So Jim Dickson always looking ahead is already adding 10 beds to his hospital to make room.
For NPR News, I'm Jenny Gold.
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