United States Senator Joni Ernst visited Virginia Gay Hospital Friday to gain better understanding of challenges facing rural communities and rural hospitals. Senator Ernst was also interested in receiving an update on Virginia Gay’s effort to create a national demonstration project to integrate mental health into primary care. Mike Riege, Virginia Gay Hospital CEO, Melissa Smith, Director of the Benton County Public Health Department at Virginia Gay, and Mark Mossman, hospital board president, were in Washington D.C. last year to discuss the project with Iowa representatives, including Senator Ernst’s office.

When Senator Ernst asked about opioid use and addiction, Mr. Riege provided more details of what Virginia Gay hopes to accomplish with the demonstration project. “We have a pain clinic to help deal with issues of chronic pain and to help prevent opioid dependency,” Mike said, “but we want to extend the effort to include a pain psychologist as well. In putting together the demonstration project, we’re hoping to involve the state and federal governments, funds from Virginia Gay, and support from the Virginia Gay Healthcare Foundation.”

Mike also explained how important it is to patients and to primary care providers that mental and behavior health services be available when needed, not with an appointment that can be months in the future. “Our hope is that Virginia Gay’s pioneering work will someday result in all critical access hospitals being able to offer on-site mental health services,” Mike said, “whether that is through a social worker or a psychologist. Those services would go a long way toward reducing the rate of suicide, legal and illegal drug addiction, and the associated problems increasingly faced by the people in rural Iowa.”

Senator Ernst recalled the tragic events leading to her first bill in the Senate, aimed at improving access of veterans to mental health services. A young veteran in Des Moines visited a VA hospital after suffering from mental distress. He received a prescription and an appointment that was weeks away. He died of suicide shortly after his hospital visit.

“So what my bill does,” explained the senator, “is speed up veterans’ access to mental health services. If the VA can’t work them in quickly perhaps another mental health provider can, so let’s get them there as soon as possible and do all we can to prevent these tragic deaths.”

As discussion turned to the particular problems affecting Benton County, Mike Riege shared that the second concern noted in the last community benefits survey was obesity in children. “That’s why we’re trying to do what we can to find resources for trails in Vinton,” Mike said. “The vision is that with a trails system around the community and connecting all the schools, kids might be walking to school rather than getting a ride and parents would be more likely to take them on biking and walking excursions as part of routine family activities.”

When asked about the lightning rod topic of Obama care, Senator Ernst explained that she agrees with the goal to get more people insured and to provide higher quality health care at lower cost. “So the goals aren’t in question, but I worry about a number of things,” said the senator. “There are all the changes that hospitals and physicians have to deal with and those changes are sometimes implemented so quickly that it’s almost impossible to comply with them. Also, many of the mandates haven’t been well thought out and they create problems of their own. Another concern is the cost of insurance coverage. A gentleman told me last week that his health insurance increased $400 a month. I can tell you he hasn’t been getting raises like that. So what I want to see, and what many of us want to see, is a repeal of the law as we know it but also to create a replacement that is better for everyone.”

Senator Ernst also addressed a question about Iowa's plan to privatize Medicaid by saying, “I’ve heard many concerns from constituents, health care providers and many of the agencies providing ancillary services like transportation. Because this is an issue addressed at the state level, not the federal level, I haven’t gotten actively involved but my office has tried to help constituents find the information and the help they need to successfully navigate the change.”

In the midst of all the serious talk was a moment of humor regarding all the confusion privatization of Medicaid has created when Mike Riege said, “There are 7,000 doctors in the state of Iowa but according to the state apparently 14,000 have signed agreements with the privatized care companies.”

Issues related to health care weren’t the only topics up for discussion. Mark Mossman asked Senator Ernst to consider indexing taxation on Social Security. “When the rule was put in place many years ago the cap on earnings sounded like a lot of money and it may have been. But today,” Mark shared, “a tax that was meant to fall on a few is falling on the many and I don’t think that was the intention.”

Mayor John Watson echoed Mark’s concerns about Vinton’s older residents when he explained how difficult he found it raise taxes and user fees. He used water rates as an example. “The Environmental Protection Agency says we have to do X, Y, or Z and complying with those requirements increases the cost of water and sewer for the entire community, then we have to tell everyone water rates are going up.”

In typical fashion for Mayor Watson he posed a humorous but hypothetical question for Senator Ernst. “Now that I think about it, they can’t really arrest an entire community, can they?”

At 5:00 the senator was off to her next stop, part of her effort to visit all 99 counties in the state. She shared how her goal is to meet as many people as possible, in schools, hospitals and other community venues so she understands as well as she can the substance of the issues facing Iowans.

At the close of the meeting Mike Riege said of Senator Ernst, “I think her genuine warmth and care for the people of Iowa, especially those of us in rural Iowa, erases political labels. Her demeanor and respect for everyone she meets is a reminder that we are all in this together.”

“I’m hopeful,” Mike explained, “that Virginia Gay will be able to achieve some very ambitious goals while at the same time working through just an incredible avalanche of new requirements, quality measures, reimbursement changes and implementation of electronic medical records to document absolutely everything a doctor or other provider does for a patient.”

Those ambitious goals include supporting community efforts to create trails, incorporating mental health into primary care, dealing with the conflict between the desire to alleviate pain and the complexities of recognizing pain as a complex issue involving many psychological factors.

“Just as John dislikes telling seniors their expenses are going to increase, and Senator Ernst has a deep emotional commitment to protecting veterans, I dislike asking our staff to do even more when they have already been required to do so much,” said Mike. “But this is what the future looks like for small hospitals. The pressures are intense and only the most exceptional of them are going to survive. My goal is that through these initiatives Virginia Gay is one of the most exceptional there is at providing affordable, high quality care.”