KAREN VIBERT-KENNEDY/Sun-Gazette Steve Johnson, UPMC President and CEO speaks at UPMC in WIlliamsport, during a roundtable discussion about vaccine rollout, telehealth, and legislation to improve rural hospital payment rates.

A federal lawmaker says he is focused on disparity between health services in rural versus urban locations.

U.S. Rep. Fred Keller, R-Kreamer, has re-introduced federal legislation that might help out rural health care providers such as UPMC Susquehanna.

He recently visited with UPMC administrators during a roundtable discussion on costs associated with the COVID-19 pandemic and hospital operational expenses he might be able to assist on.

“Health systems based in rural communities are more disadvantaged than those in urban settings,” said Steven Johnson, UPMC Susquehanna president and CEO.

Both city hospitals and those in more rural settings are on the frontlines in the pandemic, which has contributed to higher operational costs.

However, the rural hospitals, many of which lie in UPMC coverage areas, are not treated with parity in terms of Medicare reimbursement, Johnson said.

To help with that issue and others, Keller said he reintroduced the Rural Help Act, with co-sponsors Glenn “GT” Thompson, R-Howard and others in Congress.

The legislation aims to bring parity to inpatient Medicare reimbursement payments between rural and urban hospitals.

The operational costs are driving some rural hospitals to close their doors.

Over the last 10 years, 124 rural hospitals have closed with another 453 at risk for closure, according to the National Rural Health Association.

“To bring it to home, we did have a rural hospital — Sunbury — close,” Johnson said. “It can happen in north-central Pennsylvania.”

To cap drug prices, Keller was asked to see if modifications to pharmaceutical company margins could be lowered as part of the Public Health Service Act (340B).

The act requires pharmaceutical manufacturers participating in Medicaid to sell outpatient drugs at discounted prices to health care organizations that care for patients in vulnerable communities.

“Unique about that is there are no federal, state or tax dollars in (340B),” Johnson said.

Pharmaceutical companies generally operate with high profit margins. Margin is the difference between income/revenue and the expense of operating the business.

It is not unheard of for them to have a 20 percent margin while a hospital might have a 2 percent or less margin, Johnson said.

Some rural hospitals have no positive margin.

Moreover, the combined cost of the program to the pharmaceutical industry represents about 1 percent of the revenue.

The argument drug-makers have that it takes away from profits is a somewhat disingenuous one, Johnson said.

Keller and the health care professionals want to see internet broadband expansion in the same urgency as the nation’s interstate highway system in the 1950s.

That can help in the delivery of proper telehealth services, for providers and customers.

The goal would be for a user of internet for telehealth purposes on Route 6 in the state Northern Tier to have the same access to internet as those on Interstate 95 near Washington, D.C., Johnson said.

“Connectivity is not just for patients,” said Tyler Wagner, a UPMC Susquehanna spokesman. “We as providers may be added to connectivity ability to provide services,” he said.

Hospitals, such as those with UPMC, must wait for nurses who have licenses in other states to reapply for a Pennsylvania nurse license, said Susan Duchman, vice president for care services and chief nursing officer at UPMC Susquehanna, and Dawn Wright, vice president of human resources.

“The waiting for the administration can exact a penalty for the prospective employer and candidates themselves,” Johnson said.

A national licensing compact exists between 34 states which has “reciprocity and recognizes licenses of nurses and other health care providers in different states.”

“Unfortunately,” Johnson said, “the process does not exist in Pennsylvania.”

It affects a nurse prospect living in New York, for example, who wants to drive across the state line to work.

Keller said he would take the tips back to his team as he drafts legislation.