That Beloved Hospital? It’s Driving Up Health Care Costs – NY Times

It’s not just us local critics of our expensive hospital talking about the rising costs, but a national discussion. Journalist and physician brings up some sobering thoughts and why we are unlikely to see any change in this situation.

Data shows that hospitals are by far the biggest cost in our $3.5 trillion health care system, where spending is growing faster than gross domestic product, inflation and wage growth. Spending on hospitals represents 44 percent of personal expenses for the privately insured, according to Rand

A report this year from researchers at Yale and other universities found that hospital prices increased a whopping 42 percent from 2007 to 2014 for inpatient care and 25 percent for outpatient care, compared with 18 percent and 6 percent for physicians.

We don’t need government-run healthcare to get affordable, universal coverage – Washington Post

A very interesting opinion piece (that dovetails with the last post of mine discussing that a large amount of lobbyists are out to kill the idea of Medicare for All). I don’t think that Third Way is a lobbying arm of the healthcare industry, but I would love to get some feedback by my readers as to what they think of this proposal. It does merit a good debate, I believe. It might even be possible to get a great many Americans on board with this, since they get to keep their doctor, it doesn’t put every medical professional into having to accept the uneconomic reimbursal rates of Medicare/medicaid, it eliminates medical bankruptcies, and it covers everyone in a way that is easy to implement. Thoughts? Am I missing something here?

From the article:

America can insure everyone without changing anyone’s existing health coverage. It won’t require replacing Obamacare with a single-payer, government-run system. Instead, we can build upon Obamacare with two simple, game-changing features: a universal cap on premiums and out-of-pocket expenses, and an automatic coverage system that places the uninsured in a plan they can depend on and afford.

UPDATE: After thinking about it, here’s my, and a medical friend’s thoughts:

A missing element in this is that it doesn’t change the issue that not everyone with insurance gets the coverage they need. Some providers don’t take more than one or two of the ACA options. Some don’t take any. Many things docs want to do arent covered by Obamacare, Medicare or independent insurers. If your doc says you need an MRI, and the ACA people say no, what then? Why is an insurance bureaucrat more knowledgeable about your care than your doctor? The devil is in the details in the current ACA & in this one too. In Canada, everyone who walks in the clinics or hospitals gets the same care. This proposal at least in the article, does not achieve that. Reimbursements in the ACA often barely cover the cost of treatment. That’s why some docs won’t take them. What about the caps? Meaning some programs only allow you to see a doc 4 or 5 times a year, then you are out of luck and out of pocket. Will it cover all needed coverage? So much missing in this article. Would love to have the authors point us to more indepth overviews of this. Interesting to read some of the comments, which seem to say that Third Way is a tool of the Right, some say it’s a tool of the Left. Wonder what the reality is? 

https://www.washingtonpost.com/opinions/2019/02/19/we-dont-need-government-run-health-care-get-affordable-universal-coverage/

Hospital Lobbying in 2018 By the Numbers

It’s always interesting to review where the big money is spent on lobbying. Today’s article in the Healthcare Dive (link at bottom of page) covered the an overview of hospital lobbying efforts highlight a few interesting issues (facts?):

  • The last lines point out that political rhetoric for “Medicare for All” seems to die after elections. Gavin Newsome in CA and the Illinois legislature has had a bill under study for two years without movement. The Medicare for All sounds like it’s not much more than a political ploy to help get politicians elected. We’ll have to see what becomes of the bills in the Washingon State legislature before putting the final nails in the coffin of this idea of Bernie Sanders. A question could be asked that if it’s that’s important to Sanders, is he involved in lobbying these states to implement it?
  • The 340B program, which has been a political hot potato, continues to be lobbied for by hospitals. There is much to criticize in this program, which supposedly provides direct subsidies to low income patients, but has been manipulated by both big Pharma (which wants to kill it) and hospitals (which has found ways to use it to make money for their bottom line). Yes, low income patients are getting drugs at a lower cost through this program but it leads one wondering if they could get even lower prices if the money was actually given to them directly, which was the original intent of the bill. We’re a long ways from that original intent, and even our hospital is profiting from the program, and finding further ways to incorporate it into future hospital planning.
  • It’s not all cynical lobbying though, as the hospital lobby fought hard against efforts to kill the ACA, helped support more funds for mental health care and much more.
  • Read the whole story at the following link.

https://www.healthcaredive.com/news/hospital-lobbying-in-2018-by-the-numbers/548262/

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.

https://www.healthcaredive.com/news/hospital-lobby-ramps-up-medicare-for-all-opposition/547678/

In states, Democrats start delivering on health care pledges – Chicago Sun Times

The outcome of the Blue Wave of November is starting to be felt. The article, while from Chicago, opens with Washington State and California as examples. In case you haven’t been following, newly elected Governor Gavin Newsome is off to an incredible start. He ran on healthcare as a major issue, and is already starting to deliver.

https://chicago.suntimes.com/news/democrats-midterm-election-campaign-promise-health-care-affordable-healthcare/

V.A. Seeks to Redirect Billions of Dollars Into Private Care – NY Times

Whatever could go wrong with this proposal? Everything. A long time goal of the Koch Brothers and the Libertarian right wing,  the Trump administration seems bent on carrying out this ill advised plan. If you are a vet, and value the notion of being supported for your health costs in the future, you better come out against this now. The proposal shifts money from a low cost federal government model to a high cost, low value private world of care where you will be milked for your savings. This is a recipe for disaster. What might be done to fix the situation? Shift money from military spending to the V.A. It would cost far less. One less fighter would add billions to the V.A. now. No new taxes needed. But I’m not a vet. Ultimately, it’s not my battle. It’s yours. I’ll remind you of a quote from a Republican operative, Grover Nordquist”,”

“Our goal is to shrink government to the size where we can drown it in a bathtub. “

 

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.