Bill will make major difference for small hospitals.

At Community Hospital in McCook this morning, Jim Ulrich was on pins and needles. After 18 months of intense negotiations with national lawmakers, the U.S. Senate was voting on Medicare reform legislation.

Although prescription drugs were the principal purpose of the bill, that was not Ulrich's main concern as he watched the senators vote, one by one, on C-Span.

His interest was the "Rural Community Hospital Demonstration Project," a plan that was conceived in late spring of 2002 by Gary Beiganski, president of Community Hospital in McCook, and administrators from Box Butte Hospital in Alliance and Tri-County Hospital in Lexington.

"We thought the bill would pass," said Ulrich, who is Community Hospital's vice president for finance and support. But he still agonized over every vote this morning, until the final Senate tally, 54-44, assured passage and advanced the plan to President Bush for his signature. Earlier, the House had approved the Medicare reform package, 220-215. As a strong advocate of the Medicare reform plan, the President's signing is regarded as a certainty.

While the overall bill has far-reaching implications, a group of mid-sized hospitals in Nebraska -- called the "Magnificent Seven" -- are still pinching themselves in disbelief that they could pull off such a legislative feat as they did.

As part of only a select few hospitals in the nation, the Nebraska hospitals will receive an estimated $22.2 million over a five-year period to help offset the cost of providing care to Medicare patients.

In the case of Community Hospital in McCook alone, Ulrich said the legislation will mean "at least $690,000 a year" in additional Medicare compensation.

It was a formidable task from the start. The seven Nebraska hospitals knew they were being short-changed. On one side, they were too large to receive Critical Access Care financial assistance. And, on the other, they were too small to achieve the volume enjoyed by larger hospitals.

And, so, they began, uniting their efforts and appealing to Nebraska's national legislators for help. "They were all great in supporting us," Ulrich said, "especially Nelson who carried the legislation through its initial stages into its merger with the Medicare bill."

It will be a while before the additional money starts flowing to Nebraska's mid-sized hospitals. Ulrich expects the initial reporting period for the new reimbursement plan to be October 2004 through January 2005, with the cost changes to be take place July 1, 2005, and thereafter.

Amazing, isn't it? In a nation this large, and in a government this complex, the needs of seven, mid-sized rural hospitals in Nebraska warranted special consideration in a federal legislative package.

Thanks, Gary Bieganski and Jim Ulrich. And thanks, Sen. Nelson, for your leadership. Together, with the help of many, many others, you have pulled off a tremendous legislative coup which will have immense benefit to hometown hospitals in Nebraska.