JEFFERSON, Iowa – In a place where access can mean everything, a visit from U.S. Senator Chuck Grassley turned into a candid, ground-level look at rural healthcare and its importance to the communities like those in Greene County.
Greene County Medical Center CEO, Chad Butterfield led Grassley through a facility that tells two stories at once. A legacy dating back to 1937 and a system actively reinventing itself amid the ever-changing healthcare landscape. The tour moved through the original corridors and the modern addition where a newly installed MRI unit, operational since January, represents their progress. “We’ve already seen an increase in volume and patients report being happy about the ease of access and comfort with the new MRI,” said Radiology Tech, Saige Pietig.
Butterfield emphasized that investments like the MRI are about more than technology. They are about keeping care local. “Everything we do is centered on serving our communities,” he said. “That is what drives all 200 plus of our employees.”
The group also toured repurposed areas of the original facility that now house oncology and wound care as well as cardiac and pulmonary rehab services, all part of a broader effort to adapt to shifting healthcare demands. “It’s all about evolving,” Butterfield explained. “We’re taking what we have and making it work for what our patients need today and into the next 10, 15, 25 years and beyond.”
That need, however, is growing more complex. During a roundtable discussion with department leaders, providers, board members and administrators, Butterfield pointed to a pull of patients, providers and services toward urban centers. “That puts pressure on communities like ours to keep up,” he said.
Workforce shortages, especially in family medicine, remain a nationwide concern. However, recruiting physicians to rural areas is becoming increasingly difficult, often requiring reliance on foreign-born providers and navigation of complicated visa processes. Grassley acknowledged these challenges, noting both policy limitations and ongoing efforts to expand rural residency programs. “it’s pretty hard to predict the future,” he said, “but we’re trying to create pathways to keep healthcare in rural America.”
Medicaid policy changes resulting in more uninsured patients, delayed care and the risk of increased bad debt were also discussed. “Those pressures don’t just disappear,” Butterfield pointed out. “They land on rural healthcare organizations.”
Grassley defended recent federal changes as an attempt to stabilize pandemic-era spending, but said legislators left the door open to revisions. “We make decisions that sometimes work and sometimes don’t,” he said. “If there’s a major problem, we have the time to make corrections.”
Staff also raised concerns about the day-to-day realities of care delivery, particularly insurance pre-authorizations and the restrictions under managed care plans. Grassley expressed frustration with the inefficiencies when 95% of pre-authorizations are generally approved anyway. Recent legislation aimed at reducing pre-authorizations by as much as 40 percent has not yet been realized, according to what Grassley was told by leadership at Greene County Medical Center and other medical professionals.
All agreed there is one bright spot that stood out in the conversation regarding access to care, particularly in family medicine and behavioral health. “One of the positives to come out of the pandemic was telehealth,” Grassley said. “It’s especially important for rural America moving forward.”
Butterfield closed the session with appreciation and a clear message about the importance of being heard. “Thank you for taking the time to come here and listen,” he said. This is about working together, sharing what we are facing on the ground and finding solutions that actually work for rural communities like ours.”
Grassley’s visit was part of his annual tour of all 99 Iowa counties, aimed at connecting with constituents who can’t make the trip to Washington, D.C.