Any rural hospital that is in the black is doing better than most, says the administrator of Central Valley Medical Center in Nephi and Gunnison Valley Hospital.

"Gunnison Valley is doing much better than Central Valley," said Mark Stoddard, "but both could have a very bright future."Stoddard, who said he is "cautiously optimistic," said the Nephi hospital is slightly in the black and Gunnison hospital is solidly in the black.

He said the hospital in Gunnison has a slightly higher patient load, has one more physician than the Nephi hospital does, is farther from a larger hospital and draws from a larger area than does Nephi.

Medicare and Medicaid reimburse rural hospitals less than urban hospitals, said Stoddard. He said that problem should be rectified. Part of the reason for low reimbursement, said Stoddard, is rural hospitals and physicians, in order to keep costs within reach for their patients, have typically charged less for their services. Therefore, when Medicare reimbursements were first designed, it was assumed that rural health care costs less.

Stoddard said the assumption is incorrect. Actual costs indicate the expense of running a hospital - paying for heat, fixed costs and staff - can be more of a drain on a rural hospital because it has a lower patient census than the larger hospital.

"Rural physicians typically receive less than their urban counterparts," said Stoddard. "Utah rural health care providers receive substantially less than their counterparts in Nevada, Colorado, Idaho and Arizona."

By moving to an urban area, said Stoddard, the rural doctor could expect "to see fewer patients and make more money. I think that's very unfortunate."

Rural physicians in Nephi and Gunnison have quality training and provide quality care, said Stoddard.

State legislators and federal congressional representatives should enhance the rural reimbursements for rural physicians and hospitals, he said. "I think that's critical," he said.

Rural hospitals treat a large number of elderly patients, he said. Many older residents stay in rural areas and others return when they retire.

"I'm very optimistic about the growth capability (of Nephi and Gunnison)," said Stoddard. Growth and industry will enhance the viability of health care.

A strong and growing economy, a good core of physicians, an adequate number of patients in the market area and adequate care reimbursement would help the rural health-care system. "When all those things fall into place, then we have a good, viable institution."

"There is a great deal that can yet be done to enhance the viability of rural hospitals. We are diligently working as a hospital and as a state group of hospitals to make a difference," said Stoddard.

He said Gunnison recently obtained a $25,000 grant that will be used to purchase a mammography machine.

Another $50,000 will be used to expand the clinic in Nephi.

The Rural Health Care Foundation will be separate from the hospital boards but will solicit funding for equipment and expansion at both Nephi and Gunnison. "The foundation board has been the same board as the Central Valley board," said Stoddard, "but the foundation will now be separate."

Grants are critical to rural hospitals, said Stoddard. One recent grant of $100,000 will help expand the foundation. Over the past five to seven years more than $500,000 has come to the hospitals in grants. The money has gone to buy much needed equipment.

Sharing an administrator has worked well for both Gunnison and Nephi, said Stoddard. He serves two days in Nephi and two in Gunnison and alternates the extra day for a five-day week between the two facilities.

The two hospitals also share a controller and computer skills and some supplies.