Healthcare Experts Speak Out on Rural Hospitals’ Medicare Cuts
By - As RevCycleIntelligence.com recently reported, recent Congress testimony from 4 rural hospital leaders representing the Centers for Medicare & Medicaid Services (CMS) demanded urgently implemented change to alleviate rural hospitals’ ongoing financial struggles. Rural hospitals are feeling the burning sting of Medicare reimbursement cuts. This RevCycleIntelligence.com article stirred up a great deal of quite headstrong opinion about where rural hospitals stand within the healthcare industry and where energies should be focused next. The following is an abridged collection of recent LinkedIn commentary from a variety of healthcare leaders and experts.
Survival requires a better solution
According to a Chief Financial Officer and Director of Operations, waiting to receive payment from a government $18 trillion in debt may not exactly be the wisest idea. “I am not disparaging the work of rural health,” he states. “I'm saying that being a good performer within a dysfunctional and unsustainable system is not a winner. There is a better solution for those who want to survive.”
“It is projected that in the U.S. that the nation will spend approximately $10,000.00 per person for healthcare expenses in 2014. That expense is for every person, whether young, old, rich, poor, insured or uninsured,” he maintains. “With a population health model containing 10,000 persons[,] the approximate gross median income on a direct care basis is $100,000,000.00. Under pioneer CMS programs and Oregon State's CCO program[,] Medicare and Medicaid dollars are distributed to providers within a district based on a population health model for the care of those persons,” he adds.
“If the district keeps them healthier than they were before for less cost, they make money," he claims. "If the providers allow the population to become less healthy, they are at risk for the additional cost,” he states. Seventy percent of healthcare dollars are spent on 10 percent of the population, which means $70 million is essentially available to provide care for $1,000 beneficiaries, he adds.
“We simply need to accept the capitated amount in the form of a prepaid lump sum and create a business model that relieves rural health of the onerous regulation and reporting burden,” he advises. “Healthcare in the U.S. already costs twice as much as other industrialized nations. There is more than enough money in the system, we are spending it on things other than patient care.”
Rural hospitals only represent a small cost percentage
According to a CEO and President, studies prove rural hospitals operarate more economically than urban hospitals. “If anything, more care needs to be provided in the rural setting because of those cost savings. While I agree that healthcare costs overall have to come down, rural healthcare represents a very small percentage of overall healthcare costs,” he states. “Focusing on changes in rural healthcare will have little impact on total expenditures, but would result in a significant negative impact on rural residents access to care.”
Physicians are not architects; architects are not physicians
According to a Chief Executive Officer, if she had a dollar for every unfunded mandate bestowed on providers by the healthcare system, she would be a rich woman.
“This is much more complex than a community health clinic, she states. “A local wellness group owned by physicians, there begins the issue. Who pays them?” she asks. “This is why I don't design buildings and architects don't run healthcare systems. Don't take offense, if it was that easy we would not be in the mess we are in," she maintains.
Although capitalism is beneficial for most businesses, challenges do not stem from those who pay but from those who are economically disadvantaged, or chronically or mentally ill, she asserts. “I know a lot of people in and out of healthcare, people much more capable than I,” she claims. “I have yet to find anyone who can see a way out without having losers. The losers are the poor, underserved, and mentally ill,” she states. “Every CEO I know is struggling to find care for this population. Yet how we as a society treat our most vulnerable defines our humanity.”
A solution is welcomed, she maintains. “If you think you can inspire doctors to accept capped payments for the poor, think again. If you think the poor will get adequate treatment under a capped model[,] think again. No one is willing to lift regulation because greed will define access. I have been managing physician contracts for years [and] that is where the rubber meets the road.”
