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.

 

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.

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

 

 

 

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.