SCOTUS REJECTS PLANNED PARENTHOOD CASE. [HuffPost]

Great news! Read the whole story at the Huffington Post.

SCOTUS REJECTS PLANNED PARENTHOOD CASE The Supreme Court, with three dissenting justices, ducked a high-profile case by rejecting appeals from Kansas and Louisiana in their effort to strip Medicaid money from Planned Parenthood. The court’s reluctance to take up new cases on volatile social issues is putting it on a collision course with Trump, whose Justice Department is trying to rush such disputes through the appeals system to get them before the nine justices as quickly as possible. [HuffPost]

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.

 

Three take-aways from Nancy Guinto’s transparency testimony to the US Senate HELP Committee – State of Reform

Nancy Guinto, Executive Director of the Washington Health Alliance (WHA), testified before the US Senate HELP (Health, Education, Labor and Pensions) Committee last week about how price transparency initiatives can increase value in health care. Three key takeaways:

  • Congress should create incentives to align stakeholder interests in leveraging data to improve care value. Congress should look across public and private sectors to coordinate efforts to increase transparency.
  • Congress should support federal agency efforts to increase transparency by promoting initiatives that tie cost, quality, and value together and by making access to data less burdensome.
  • Congress should leverage existing networks that promote transparency, like regional health improvement collaborative, that already have the trust and support of local stakeholders and who are already working to make care improvements.

Those of us involved in the Jefferson County Healthcare Access Group (CHA) have struggled for a few years now to increase pricing transparency at Jefferson Healthcare. We have met with resistance every step of the way. Breakthroughs in the last year have led to citizens having a somewhat better understanding of the prices they face before they get into the hospital. We fully support the efforts of the Washington Healthcare Alliance.

It is clear to those of us involved in understanding the healthcare industry on a local level, that increasing centralization, decreasing independent medical providers, penalization of individual providers by Congressional funding mandates,  and a lack of transparency are creating a system the more resembles a monopoly, costs more and does not  necessarily provide better indices of health.

Read more on this at

https://stateofreform.com/featured/2018/09/three-take-aways-from-nancy-guintos-transparency-testimony-to-the-us-senate-help-committee/

 

Trump Administration Guts Title X funding for most clinics

The Trump administration has radically changed the Title X funding model. It is going all out to cut funding to any women’s health care clinic that provides any kind of abortion counseling services. Here’s some of the details.

Require that Title X funded activities have full physical and financial separation from abortion-related activities. In addition to separate accounting and electronic and paper health records, providers would need to have separate treatment, consultation, examination and waiting rooms, office entrances and exits, workstations, signs, phone numbers, email addresses, educational services, websites, and staff. This new requirement would essentially disqualify any provider from receiving Title X funds if they also offered abortions.

Link to the PDF of the full report

Issue-Brief-Proposed-Changes-to-Title-X-Implications-for-Women-and-Family-Planning-Providers

 

 

 

Abuse of 340B Program Impacts Patient Care -Oncology Nursing News

Jefferson Healthcare and many other rural hospitals, take advantage of a Federal program called 340B.

As the article states:

This little-known federal program was created to help uninsured or vulnerable patients get access valuable medications regardless of their abilities to pay. This was done by providing certain participating hospitals or safety net clinics with discounted medicines. The 340B program has become an extremely important program for patients in need in this era of unaffordable and unsustainable drug prices.

The article lays out the problems with the 340B program and how some hospitals are abusing it to help themselves remain profitable.

While the point of sharing this article is not to infer that Jefferson Healthcare is in any way one of the ‘bad actors’ in the 340B debate, this article gives the average person a very good quick overview of the controversy.  The battle over 340B is playing out in Congress, and it’s outcome will affect JHC. JHC does a great deal charity care, including use of 340B funds, and the program to offer charity care has been recently reformatted to allow people who do not have the means to afford to get needed care. (More on that can be found at the JHC website, JHC Charity Care overview )

I will be looking into the local ramifications of this issue in upcoming months, and should have a more comprehensive overview on them  later.

But for now. Here’s a good quote:

For too many hospitals, the 340B program has become a road to profits, not a safety net and not a way to expand charity care for uninsured, indigent patients. For too many patients, particularly those with cancer, the 340B program has not reduced their cost of care 1 cent.

Read the whole opinion piece here:

https://www.oncnursingnews.com/web-exclusives/abuse-of-340b-program-impacts-patient-care

 

 

 

70 House Democrats Launch “Medicare for All” Caucus – Democracy Now

If the Dems are ever going to win back the House, this is the way it has to be done. Offering working people real solutions for their problems, like healthcare.  How could we pay for it? Well, the President wants NATO members to increase their spending by 2% a year. What if we reversed that and reduced our spending in NATO by 2% a year to match theirs? Yep, that would pay for this proposal. How do you think that all the other first world countries pay for universal healthcare? They don’t spend 50% of their discretionary budget on military spending, like we do. One day in some distant future America, we may finally dramatically reduce the spending on this military/industrial complex that President Eisenhower warned us against. We could then use the monies on our citizens welfare, rather than fueling corporate profits at our tax payers expense.

Declaring that healthcare is a human right, at least 70 Democrats have signed on to a new “Medicare for All” House Caucus. Speaking on Capitol Hill Thursday, caucus co-chair Congressmember Pramila Jayapal of Washington state said the U.S. could provide universal healthcare by lowering the age of Medicare eligibility from 65 to zero.

https://www.democracynow.org/2018/7/20/headlines/70_house_democrats_launch_medicare_for_all_caucus

Trump administration freezes risk-adjustment payments – Modern Healthcare

The administration continues it’s battle to destroy protecting middle and low income folks from medical financial ruin continues.

The Trump administration is halting billions of dollars of payments to insurers under the Affordable Care Act’s risk-adjustment program, a move that further disrupts the insurance market and could lead to more premium increases next year.

http://www.modernhealthcare.com/article/20180708/NEWS/180709931?utm_source=modernhealthcare&utm_medium=email&utm_content=20180708-NEWS-180709931&utm_campaign=mh-alert