ms. peterson? >> chairman blunt, ranking member murray and members of the subcommittee, thank you for the invitation to testify today. my name is julie peterson, and i'm the administrator of pmh medical center, a critical access hospital located in prosser, washington, a community of about 6,000 people. pmh is organized as a public hospital district, and we serve about 68,000 rural residents in two counties and five small towns. the mission of rural health care providers like pmh is to ensure access to high quality, affordable care for populations that are challenged disproportionately by distance, poverty, age, chronic conditions, and cultural barriers. many of our patients do not have reliable transportation, paid sick leave, and the other resources that allow them to travel to receive care outside of their communities. in short, rural communities are older, sicker, have poor health status, and face significant economic challenges. it's never been easy to provide access to high quality care in th

ms. peterson? >> chairman blunt ranking member murray and members of the subcommittee, thank you for the invitation to testify today. my name is julie peterson, and i'm the administrator of pmh medical center, a critical access hospital located in prosser, washington, a community of about 6,000 people. pmh is organize nieszed as a public hospital district, and we serve about 68,000 rural residents in two counties and five small towns. the mission of rural health care providers like pmh is to ensure access to high quality, affordable care for populations that are challenged disproportionately by distance, poverty, age chronic conditions, and cultural barriers. many of our patients do not have reliable transportation, paid sick leave, and the other resources that allow them to travel to receive care outside of their communities. in short rural communities are older, sicker, have poor health status, and face significant economic challenges. it's never been easy to provide access to high quality care i

ms. peterson. mr. stover? >> mr. chairman and members of the committee thank you for the opportunity to speak to you today. my name is george stover, and i serve as the chief executive officer of hospital district number one of rice county in lyons county. lyons has a population of 3800. our community hospital, which first opened in 1959 is a 25-bed critical access hospital that employees approximately 150 individuals. rural community hospitals have a long and distinguished commitmentment of providing care for all who seek it 24/7 365. more than 36% of all kansans live in rural areas and depend on a local hospital serving their community. rural hospitals face a unique set of challenges because of the remote geographic location small size scarce workforce, physician shortages, higher percentage of medicare and medicaid patients and a constrained financial resources that limited access to capital. these challenges alone would make it difficult for many rural hospitals to survive. however, one disturbing challenge that

ms. peterson talked about telemedicine as well. i just would like to the summit of the costs associated with the telemedicine and now they're paid for. as i was listening to testimony i jotted down three things i think that a hospital would have to pay for the equipment. i'm interested if you could just i'm sure you've told us in your testimony but i'd like to get this in a short summary so that i can understand it. you have to be good how to pay for the equipment. you've got to be good how to connect and how that is paid for. and then finally how does the provider get reimbursed for providing the service? my question that there is when the university of kansas medical center in kansas city provides telehealth to the rice county district number one hospital is there a reimbursement to the physician who is present in kansas city at the major hospital? the is there any reimbursement but then comes to the hospital that is providing this service at the other end? >> so your points are absolutely correct. there has to be a purchase of e

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