Feb
20

Rural hospitals – and healthcare – are in deep trouble.

With the unwinding of Medicaid post-COVID emergency, rural healthcare is falling deeper into financial trouble.

Consulting form Chartis just published their review of rural healthcare…among the findings

The unwinding issue is exacerbating problems in states that failed to expand Medicaid…the vast majority of which are those with the most hospitals in financial distress.  Simply put – they have to deliver way more healthcare to people without health insurance.

FromChartis:

Across the 10 remaining non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming), the percentage of facilities with a negative operating margin increased year-over-year from 51% to 55%. These states are home to more than 600 rural hospitals…Several of these states are among the most severely affected by hospital closures and a loss of access to care.

The percentage of America’s rural hospitals operating in the red jumped from 43% to 50% in the last 12 months.

418 rural hospitals are “vulnerable to closure” according to a new, expanded
statistical analysis.

Healthcare deserts are a huge problem for rural America, especially in areas with lots of extractive industries (mining, energy, agriculture. Workers in those industries are much more likely to suffer severe occupational injuries, injuries that benefit greatly from care delivered in the “golden hour”.

What does this mean for you?

Not expanding Medicaid is killing rural healthcare.


Feb
7

Signs of the coming apocalypse

Medicare is slashing what it pays physicians, an annual event that – till now – was almost always rejected by Congress.

That will reduce old folks’ access to care, cut workers’ comp fee schedules, and likely lead to more provider consolidation. 

This from Becker’s:

In its 2024 Physician Fee Schedule Final Rule released Nov. 2, CMS reduced overall physician pay by 1.25% and updated the Medicare conversion factor to $32.74, a 3.4% decrease from last year.

Nope, a fix wasn’t in any of the “continuing resolutions” Congress passed last year and earlier in January (“CRs” are a stop-gap, emergency funding step more often seen in desperately poor banana republics than in the “greatest nation in the world.)

As a result, docs’ pay will be cut about 3 1/2%…and they are none too happy about it. (Read this for details on potential implications)

Okay that’s bad, right?

Not as bad as what’s coming.

Reminder – if Congress doesn’t pass a budget – in exactly one month – all Federal agenciesincluding Medicare, the VA, Defense, the FAA… face budget cuts. Weapons procurement, care for veterans, agriculture inspections, airplane safety inspections (this isn’t a problem, right??) are just a few.

Remember way back (as in two years ago) when Congress’ wait-till-the-last-minute-to-get-stuff-done made us all nuts…if we knew then how dysfunctional the House would be now we’d have been quite happy for what we did have.

Yep, Republicans in the House of Representatives’ refused to even vote on an immigration reform bill – THE hot issue in Washington and around the country – a bill that gave them everything they wanted.

House GOP – Yay, we finally got the soccer ball!  Let’s play! Wait…how do you play? I dunno…you know?  Nope – you? Nuh-uh…you? No clue…you? Uh…I thought it had pointy ends…Someone pick it up…NO way dude! Not me…

What does this mean for you?
To quote HL Mencken, you get the government you deserve, and you deserve to get it good and hard.

PS – Over the lastly 20 years I’ve written a lot about the incredibly screwed-up Medicare reimbursement  process…


Jan
9

Prior auth – are you flying blind?

A pending CMS rule may lead to major changes in the use of Prior Authorization, changes that would reverberate across all payers – Medicare, Medicaid, group health, Exchange plans and workers’ comp.

Remember work comp is the flea on the tail of the healthcare elephant:

  • WC is 0.7% of total US medical spend and
  • a tiny portion of most providers’ patients and
  • the draft regs have no exemption for workers’ comp.

The proposed rule is now under review after public comments; there are a wealth of implications and potential issues including:

IT

  • requirements re new APIs (electronic links) in PA IT applications including payer and provider interfaces  – idea being to streamline flow of information between payers and providers
  • payer-to-payer data exchange requirements – essentially linking payers together so a specific patient’s entire health record is kept by its current payer (given patients’ high propensity to switch payers, this will be darn challenging.
    • work comp would have to integrate with many other payers...
  • build automated processes for providers to determine if a PA is required –  idea being to reduce confusion as to what procedures do and do not require a PA

PA processes

  • tight time frames for PA processes and possible reduction to 48 hours for expedited requests
  • mandatory requirement for payers to include a specific reason for denials
  • mandatory reporting for most providers

There’s a lot more to this…I’ve just scratched the surface here.

What does this mean for you?

if you aren’t paying attention to what’s happening in the larger healthcare world, you’re flying blind.

Make no mistake, what CMS does – whether its fee schedules, interoperability requirements, Medicaid eligibility, drug pricing, reimbursement policies, network adequacy or PA changes – affects you.

 


Dec
11

Healthcare regains the political stage

Healthcare has not been on the political landscape since the last attempt to overturn the Affordable Care Act aka ObamaCare failed…and then-candidate Trump talked up his very-hard-and-actually-impossible-to-locate HealthPlan.

Just-released polling indicates several healthcare issues are top-of-mind for voters across the political spectrum.

  • 4 out of 5 voters say it is “very important” for candidates to talk about healthcare affordability...making healthcare the second most important topic among respondents.
  • The ACA is back in voters’ minds with almost half of poll respondents stating the ACA’s future is “very important issue”.
  • Medicare and Medicaid are also top of mind for voters as is access to mental healthcare with 75% and 70% of respondents respectively stating these issues
  • Related, about a quarter of voters (24%) say they would only vote for a candidate who shares their views on abortion.

What does this mean for you?

As America ages and healthcare becomes increasingly unaffordable, more voters are more about healthcare. 

 


Nov
3

Here’s some of the good stuff happening these days…

The number of workers with paid sick leave has jumped…lowest-wage workers’ access to paid sick leave has nearly doubled from 20% to 39% since 2010 – driven by more states enacting paid sick leave laws, according to a new Economic Policy Institute report. Overall, almost 4 out of 5 U.S. private-sector workers have paid sick leave, up from 3 of 5 in 2010.

Home care workers’ pay is going up...almost every state has bumped up wages for home care workers, a long-needed change that might help ease the hone care staffing crisis.

Know those yellow pill bottles that have been around forever…and will be around almost forever? Almost 200 billion are added to landfills and trash every year… CabinetHealth is pioneering recyclable – and refillable – glass pill containers…a way better way to get your meds.

Ok, leaving aside the obvious positivity – this is definitely facepalm worthy…there’s this NEW THING among Gen Z’ers...a “silent walk”…aka going for a walk without your phone!!

Who woulda thunk it? Just…walking? And yes, a TikTok’er discovered this revolutionary new idea, and it is…trending!!!

Next up…Silent Walking athleisure wear, shoes, hats, and rain gear, maybe logo that says “don’t disturb – Silent walking”.


Oct
30

Good news Monday starts with this from the Economist, a beacon of objectivity (reformatted for clarity):

a steady stream of better-than-expected data has left analysts scrambling to lift their forecasts.

    • New orders for manufacturing firms reached their highest in nine months in July.
    • Retail sales were perky last month, too, with consumers splurging on everything from restaurant meals to online shopping and clothing to sporting goods.
    • The construction industry has also been buoyant, supported by a rebound in homebuilding.
    • the labour market… has remained hot, making it relatively easy for people to find work at decent wages.
    • The total number of jobs in America has been growing faster than the working-age population, helping to keep the unemployment rate at 3.5%, just shy of a five-decade low.

Oh, and those naysayers, remember they are the ones who’ve been doomsaying a recession is imminent…for more than two years.

“Eventually” that may happen – and “eventually” my granddaughter may have grandkids…

Oh, and our economy has far outperformed the rest of the developed world over the last few years.

One measure of a country is how it cares for the less fortunate…thanks to recent changes in Medicaid thousands of homeless people are now getting primary care, which is:

A) the right thing to do and

B) saves a boatload of dollars as these homeless folks are far less likely to go to the ER which costs a shipload more than getting basic primary care.

What does this mean for you?

Don’t get caught up in all the negativity…workers are doing better and better, jobs are plentiful, we are improving the lives of the less fortunate…and the US is leading the world.


Oct
27

Awful news Friday

I wrote the post below 4 years ago…and I’m heartbroken that it’s truer now than it was back then.

Our daughter went to school near Lewiston…I’m heartened that she graduated years ago and guilt-ridden that other parents and family are terrified their kids and family members may be the next victims.

It’s easy – and completely wrong – to say it’s all random.  It isn’t.

At all.

The epidemic of death by firearm is uniquely American.

Take responsibility.

  • Demand red flag warnings.
  • Demand assault weapon bans
  • Demand universal background checks. 

Or accept the blame.

Guns and public health

Guns are a major public health and safety problem. Guns are associated with tens of thousands of deaths every year, most preventable.

And we Americans are among the world leaders in death via firearm.

Before you make any assumptions – I own guns. I hunt – although I’m a pretty poor hunter.

My dad taught me to shoot, and handle firearms, and gun safety. Among the guns I own are his service rifle – a 1903 Springfield – from WW2 and the revolver he carried while flying in B-17s over Europe. They mean a lot to me, and one day I’ll pass them down to my kids.

A couple key factoids that are worth considering.

  1.  Most Americans – and most Republicans – want background checks and “red flag” laws.  And most Americans want stricter control of gun sales in general.

2. Firearms are used to commit far more suicides than homicides.

3.  People who attempt suicide with a gun are much more likely to die than those who use other means.

4. There’s a strong correlation between higher rates of gun ownership and higher suicide rates.

5.  Lastly, every day 65 people use guns to kill themselves.

Guns are a major public health concern, yet no other public health menace gets the same public support.  As a gun owner, I’m deeply troubled by the willingness of some to advocate positions that will get more guns into more hands – which will lead to more unnecessary tragedies.

What does this mean for you?

The data is clear – people want stricter gun laws – and for very good reason


Oct
25

Medical costs are going up because…

Wonder why that office visit/imaging study/minor surgery/diagnostic test costs twice what it did last year?

Partly/mostly because the physician practice was acquired by a health system or big hospital…which – under current Federal law – allows the new owner to upcharge for “facility fees.”

VERY briefly, way back in 1997 Congress passed the Balanced Budget Act, a giant bill that, among other things, allowed facilities to tack on a facility charge for services delivered in its facilities.

That oversight is a key reason health systems have been snapping up provider practices as fast as they can, paying gazillions for primary care, specialty care, imaging, PT, you name it. (another key reason is health systems want to own as much of the care delivery and referral process – and fees – as possible)

This from Health Services Research:

Medicare reimbursement for physician services would have been $114 000 higher per physician per year if a physician were integrated [part of a health system] compared to being non‐integrated.

The differential varied greatly by type of service…

The solution seems pretty simple…to quote Health Affairs,

Pay for common ambulatory services under the rates, codes and policies in the physician fee schedule regardless of location

There’s an effort underway to at least partially remedy this by moving to a site-neutral reimbursement…but as it will take Congressional action that is a heavy lift indeed…especially given the current House of Representatives.

What does this mean for you?

Two things…

  • Think through potential unintended consequences BEFORE its too late
  • Rethink network contracting strategies…lock in pricing with office-based practices.

Oct
11

Yay North Carolina!

The Tar Heel State is the latest to expand access to Medicaid, a move that will drastically improve the health of 600,000 (!!!) North Carolinians and financial stability of dozens of hospitals and hundreds of other care providers.

40 states have now expanded Medicaid under the Affordable Care Act (aka Obamacare)…holdouts include Florida, Texas, Mississippi, Alabama, Missouri…

Think this doesn’t impact workers comp?

Think again.

States where work comp facility costs have risen the most – courtesy WCRI.

This from Captain Obvious – Hospitals in states that failed to expand Medicaid are using workers’ comp as a financial lifeline.

What does this mean for you??

Failing to expand Medicaid is unconscionable.  It greatly improves the health of babies, moms, kids, and older folks – at very, very little cost to taxpayers. 

The blatant hypocrisy of politicians claiming to respect life while blocking Medicaid expansion is disgusting.


Sep
27

Medical debt is crushing Americans

One out of three adults has medical debt. 

For many, this has a major impact on daily life…

Medical debt can be a huge obstacle, preventing families from buying a home, purchasing or leasing a vehicle, even paying for college for their kids.

That’s because credit bureaus include medical debt in their scoring algorithms. 

Looks like that will be changing…

From the Vice President:

The Consumer Financial Protection Bureau will propose a new rule to make clear that medical debt cannot impact the credit scores of the American people.  Once this rule is final, it will mean, one, that

consumer credit reports will not include medical debt and, two, that

creditors will not be able to use medical debt to determine a person’s eligibility for credit. 

Almost 2/3rds of those with medical debt had insurance when they began treatment...a quarter of those had their claims denied.

What does this mean for you?

Help is on the way.