Trump Administration Slashes Medicare/Medicaid Payments. Local Hospital Is Targeted

The Peninsula Daily News (PDN) is reporting that the Trump Administration, against the wishes of hundreds of letters and testimony against it, is slashing Medicare and Medicaid reimbursal rates to clinics more than 250ft away from a central hospital. The new rule is called the “CY (for Calendar Year) 2019 Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System”

The rule announcement from July is found at

https://www.cms.gov/newsroom/press-releases/cms-empowers-patients-and-ensures-site-neutral-payment-proposed-rule

and the October 30th update is found here:

https://www.cms.gov/newsroom/fact-sheets/cms-finalizes-hospital-outpatient-and-ambulatory-surgical-center-policy-and-payment-changes

The goal of the proposed rule was to eliminate patient clinic visits to hospital clinics that charge more than non hospital clinics. The Center for Medicare and Medicaid Services (CMS) claims in it’s press release that, “Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.” They offer no proof to that claim.

The most affected facility for this on the Olympic Peninsula is Olympic Medical Center’s (OMC) offsite clinics in Sequim. Ironically the clinics serve a population that voted for President Trump in the last election and they will, if this rule is not overturned via legislation, be the most effected by it. The chart at the link below shows how various precincts voted in 2016.

https://www.nytimes.com/interactive/2018/upshot/election-2016-voting-precinct-maps.html#8.27/47.920/-122.715

The PDN is reporting that payments may be slashed up to 60%, which would apparently make these clinics financially nonviable. Medicare and Medicaid payments today are so lean that many physicians do not take new Medicaid/Medicare patients because they cannot survive on the reimbursal rates.

The outcome of this will be that seniors and the poor will have to travel further for medical care, and that some hospitals, like OMC may be forced to close their remote facilities and possibly even put their main hospitals in financial jeopardy. Hospital closings in the last decade in rural areas have reached new highs, leading to rural areas often being the most under-served areas for healthcare in the country. Forbes magazine, in 2017, had an article that researched the issue and found that “Approximately 2300 rural hospitals are in the United States. Of those, 81 have closed since 2010.” Forbes went on to show how President Trump’s proposed healthcare cuts were putting “673…at risk of closing”. The full story from Forbes is available at https://www.forbes.com/sites/bisnow/2017/07/26/obamacare-repeal-could-cripple-rural-hospitals-and-lead-to-more-closures/#6dbd6b4f42b8

It is not known how this will affect Jefferson Healthcare (JHC) as they have kept their clinics within the required 250 yard rule. They have worked around the issue by setting up their clinics in Quilcene and Port Ludlow in a different legal framework. They claim that they will be less affected.

There have been rumors from healthcare providers that other standalone clinics may be affected, those not attached to a hospital. We will track those as we hear from the community. Your comments and insights are welcome to be sent to albergstein@gmail.com

What is happening is an ongoing push to centralize healthcare in urban centers and reduce the costs. While healthcare costs are rising, much of these costs are centered in the last years of life. Our insistence on providing all out high cost medical support to terminally ill patients, for example, rather than focusing on expanded hospice care has led to a heavy weighing of costs to end of life medical intervention. From personal experience, I can say that in some locales there seems to not be honest dialogue between patient and provider about the likelihood of a successful outcome, leading to the patient not knowing that they are essentially terminally ill and wanting to continue, under the providers suggestions, with expensive treatment that will only likely extend life a few months.

Medical providers are also, due to litigation costs, often insisting on far more tests than necessary, driving up costs. There is no easy route out of that issue, as patient expectations are not often aligned with actual healthcare scenarios and outcomes. The inability to also properly judge physician history and ratings also make it hard for patients to know when some providers have a history of malpractice.

But the slashing of medicaid and medicare costs to OMC and other hospitals like it, is a cynical ploy by the Trump Administration and Congress to do a stealth attack on these services, one which was highlighted in an article last month.

Larry Kudlow, the director of the Trump White House’s National Economic Council, recently said he wants to take aim at “entitlements” as early as “next year.” A few months earlier, House Speaker Paul Ryan (R-Wis.) said he wants to see policymakers bring the budget closer to balance by cutting “entitlements.” Rep. Steve Stivers (R-Ohio), who currently chairs the National Republican Congressional Committee, made the same argument in August.

And now Senate Majority Leader Mitch McConnell is making the identical pitch.

http://www.msnbc.com/rachel-maddow-show/mcconnell-eyes-cuts-medicare-social-security-address-deficit

This all comes after slashing taxes to the wealthiest Americans and corporations earlier in the year.

It is worth remembering that this administration and previous ones have spent approx. $170M a day for 16 years funding the war in Afghanistan. We have the money to fund Medicare and Medicaid at appropriate levels. It’s all about priorities.

Just last month, our legislators from both Clallam and Jefferson counties, including some of our county and hospital commissioners and executives, traveled to Washington D.C. and met with numerous staffers, both at the White House and Congress. Some of them, such as Republican Congresswoman Jamie Herrera Butler, was not in Washington and sent out a staffer who knew nothing of the issues.

It remains to be seen if our legislators can fix this problem in Congress next year. If you want to help ensure it gets done, vote Democratic on Tuesday November 6th. Putting Democrats at least in charge of the House will allow a real debate and bipartisan approach on how this all proceeds. Representative Kilmer, who is up for re-election, along with other Democratic Representatives have been fighting hard to protect rural hospitals. These politicians are not perfect. None of them will agree with all of us all the time. That’s just not how this representative democracy works. But these Democratic politicians in our district have a track record and to elect more Republicans and expect a different outcome seems unrealistic.

Otherwise these kind of cuts are going to continue to come at us, with the outcome being far worse healthcare options for all of us, no matter who you voted for in this election. This is not “making America great again.”

The final rule will appear in the November 13, 2015 Federal Register and can be downloaded from the Federal Register at: http://www.ofr.gov/inspection.aspx?AspxAutoDetectCookieSupport=1.

 

One-of-a kind collaboration expected to train health care workers on Peninsula – PDN

This is a great idea to try and work to train and bring on qualified local people quickly.  Thanks to the Littlejohns and the Jamestown S’Klallam Tribe for also helping to fund the initiative. Jefferson Healthcare has tried with little success to find medical professionals willing to relocate here for the long term. I personally have seen them pass over qualified local candidates in favor of people from elsewhere, only to see them leave after a few years of work here. Now this program presents the opportunity to grow candidates on the peninsula, which is far more likely to having them stay for the long haul. A good use of our tax dollars, I’d say.

PORT ANGELES — Peninsula College is teaming up with health care providers from Clallam and Jefferson counties in a wide-ranging $1 million effort funded by state lawmakers, the college foundation, local hospitals and others. The goal: Add registered nurses, medical assistants and certified nursing assistants to a rural medical industry workforce on the North Olympic Peninsula that is typically starving for job applicants.

http://www.peninsuladailynews.com/news/one-of-a-kind-collaboration-expected-to-train-health-care-workers-on-peninsula/

Medicare proposal bad news for OMC, says CEO – PDN

So here comes the first of many negative changes to the health care from the Republican dominated Congress. There is still a chance this won’t be implemented, but don’t bet on it. Americans have put these people into office, they have taken away the government’s ability to negotiate drug prices and now are going to take away the funds needed to protect the most helpless of us from losing their medications.

PORT ANGELES — In the first six months of 2017, Olympic Medical Center reported a $1.1 million loss in revenue, and it could face more financial setbacks next year if Medicare weakens a discount drug program, Chief Executive Officer Eric Lewis said.

You may need to sign up for a subscription to read this, but please do. Support your local newspaper or you may find it gone!

http://www.peninsuladailynews.com/news/medicare-proposal-bad-news-for-omc-says-ceo/

POINT OF VIEW: The Peninsula’s dental health emergency – PDN

By Dr. Michael Maxwell
ACROSS THE STATE and in the North Olympic Peninsula, low-income people are facing an oral health crisis.
Simply put, there are not enough clinics and providers to serve them.
In Clallam County, only 22 percent of adults on Medicaid and just 41 percent of children on Medicaid received dental care in 2015.
In the same year in Jefferson County, only 12.7 percent of adults on Medicaid and just 37 percent of children on Medicaid received dental care.
This is not a cosmetic luxury but a serious health concern that is taking a huge toll on our communities.
Many health care advocates are urging our state Legislature to address this crisis.
 
Read the rest of the story at:
Dr. Michael Maxwell is a family physician and CEO of the North Olympic Healthcare Network, a ­federally qualified community health center in Port Angeles.
He lives in Port Angeles.

Washington leaders announce $2.7 million federal grant to increase apprenticeship opportunities

More good news. The Federal government has just granted Washington State $2.7 Million dollars to help fund apprenticeship programs. Related to the issues covered by this blog, there is this phrase:

Under Project RAISE, the state will work with various partners to expand apprenticeships, develop a high school-based manufacturing program at select schools, and increase industry demand in rural health care networks. (Jefferson and Clallam County hospitals are considered part of rural health care networks). It will also allow L&I to improve its tracking of growth and success of youth apprenticeships.

L&I filed for the grant based on the need to help more people find and keep jobs. The agency’s Apprenticeship Program helps employer and employee groups develop and maintain on-the-job training programs. There are more than 12,000 active apprentices participating in programs across the state.

We will continue to track this story for outcomes in our region.

Summary

Hundreds of Washington workers will have opportunities for job-based apprenticeships, thanks to a new $2.7 million federal grant the state will receive over the next 18 months. Washington state and federal leaders announced today that the U.S. Department of Labor has chosen Washington as one of 37 grantees to help grow and diversify apprenticeships around the country

State Press Release: http://www.governor.wa.gov/news-media/washington-leaders-announce-27-million-federal-grant-increase-apprenticeship

Federal Press Release. https://www.whitehouse.gov/the-press-office/2016/10/21/fact-sheet-investing-more-50-million-through-apprenticeshipusa-expand

Update on the Governor’s new State-Federal Partnership

The announcement last week from the Governor.

OLYMPIA –Gov. Jay Inslee and the Washington State Health Care Authority (HCA) announced today a new state-federal partnership that will bolster state efforts to improve the physical and mental health of Washington families and transform the state’s Apple Health (Medicaid) program to control costs.

After months of detailed negotiations, the HCA—in partnership with the Department of Social and Health Services (DSHS)—and the federal Centers for Medicare & Medicaid Services (CMS) reached an agreement in-principle, on a five-year Medicaid demonstration waiver to continue implementing the governor’s Healthier Washington plan.

To get more input on this, I talked to Dr. Elya Moore, who is the Executive Director of the Olympic Community of Health, which is the Accountable Community of Health (ACH) that will help implement this new project on the Olympic Peninsula, and in Kitsap County.  There are eight similar ACH’s in various districts around the State.

Dr. Moore described the new program as a very positive step towards focusing on prevention and proactive management for conditions like diabetes and mental illness, along with addressing opiate dependency. To help illustrate the scope of this federal grant, the figure is 1/2 of the NFL budget, so it’s a large number. The breakdown of need  for our three counties are illustrative: In 2015 24% of people in our three counties were on Medicaid (27% is the statewide average); 30% of the health care recipients have been  prescribed opiates. Opiate use also often can lead to opiate abuse. The problem is very large in our counties. This grant will be used to address those and other issues.

The program, as described by the Governor, will also fund supported employment and housing services and long term care services along with supports for unpaid family caregivers so they are able to keep caring for their loved ones. The hoped for result will be less use of high-cost services  and better health outcomes.

The ACH in our district is comprised of a 22-member Governing Board including  15 sectors and seven tribes. There is also an Executive Committee and Regional Health Assessment and Planning Committee to review health assessments and advise board on regional priorities.

Dr. Moore said she hopes that  the money will be spent on programs to do the following:

  • Address chronic disease management and prevention.
  • Help with access of dental, behavioral  health,chronic disease, aging in place, integration of care and early childhood health.

The money from the Federal government will flow through two different paths. Approx $65 million will go towards the Healthier Washington program, and then into programs that the ACHs help coordinate that are the focus of that program. An additional new $1.25 Billion will flow through State programs  and also into State ACHs, for the programs that will help in healthcare transformation. Another $375M will be used on programs for in place housing programs for care maintenance and services that delay or divert the need for intensive interventions such as support for people who need long-term services. . (That money will not flow through the ACH’s but a different state program).

Once the funding has arrived, which is supposed to be very soon, the ACH for the Olympic Peninsula will then kick off projects to use that money effectively and on priorities. Opioid prevention and response is a major priority project to kick off. It is to be determined how much money will be used on this project, as the project has not yet been scoped. Other projects that address the other issues will follow soon.

We will continue to track this program in the future.