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.

 

Jefferson County Dems endorse all candidates.

In a high spirited meeting running over three hours, Jefferson County Democrats endorsed all candidates presented on their slate. The entire list can be viewed under the tab at the top of this page, titled 2018 Elections.

The three candidates that drew the most debate were Joe Nole for Sheriff, Maria Cantwell for Senator and Derek Kilmer for House of Representatives.

The debate on Joe Nole’s endorsement came from a group of people who brought up issues that had happened under his temporary leadership as interim sheriff in the months before Dave Stanko’s election. They also discussed issues of aggressive policing, (not by Joe but by officers under his command at that point) and positions that Joe was claimed to have made. They also were in support of Sheriff Stanko. Ultimately, a series of speakers who have worked with Mr. Nole, including outgoing County Commissioner Kathleen Kler, allowed for a clear win for endorsement.

Opposition to Derek Kilmer came from what is known as the “Progressives”, who primarily were supporters of Senator Bernie Sanders. They identified a number of issues that Rep. Kilmer has not taken a stand on, or has supported. Single Payer Healthcare, bills that supported Israel to the exclusion of Palestinians, and his vote supporting the massive recent military budget (HR5515) and tax bills, which far exceeded the demands of President Trump. To be clear, many Democrats ended up supporting the bills as there were numerous items added that they requested. Representative Kilmer also has not achieved anything of substance around the expansion of the Navy airbase and it’s subsequent noise issues for the entire north Sound and Strait. He has done nothing of substance to also protect the west end of the Olympic Peninsula from being used as a Navy training ground with low flying jets over the west side of the Olympic National Park. These issues have engendered huge meeting turnouts and thousands of letters of support for him to take action. However, as of this writing, his efforts have seemed very unsubstantial.  Representative Kilmer  has been endorsed 100% by Planned Parenthood, Human Rights Campaign, and to a lesser degree, by the ACLU (88%) and The League for Conservation Voters (92%). His entire voting record can be viewed here:

https://www.govtrack.us/congress/members/derek_kilmer/412583

Similar issues were raised about Senator Maria Cantwell. Senator Cantwell did vote no on the Defense Appropriations Act. Senator Cantwell has been endorsed 100% by Planned Parenthood, Human Rights Campaign, and to a lesser degree, by the ACLU (88%) and The League for Conservation Voters (91%). Her voting record can be found at

https://www.govtrack.us/congress/members/maria_cantwell/300018

Supporters of the two argued for Democratic unity in the face of goals to take back the House and Senate, along with positive bills that both had supported. Ultimately, both easily won endorsement.

 

 

 

 

Lisa Holt resigns from Jefferson Healthcare

Jefferson County Healthcare announced the resignation of Lisa Holt, chief ancillary officer for the hospital. Ms Holt, had been with JHC since May 2013, according to her profile on LinkedIn. Prior to that she had been Nursing Director of Education at Centura Institute in Orlando Florida. There was no word on what Ms. Holt will be doing next. But the unexpected resignation and her immediate leaving the senior position seemed difficult to understand, since she appeared to have a very positive relationship with the rest of the Senior Leadership Group surrounding Mr. Glenn. There was no one immediately named as a successor.  It would seem that Mr. Glenn would have wanted her to help with a transition period, and that JHC would have made an announcement thanking her for her work. As of Monday morning, her photograph had been removed from the JHC web site leadership team.

Turnover at JHC appears to above average. Mr. Glenn has admitted to turnover being an issue in public meetings in the past few years.  However, it has never apparently been a significant issue in his reviews, completed by the Hospital Commissioners.

Need for high school clinic supplies

UPDATE:THANKS TO YOUR EFFORTS

THIS HAS BEEN FUNDED!

The cause: Jefferson’s Public Health clinics have an opportunity to replace ancient equipment with refurbished items at a bargain basement rate, for which they have no budget.

When students need counseling or help with family planning products, human papillomava virus (HPV) vaccinations, testing for sexually transmitted disease (STDs), and other more routine health problems, these services are provided discreetly and with great care by specially trained Public Health (PH) nurses. No other state high schools on the Olympic Peninsula provide these essential services. Jefferson County PH runs on a shoestring budget, always a little short of their needs.

You can help, now.

Our new project is local, but critical to getting appropriate health care to un-insured or under-insured Public Health patients, especially those in the high school clinics.

The goal is to raise $3k so they can acquire a new exam table (the current one is still in use but is dangerous and uncomfortable for large people) and replace a very old autoclave that is used to sterilize IUD insertion packs and reusable speculums. Normally, these items would cost many thousands of dollars, but PH connected with a company that refurbishes equipment so that it sells for a more reasonable price. These deals are only available this summer.

The best part is – you can donate to this cause through Public Health directly. (see below) and your contribution is tax-deductible.

Generous local donors have already raised $10k for the Greater Northwest Planned Parenthood last fall. Now, let’s help our local family planning providers.  Send your donation to:

School-based clinic supplies

J.C.P.H. – 615 Sheridan, PT, WA 98368

Thank you for supporting Port Townsend’s family planning services for women and girls.

Please send your check as soon as possible.

 

 

 

Jefferson Healthcare running in red for first half of year

At the July 25th Hospital Commissioners meeting, CFO Hillary Whittington laid out the current fiscal situation to the Commissioners. She stated that the hospital would need approximately $540k by end of the year to break even.   They are expecting approximately  $1M from Medicare billing, but will still have the shortfall.

“(We need to ) Improve our business practice by about $540k by the end of the year.” She went on to discuss where the cuts to the budget would have to come. “It sounds like a lot of money, but when you look at overtime premium pay, supplies and professional fees and services…I have no doubt we can find $540k.”

In the first half of the year, the hospital has paid for a number of expensive consultants, along with a new paging system for doctors, even with the known shortfall looming. Now, the front line that addresses patient needs will be the area cut back due to the shortfall.

Newly elected Commissioner McComas, who touted his financial acumen during his bitter election fight, had nothing to ask of Ms. Whittington. Neither did Commissioner Kolff. When asked for comment about the situation, Mr. Kolff said that “Budget shortfalls are a concern to all, ” and declined to comment further

Additionally, the hospital is planning to open a retail outpatient pharmacy inside the hospital. While there are valid reasons that the hospital gives for the move, (i.e. making sure patients fill their prescriptions before leaving the hospital) the move could threaten the well loved Don’s Pharmacy and the relationship of the hospital to Safeway. Some critics see it as a move to capture the lucrative federal money known as 340B money that currently is handed over to Safeway for fulfilling low income prescriptions. The controversy over 340B is that the money was originally intended to be given *directly* to low income consumers to shop for the best deal, but instead has been co-opted by hospitals and pharmacies as a separate revenue stream. Pharmaceutical companies have been lobbying Congress for a few years now to kill the 340B program. The hospital has a special accounting bucket for the money it makes off the 340B program.

Additionally at an earlier meeting in the year the JHC pharmacist indicated that the hospital’s expansion of it’s cancer treatment centers will allow it to capture more of the money made from chemo treatments. How this all helps lower costs for Jefferson County residents who own the hospital is not clear. No discussion was made of the effect on local pharmacies nor of using other low cost providers such as online, Costco or Walmart to fulfill the need. Apparently the hospital executives and commissioners felt that adding headcount to create the pharmacy was creating a valuable enough revenue stream to allow it to go forward, while cutting the overtime and budgets of the front line staff.

 

Lack of local SANE staff leads to conviction of rape to be overturned- PT Leader

One of the most significant healthcare issues in the county is a lack of a trained Sexual Assault Nurse Examiner (SANE) on the staff of Jefferson Healthcare. Behind the scenes a number of women have been meeting with our elected officials and members of Jefferson Healthcare to address this problem. While the following court case has more issues than just a lack of a SANE staff member, it does point out that without one, a man convicted of rape might be freed even if the victim knows him and can make the claim that he did the rape.
The problem with attempting to do what Mr. Haas said to do, is that the closest SANE trained staff is in Kitsap county. It is not likely that a victim is going to feel like driving or being driven just after being raped, to a distant county to be treated by staff and perhaps police who may or may not be supportive of her claims is not a reasonable request.
It seems that this case should be a reason that the public come to an upcoming Jefferson Healthcare Commission meeting and demand that JHC implement a SANE as quickly as possible. It could be your child, grandchild or partner next.
On April 26, Jefferson County Superior Court Judge Keith Harper ordered those charges be dismissed without prejudice, after Jefferson County Prosecuting Attorney Michael Haas moved to dismiss the case April 25, “due to a number of evidentiary problems,” according to Haas’ declaration of counsel filed with the court.
In the declaration, Haas wrote the alleged victim should have been sent to a sexual assault nurse examiner “almost immediately” after law enforcement received reports of sexual assault on her.

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/