Hospital lobby ramps up ‘Medicare for all’ opposition – Healthcare Dive

We had an inkling that the Medicare for All would find heavy opposition quickly. Was debating a supporter on FB just yesterday saying essentially exactly what this article states. A day later, here we are. Want to state clearly here and now that I support getting the U.S. to a universal healthcare place, but I’m very dubious that Medicare for All is a way that will garner enough support. Why? Because the government has done a terrible job of reimbursing front line providers for their time. Many front line providers are not accepting Medicare patients, or new Medicare patients. Hospitals are subsidizing this cost by higher costs elsewhere. This has to be fixed before this idea will gain ground with providers. While it would be great to tear down the whole system and start fresh, that just is political rhetoric to get the base motivated to vote next year, a non starter in this current climate with Republicans controlling two branches of government. And we haven’t yet seen the money from the special interest groups show up in any large scale way.

The article points out that the AMA, PHrMa, American Health Insurance Plans, and the Federation of American Hospitals have come out against it, asking Congress to “fix what’s broken and improve what’s working, don’t start over”. My guess is that for a start, raising reimbursals for Primary Care would be a good place for Congress to begin, to slow the bleeding of funds from hospitals etc. In fact, the article points this out, from a document from the coalition of these providers, showing that “66% of hospitals received Medicare payments less than the cost of care, for an industry wide shortfall of $53.9 Billion dollars. Locally, I know that Jefferson Healthcare would be considered part of that amount. While the nurses union claims that hospital coffers have ‘swelled’ there is no truth in that here locally. Of course, we are a public hospital, but the ACA has helped our bottom line, allowing for JCH to better support primary care by hiring more providers, for example. While proponents are arguing that the reduction in administrative costs would help, there is no real understanding of whether these costs would be offset here locally.

Read the whole article for a better understanding. It brings the Koch Brothers into the picture for their efforts, along with the Nurses Union, etc.

Hospital lobbies are mounting a coordinated effort to dissuade legislators from supporting Medicare for all, a policy health systems argue would cut into profits and ultimately force facilities to shutter.

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.

In Rural Washington, Pediatricians A Scarce Commodity -KUOW

More on the slow motion collapse of our health care system. The problem, across the board is that medical professionals are getting squeezed by both State healthcare systems and large insurance companies. If you aren’t willing to raise your taxes to cover your physicians costs, you won’t have one. Here’s a case study right here in our state.

For the past 16 years, Jill Hutton has been managing a pediatric clinic in Aberdeen that once treated 70 to 100 children a day. But now it’s empty. She’s working on shutting it down


Jefferson Healthcare hospital institutes sliding fee scale – PDN

Over the last number of years, a variety of people have petitioned JHC to look into their practices of charity care along with their collections policies that have resulted in people being sent to court and into bankruptcy over relatively small amounts (some have been larger amounts, to be sure).

Members of the Local 2020 group, Citizens Healthcare Access (CHA) went so far as to go to court to obtain records of collections as the hospital was unwilling to share them with the public (shocking coming  from a public hospital).

With citizens groups and some Hospital Commissioners agitating for transparency and better charity care clarity, the hospital finally convened a Patient Financial Experience Task Force, which worked for months in secrecy over their goals. Steve Workman, a citizen activist who often attends the CHA meetings, along with now Hospital Commissioner Bruce McComas were members of the task force.

The new sliding scale has allowed greater flexibility and transparency to low income and no income households. While some online critics are criticizing the program as “too generous” this is being implemented for people who, at these levels, simply do not have a way to pay for services without bankrupting their families. It still allows for the hospital to setup payment schedules for those that may have savings or other financial resources.  If they did not have these options, the only other options for these people are simply to not seek care for themselves and their children, leaving them to suffer rather than receive care. (I have talked to single moms working two or three jobs who had to make the choice of putting food on the table or seeking healthcare for their sick children.)

The sliding scale is not new at JHC. But they have expanded and clarified it. The next issue to address is the lack of transparency on pricing. While it’s good to be able to know that even if you can’t afford care you can be worked into the system, the ability to know what you are going to be charged before seeking care is also pretty fundamental to a free and open market. Utimately, the best option is universal healthcare, or some kind of single payers system. We built our interstate systems across the country on the taxes that *all* taxpayers paid. There is a deep and proven set of systems in industrialized countries like ours that do single payer, in fact we are the only ones that don’t. The results do not prove that we are better, our stats prove we are much worse than other countries in the standards of care and longevity.  Most people in the US have never even experienced single payer (I have).  It’s shocking to see what we have setup and how badly it compares to others, even Canada.

Jefferson Healthcare hospital has implemented a new sliding fee scale for charity care that is helping more families pay for their health care.

“This is currently one of the most generous plans in the state,” said Amy Yaley, spokeswoman for Jefferson Healthcare. “For the people that we are providing health care for, we are definitely making an impact on their financial burden.”

Medicare plans big payment changes for knee and hip replacements – LA Times

Back in July, the LA Times reported on this. Just seeing it now. The changes would happen in this coming January. The world of fee for service is slowly ending in the U.S.  The insurance companies and others paying for poor outcomes are going to demand improvement, though they too are the part of the problem in our current system.

Perhaps the AMA and others might want to consider getting ahead of the curve and supporting Single Payer before it is the tsunami that washes over them. Better to ride the wave than get buried by it.

The California Public Employees’ Retirement System, one of the nation’s biggest healthcare purchasers, adopted a similar idea called reference pricing for joint replacement surgeries.

The giant pension fund limited what it would pay for knee and hip surgeries to $30,000 after finding that its hospital bills ranged from $15,000 to $110,000 with no discernible difference in quality. The program saved CalPERS more than $5 million over a two-year period.

MARCA final rule released

Sweeping changes for Medicare physician reimbursement are in store as federal officials look to ease eligible clinicians into the new outcomes-based program

So what this means is related to deployment of electronic health care (EHC) systems and outcome based reimbursement for physicians, clinics and hospitals. This likely won’t have much to do for us here in Jefferson County, because we have already seen our independent providers pretty much wiped out and subsumed, for better or worse, by Jefferson Healthcare. Those left standing in our county and Clallam, will be able to possibly get better reimbursements, but it will require continued deployment and measurable patient use, of EHC. The details are massive, and unlikely to be implemented by small clinics and providers given the small payback from the Feds. However, this update has been put together after input (some quite negative apparently) by tens of thousands of smaller providers. So we hope that it is going to lead to greater reimburses to them for their efforts.

The move towards EHRs has seriously, once again, been an issue that favored the large healthcare chains over small providers. The small providers I’ve talked to either refuse to expend the energy and resources to do it, or just close up shop. It’s funny, health care seemed to work fine for  decades without EHR, and when the insurance companies and others get into the business in a big way, all of sudden we need it to survive. Our indices of health continue to go down, health care costs continue to rise, while our privacy is compromised by the millions of records that have been hacked over the last few years. Additionally, providers are expending vast resources on dubious technology.  Rather than come up with better security, the providers are basically told to go online or don’t expect reimbursements.  It argues that if we are going to be forced to do that, we should get rid of the insurance middlemen and simply go single payer. As a certain presidential candidate has asked, “What do we have to lose?” (I am not endorsing that candidate by quoting him as it was in context to a very different issue).

MACRA Final Rule Released