Dear Congressmen Camp and Upton:

As the administrator and chief operating officer of Borgess-Lee Memorial Hospital (BLMH) in Dowagiac, I am writing to express the importance of the rural health care safety net.
Rural hospitals give patients access to care and create jobs in rural Michigan. The changes to rural health programs proposed in President Obama’s deficit reduction recommendations will have a devastating effect on rural hospitals across Michigan and in particular Borgess-Lee, jeopardizing its ability to continue providing health care for the Dowagiac and Cass County communities.
The Critical Access Hospital (CAH) program has had a very positive impact on BLMH since its conversion in 2002, allowing the continuation, enhancement and addition of health care services for area residents.
Without the CAH program, BLMH would probably have closed several years ago, and with any reductions in reimbursement or changes in the eligibility requirements, BLMH would likely be facing that decision in the near future.
BLMH in Dowagiac is the only hospital in Cass County and serves more than 26,000 individuals in its primary service area.
BLMH provides almost 100,000 ambulatory visits, 9,000 Emergency Department visits and 3,000 inpatient days to this community each year.
As you can see, BLMH provides for essential health care services in southwest Michigan.
The hospital is the backbone of the local health care service net.
As we employee 100 percent of the providers in Dowagiac, if the hospital closes it is unlikely any providers will remain in the community to operate independently and Dowagiac will be left without any type of medical service available locally.
Rural Americans, per capita, are older, poorer and sicker than their urban counterparts.
Rural hospitals are vital access points for rural residents and seniors to get quality and affordable health care.
This is especially true in Dowagiac. It is a financial and emotional hardship for patients and family members to travel from their home town for medical care or hospitalization.
When travel is involved care is often delayed, or worse, neglected causing for more serious health issues that are debilitating and more costly in the long run.
In addition to jeopardizing access to care, the proposed changes will also threaten the economies of small communities across Michigan, like Dowagiac.
As BLMH is the second largest employer, providing jobs for 260 individuals with an annual payroll of over $ 13 million, it is a major economic driver for Dowagiac.
If the hospital closes, this will have a significant impact in adding to the already high unemployment rates here and across Michigan.
Congress itself created the special payment structures for rural hospitals to stop the flood of hospitals closures.
During the 1980s and early 1990s, hundreds of rural hospitals closed and rural Americans lost access to health care.
During that time, our hospitals struggled to maintain financial stability in the urban-centric Medicare Prospective Payment System which penalized our facility because of our small size and unpredictable patient mix.
In response, in 1997 Congress created the CAH designation.
This designation was designed to prevent small, rural hospital closures, like BLMH, by allowing Medicare to pay CAHs for inpatient and outpatient services on the basis of reasonable costs.
Please maintain this excellent progress to assure access to health care across rural Michigan by rejecting any proposals for reductions in payments and reimbursements or changes to the requirements for the CAH program.
On behalf of Borgess-Lee Memorial and all CAHs in Michigan, I ask that you strongly make your support for Critical Access Hospitals be known to all members of the Joint Select Committee.

Joy A. Strand, MHA
Administrator and
Chief Operating Officer