Joseph Abrutz, administrator of Cameron (Mo.) Regional Medical Center, recently penned a letter to President Donald Trump calling for urgent federal reforms to sustain rural hospitals — particularly so-called “tweener” facilities that fall between critical access and larger hospital classifications.
In the letter, Mr. Abrutz applauded President Trump’s reelection and credited his COVID-era relief policies with helping rural hospitals like Cameron Regional — a 60-bed acute care hospital — navigate unprecedented financial challenges.
However, Mr. Abrutz warned that the lingering effects of the pandemic — combined with medical inflation, workforce shortages and an unfavorable reimbursement landscape — have created a “perfect storm” threatening the survival of rural hospitals.
Cameron Regional serves a medically underserved, 10-county region in northwest Missouri and operates without local tax support. Mr. Abrutz noted that the hospital receives an average of only 30 cents per dollar billed and provides a wide range of “desert services” — including obstetrics, dialysis, behavioral health, hospice and free transportation — that are increasingly rare in rural areas.
Among his chief concerns are the growing influence and reimbursement challenges posed by Medicare Advantage plans, which he described as a “debacle” for rural hospitals. He also criticized managed care Medicaid, disproportionate share hospital payment cuts, ACA-induced cost burdens on patients and ongoing Medicare sequestration.
Mr. Abrutz proposed the creation of a new federal designation — “Rural Safety Net Hospital” — with criteria tied to population need, service breadth and community poverty levels. He urged policymakers to implement cost-based reimbursement, protect against funding cuts, reform or eliminate MA plans, and remove Medicare sequestration for rural prospective payment system hospitals.
“Without major bipartisan support and significant positive financial consideration from Congress,” he wrote, “tweener hospitals will increasingly have to make extremely hard choices in regard to services and access … to stave off closure.”
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