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.

 

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

 

 

 

340B is a well-intentioned drug discount program gone awry -Stat Magazine

There have been questions raised here in Jefferson County about the issues that are covered in this article. A good example is the following statement:

A study in the journal Health Services Research examined the impact of the 340B program on the cost of cancer care. It found that hospital participation in the program is associated with a shift of patients’ care from more affordable physician offices to more expensive hospital outpatient care centers, contributing to market-wide increases in per-patient spending.

https://www.statnews.com/2018/03/22/340b-drug-discount-program-gone-awry/

Governor Signs Bills Related to Healthcare

Here’s the current list of some of the healthcare related bills signed into law recently by Governor Inslee. Use the Bill Tracker web page at the state to see the details on any of them.  My take is that it was a very successful session for healthcare related needs.

http://apps.leg.wa.gov/billinfo/

  • Relating to priority processing for adult family home license applications. (6113)
  • Relating to requiring coverage for hearing instruments under public employee and medicaid programs.(5179)
  •  Relating to human immunodeficiency virus (HIV) testing.(6580)
  • Relating to ensuring that no youth is discharged from a public system of care into homelessness.(6560)
  • Relating to expanding the access to baby and child dentistry program to serve children with disabilities. (6549)
  • Relating to promoting access to the Washington early childhood education and assistance program.(6419)
  • Relating to child support, but only including a parent’s obligation to provide medical support, use of electronic funds transfers, notice of noncompliance, adoption of the economic table recommended by the child support work group, and references to the federal poverty level in self-support reserve limitations.(6334)
  • Relating to preventing suicide by permitting the voluntary waiver of firearm rights.(5553)
  • Relating to the mental health field response teams program. (2892)
  • Relating to making technical corrections to the family and medical leave program and making no substantive changes.(2702)
  • Relating to defining best practices for the process and people involved in best interest determination of students in out-of-home care.(2684)
  • Relating to the use of perfluorinated chemicals in food packaging.(2658)
  • Relating to increasing the personal needs allowance for people in residential and institutional care settings. (2651)
  • Relating to authorizations of proposals for emergency medical care and service levies. (2627)
  • Relating to public hospital district health and wellness promotion activities and superintendent appointment and removal.
  • Relating to maximum penalties under the Washington industrial safety and health act.
  • Relating to providing women with timely information regarding their breast health.
  • Relating to improving access to reproductive health.
  • Relating to insurance coverage of tomosynthesis or three-dimensional
  • Relating to providing a business and occupation tax exemption for accountable communities of health. mammography.
  • and many more…

Senior Lobby Day in Olympia 2/22

From the Puget Sound Advocates for Retirement Action
Are you planning to go to Senior Lobby Day in Olympia, Thursday, February 22? If you haven’t made your reservation yet, please RSVP immediately.
Email govrelations@psara.org or call the PSARA office, 206-448-9646. If you need a ride or you can provide rides, please let us know.

 

Senior Lobby Day is our chance to speak with our elected representatives in Olympia about PSARA’s legislative goals. With Democrats now in control of both chambers of the legislature, this will be our best chance in years to promote PSARA’s progressive agenda.

 

The day will start at 8:00 a.m. with a continental breakfast at United Churches of Olympia, 110 11th Avenue SE, Olympia. A box lunch will also be provided at 11:30 a.m. Speakers, including PSARA lobbyist Pam Crone, will discuss legislative issues.

 

All PSARA members are also invited to meet with State House Speaker Frank Chopp at 1:30 p.m.

 

This event is FREE for all PSARA members.

 

Our elected officials need to hear your stories! RSVP for Senior Lobby Day today.

 

 

 

Bill would help hospital with its financial woes – The Daily World

Insufficient Medicaid reimbursals are helping sink rural hospitals. One of the hospitals this is meant to help is in Grays Harbor, another in Port Angeles.  Senator Van de Wege put it forward with hours just hours before the cutoff. It’s Senate Bill 6601.

OLYMPIA — A bill that would provide temporary funding to ease a financial crisis at Grays Harbor Community Hospital and two other financially struggling hospitals in the state was introduced Tuesday, just hours ahead of the bill cutoff for financial measures.

https://www.thedailyworld.com/news/bill-would-help-hospital-with-its-financial-woes/

Legislative Information

The Jefferson County Democrats sent this handy overview out. Hearings are underway for bills already introduced, comment periods are open, and things are moving very quickly.

The legislature’s site for tracking all bills is here:  Bill Information

How you can watch and participate in the legislative process from the comfort of your home. A list of bills being considered by the state legislature was matched up with a Washington State Democratic priorities agenda. It isn’t comprehensive nor does it include all of many important bills being considered but it is a covers a lot (over 80 bills) that are important to Democrats on most issues. The dates and time of bill hearings is generally known a few days in advance only.
The schedule is updated weekly and even daily. You can go here
2018 Bill Hearing Schedule
to find next weeks hearing schedules. That document is always being updated you can keep referring to it for updates.
What you will see, for example:
SB 6034    would allow county PUDs to provide end user telecommunications
When: 1/17   8:00
Comment here
Click on Senate Bill 6034 to learn more about the bill. Click on “Comment here” to leave a comment for the committee in charge of the bill.  “When” is the time the committee has scheduled a hearing on the bill. To watch any hearing on TVW, click on the bill, scroll down to available videos and watch live or later. So bookmark weekly 2018 bill hearings schedule or find it on the website.

Some important bills:

HB 1026 – Health Security Trust. – Appears dead. Not yet out of committee. No hearings scheduled as of 1/26
SB 5701 – Apple Care Trust. – Appears dead. Not yet out of committee. Had hearing on 1/16.
HB 1800 – Voting Rights Act (re-introduced)
SB 6601 – Temporary Medicaid funding to help Grays Harbor and Port Angeles Community Hospitals bridge the fact that the Feds have chosen not to properly reimburse for Medicaid coverage. Hospitals losing money with every patient, and as the old joke goes, “you can’t make it up on volume”.