Dr. Tom Dean isn't afraid to call the current state of rural health care in the United States a crisis.

"We're into some scary territory," Dean said Tuesday after speaking before the National Advisory Committee on Rural Health and Human Services in Rapid City. "I think we are looking at a major paradigm shift in the way we look at health care."

Dean is a member of the Medicare Payment Advisory Commission, the national committee that advises Congress on Medicare reimbursement payments. He's also a primary care physician in Wessington Springs.

He joined nine other South Dakota health care professionals who outlined the issues contributing to the growing health care crisis in rural South Dakota. Speakers blamed the state's rural geography, its aging population, home health care needs, unfair Medicare reimbursement payments and an urgent shortage of primary care physicians.

South Dakota needs to train more primary care providers who will practice in rural areas, because primary care physicians are the front line of care for elderly and pediatric patients, said Dr. Bruce Vogt of the Sanford School of Medicine in Vermillion.

Unfortunately, primary care is failing to attract medical students, Vogt said. It's a demanding specialty with long hours and low pay compared with other specialties. One 2005 study showed that primary care physicians earn $250,000 less annually than orthopedic specialists.

The medical school and Office of Rural Health at the South Dakota Department of Health hope to attract medical students into primary care by providing tuition assistance. They have also begun training medical students in rural settings and pairing them with primary care doctors who serve as "role models," Vogt said.

Charles Hart, chief executive of Regional Health Inc., said although the incentive programs are a start, reimbursement rates for rural hospitals and primary care physicians are the core of the problem.

He emphasized the need for increased Medicare reimbursement rates in South Dakota.

As a member of the Medicare Payment Advisory Commission, or MedPAC, Dean said setting fair reimbursement rates is an ongoing challenge. There is a huge difference in reimbursement rates between regions of the country, Dean said.

MedPAC must analyze reimbursement rates and decipher whether funds are fair and being used wisely. That often is not the case, Dean said. About 18 percent of hospital Medicare patients are re-admitted with the same diagnosis within 30 days of their discharge. Two-thirds of those could be avoided with better post-hospitalization care, he said.

A stronger primary care system will improve those numbers by providing better continuity in care, Dean said. Bundling reimbursement payments and attaching outcome expectations also may help. "Bundling," which means consolidating a payment among several providers, provides an incentive to follow-through with patient care.

But Committee member John Rockwood of Maple City, Mich., said bundling sounds like a poor solution to a big problem, especially for health care providers who aren't part of the same system.

Dean admits bundling may not be a perfect solution but said it has worked in other areas and may be the first step in changing a broken system.

"We're really in uncharted territory," he said. "But we've got to do something different or we're going to self destruct."

Contact Lynn Taylor Rick at 394-8414 or lynn.taylorrick@rapidcityjournal.com.

What is the committee?

The National Advisory Committee on Rural Health and Human Services is a citizens' panel of rural health care experts from around the country who provide recommendations to the Secretary of the Department of Health and Human Services.

The current 19-member board is chaired by former South Carolina Gov. David Beasley and includes members from 17 states.

Two of those members are from South Dakota: Deb Bowman, secretary of the SD Department of Social Services, and Dave Hewitt, chief executive of the South Dakota Association of Healthcare Organizations in Sioux Falls.

Having two members from South Dakota played a role in holding the meeting in South Dakota, Bowman said. The committee meets three times each year, once in Washington and twice in rural areas of the country.

Beasley said in the past, the secretary of the Department of Health and Human Services has implemented 40 percent of the committee's recommendations when setting policy.

The agenda

The 19 members of the National Advisory Committee on Rural Health and Human Services are visiting hospitals in Philip, Rapid City and Custer today to get a better idea about the challenges that rural health providers face.

The committee will meet briefly again at 8 a.m. Thursday, June 11, at the Hampton Inn in Rapid City. They will review the hospital visits and discuss possible recommendations to the Department of Health and Human Services. The public is welcome.