Health Care Coverage Is Not Enough. We Need Delivery System Reform. Huffington Post

Another downside to the options the Republicans are considering behind closed doors.

It’s well known that the bill to repeal the Affordable Care Act (ACA) now making its way through the Senate would deny coverage to tens of millions of Americans.  Less well known is that it would also hit the brakes on “delivery system reform,” the work of doctors and hospitals to improve quality and reduce costs. In other words, it would make quality of care worse.

http://www.huffingtonpost.com/entry/health-care-coverage-is-not-enough-we-need-delivery-system-reform_us_596b777de4b0d6341fe98c85#

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/

Commentary: Cuts to Medicaid threaten services for disabled – Everett Herald

From Lance Morehouse, the  executive director of Sherwood Community Servicesin Lake Stevens.

Regardless of the fate of attempts to repeal and replace the Affordable Care Act (ACA) in Washington, D.C., services for thousands of people with disabilities in Washington State are at stake, especially as Congress considers cuts to Medicaid.

https://www.heraldnet.com/opinion/commentary-cuts-to-medicaid-threaten-services-for-disabled/

 

The Myth of Drug Expiration Dates – ProPublica

Following the discussion we had with Dr. Art Zoloph this month on the subject of stockpiling medicines, is this superb story by ProPublica. It begs the question of why not spend the money to appropriately test drug potency over time, given the expense of buying them?

Hospitals and pharmacies are required to toss expired drugs, no matter how expensive or vital. Meanwhile the FDA has long known that many remain safe and potent for years longer.
by Marshall Allen
ProPublica, July 18, 2017

https://www.propublica.org/article/the-myth-of-drug-expiration-dates

Don’t be fooled: Health care repeal will hurt here. Crosscut

A good overview of what is at risk for the State of Washington.

The state Insurance Department has estimated that more than 700,000 residents could lose ‎coverage. That’s roughly 1 in every 10 Washingtonians who could be so affected that they would end up with no health insurance at all.

http://crosscut.com/2017/07/health-care-changes-would-hurt-washington-state-obamacare-repeal/

 

Now we know…

The Republicans have just floored their health care reform bill. You can read the details all over the internet. But it’s a disaster for rural hospital districts like ours. We have the oldest population of any county in the State and  rely heavily on Medicare reimbursement. We also have a huge poor population, which relies on Medicaid. Let’s just set aside the number of people who come to the food bank weekly.

Our reliance on  Medicare and Medicaid patients being reimbursed from the federal government at rates that make it worthwhile to do the work of caring for them, make it important not to lose what ground has been gained. Before Obamacare we were running a deficit that the taxpayers of this county paid for. Since Obamacare we are running a surplus. Not much, but not in the red. Now this. Who’s going to pay?The general attitude that I hear all the time from acquaintances and on the Internet is that they don’t want more taxes. The poor will come into the emergency rooms regardless if they are covered or not. But if the Feds don’t pay for them, it will be on us. You and I. Or the hospital could eventually close. Just ponder the words of a Kaiser Family Foundation study published in 2016 (JHC is  a 25 bed hospital):

In 2012-2013, rural hospitals had an average of 50 beds and a median of 25 beds. They had an average daily census of 7 patients and 321 employees, and they were 10 years old on average. Compared to urban hospitals, rural hospitals are more likely to be in counties with an elderly and poor population.9 According to The North Carolina Rural Health Research Program (NC RHRP) at the Cecil G. Sheps Center for Health Services Research, which tracks rural hospital closures, there were 72 rural hospital closures between January 2010 and April 2016, compared to 42 closures between 2005 and 2009, and since the 2008-2009 recession, the annual number of closures has increased each year.10 More than half of all rural hospital closures since 2010 were in the South and few Southern states have expanded Medicaid under the ACA.

http://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

The expectations are that we are in for some very hard times in the years ahead. It will take a lot of effort to keep our hospital running efficiently and staffed appropriately. Even now, we are having a hard time retaining quality medical staff even though we offer competitive salaries to Seattle, according to the hospital administration. Unfortunately, we have not done a great job at looking at foreign trained medical professionals, which are in wide spread use at Harrison and other nearby medical facilities. We also are behind the curve in the use of less expensive mid-levels, ARNPs and PAs. To the hospital district’s credit, the number of those mid-levels is up recently, probably due more to federal requirements and an inability to retain physicians, more  than anything else.

Perhaps if the Democrats win back the House and Senate and eventually the Presidency we can hope for fixes to this awful proposal which was created by a cabal of men behind closed doors. No women, even of their own party, were asked to work with them. It was despicable back room politics of the worse kind. They have even screwed their own constituents in places like Spokane and Wenatchee, as rural hospitals there are even farther from urban centers.  You have to wonder just who they represent? Or maybe we already know and this next four years will finally drive that home to their supporters in places throughout the rural west and south. Or maybe those voters and non-voters are so tuned into Fox News that they can’t connect the dots anymore.

We can only hope that we will get through the next four years without seeing a collapse of our hospital and the services it is offering, even though prices are already causing people who are aware of the high charges to drive closer into Seattle to seek competitive rates for services.

Now more than ever we need engaged, knowledgeable people in the role of Hospital District Commissioner, which is an election that is happening now. We don’t need a rubber stamp for the hospital district administration, we need deeply knowledgeable people who can roll up their sleeves and help, challenge the administration when needed and go advocate for the hospital district in the State and Federal arenas.

We need leadership from skilled medical professionals who have spent time in the trenches, understanding  both the issues of health care administration and the needs of our neighbors because they have sat in the rooms with these patients as they poured out their hearts to them about their medical conditions and their ability to pay for treatment or drugs. People who held them as they cried. Who may have given them free treatment rather than walked away. Who might have sometimes given them hard news. People who know what we have to fight for and can help guide the hospital district administration and our elected officials forward through this coming dark night.

Medicaid is for everyone – New York Times

The war on the poor in America continues. As the Republicans work in secrecy to come up with a healthcare bill to serve someone other than the average American,  The New York Times ponders the destruction of Medicaid, high on the Republicans list. If ever there was a rich vs. poor issue, this is it. If this gets implemented as the Republicans and Trump want, it will have disastrous consequences for Jefferson and Clallam Counties. Both of them have high levels of both Medicaid and Medicare beneficiaries and our hospitals budgets are based on those reimbursals being available. It is the calm before the storm here.