Donald Lloyd, CEO and president of St. Claire HealthCare in Morehead, Kentucky, has spent more than a year dealing with high food and drug costs in local hospitals. Now he’s preparing for another financial blow. That’s the loss of Medicaid reimbursements for treating people in rural Appalachia.
“For these reasons, we are all compelled to try to generate sustainable profits. [inflation] factor,” he said. “And the potential loss of reimbursement for those who qualify will only add to the burden on local agencies.”
Lloyd refers to the rollback of policies that began in 2020 in response to the public health emergency caused by COVID-19. The Families First Coronavirus Response Act required states to allow Medicaid recipients to remain enrolled even if their eligibility changes. But with that requirement ending on his April 1st and allowing states to exclude people from the program again, health officials across the country are worried that the loss of Medicaid reimbursements will hurt the financial health of hospitals. I’m worried about how it will affect
The loss of federal revenue is expected to be particularly acute for rural hospitals that operate in areas with high poverty rates and serve the elderly and low-income populations. All these factors contribute to the financial pressure on hospitals, medical officials said. Rural hospitals were already closing rapidly before the pandemic, with more than 150 closed between 2005 and 2019. Center for Healthcare Quality and Payment ReformWithout federal funding to support them, the Center estimates that 200 rural hospitals across the country are at risk of closing within the next two to three years.
a report A study released in January by George Washington University found that up to 2.5 million patients in community health centers treating both underserved rural and urban communities were redetermination of eligibilityMedical center revenues range from $1.5 billion to $2.5 billion. The Kaiser Family Foundation estimates that between 5 and 14 million people will lose their insurance. two-thirds You may not have insurance for a few months to a year.
Carrie Cochrane-McLean, chief policy officer for the National Rural Health Association, a nonprofit focused on education and advocacy on rural health issues, said the financial impact would be double.
“It’s a loss of reimbursement for services, but it could also increase the number of uninsured patients as they are no longer covered by insurance and come in when they are in a more serious condition,” she said. rice field. she said.
Leighton Koo, professor of public health at the Milken Institute at George Washington University and director of the Center for Health Policy Studies, said a simple mistake in paperwork caused many people, despite being eligible for Medicaid, to said they could lose their Medicaid. Ku said states can help by facilitating the renewal process, and those who can’t get Medicaid can find insurance at subsidized rates through the Affordable Care Act marketplace, and the Inflation Reduction Act. He pointed out that they will be able to benefit from the expanded premium subsidies until 2025. Still, he said, there would be problems.
“Hospitals and community health centers are going to have a tough time ahead, as we expect the number of uninsured people in the United States to rise somewhat over the next year despite our best efforts. said Ku.
Toni Lawson, vice president of government relations for the Idaho Hospital Association, said the state’s Department of Health and Human Services sent the letter. tens of thousands Warn about changes and options. Still, she worries about the impact of so many people losing coverage.In Idaho, it’s estimated that 150,000 people could lose Medicaid. according to Idaho Capital Sun.
“We see a majority of rural hospitals with negative operating margins right now,” Lawson said. The same decision today could affect whether they are open or closed, she said.
Lloyd said he expects fewer than 3,000 people in the communities St. Claire serves to lose their insurance.
The hospital is preparing for the decline by slowing down capital spending, even as it needs to replace operating room tables and repair and maintain wings built in the 1960s, he said. . St. Clair is also considering “reprioritizing a number of strategic growth projects,” such as responding to robotic surgery, Lloyd added.
Louisville’s Family Health Center plans to cut low-cost or no-cost medical, dental, behavioral health, and pharmacy services it was offering to uninsured patients due to an expected drop in revenue. Louisville Courier-Journal. The hospital also announced other budget cuts, including: fired, Quote End of Pandemic Payments.
Support through expanded Medicaid
The COVID-19 pandemic has helped and hurt local hospitals.
“In rural communities, most of the income comes from outpatient-like businesses, which come from outpatient surgery, imaging, and visits,” said Steve Lawler, president and CEO of the North Carolina Health Care Association. “Shutdown of hospital assets to protect them to treat COVID-19 patients will have a significant economic impact, with the cost of hospital goods and services and personnel rising by 30%. Even in the current economic climate, the impact continues, but our revenues have only increased by 2%.”
Billions of dollars of federal funding from the Paycheck Protection Program, the Healthcare Provider Relief Fund, and the U.S. Relief Plans Act during the pandemic, while addressing lost revenue and rising costs of everything from protective gear to payroll, Helped keep local hospitals alive.
“Covid-19 seems to have interrupted the long-term trend of unprofitable and closed rural hospitals,” said George Pink, associate director of the University of North Carolina Rural Health Research Program at the University of North Carolina. Stated. “But that funding has already ended.”
Health care experts say more states need policy changes, such as expanding access to Medicaid, to keep rural hospitals alive.
11 statesStates, including Alabama, Georgia, Florida, Kansas, Tennessee, and Wisconsin, have not expanded Medicaid coverage under the Affordable Care Act, putting rural hospitals in these states at a particular disadvantage. health officials said. Researchers agreed. January 2018 research article found Medicaid expansion was associated with better financial performance and lower likelihood of hospital closures. It was true.
In North Carolina, where Congress is currently considering legislation to expand Medicaid, 11 hospitals have closed since 2006, and ECU Health, which serves 29 counties, has been hit hard, largely due to financial pressure. We plan to close five clinics in the coming weeks. , Greenville Daily Reflector report in January.
Brian Floyd, ECU Health’s chief operating officer and president of the ECU Health Medical Center, told States Newsroom: Some tough decisions had to be made about whether to close some clinics. …if you don’t have Medicaid extensions. This is what happens. Poor rural communities are beginning to lose access to health care. ”
Lawler added that the expansion of Medicaid in North Carolina would help people manage chronic health problems rather than waiting to reach a crisis point that requires hospitalization or expensive treatment. his organization supports House Bill 76a bill to expand Medicaid passed the State House on thursday. If negotiations with the state Senate pass, Gov. Roy Cooper is expected to sign the bill into law, benefiting his 600,000 people in North Carolina.
Lawler said states may eventually have enough political will to join the nation in expanding Medicaid.
“Making our state healthier and helping to address the behavioral health crisis and the substance abuse crisis in North Carolina makes a lot of sense,” he said. It will help rural communities stabilize hospital and medical safety nets. ”
Lloyd, CEO of St. Claire HealthCare, said there is no doubt that Medicaid’s expansion will make a difference for hospitals. Before he came to St. Clair, he was President and CEO of CHRISTUS Health Southwest Louisiana. Louisiana expanded Medicaid in 2016 and Kentucky in 2014.
“Both Louisiana and here in Kentucky have improved access to healthcare and improved hospital sustainability after expansion. “It’s been very fortunate for the federal government that it’s lasted,” he said. It’s bigger, but at least some of the operating costs are offset.”
Will the new hospital designation help?
A new payment model that has become effective While it may be able to provide assistance to some rural hospitals in January, medical officials warn it’s not a solution for all rural hospitals.
With this change, hospitals that agree to the new rural emergency hospital designation will receive more Medicare reimbursements and monthly facility payments. The hospital had an emergency room, clinic, and outpatient care, but the patient could not stay for more than 24 hours. Additionally, hospital beds cannot exceed 50 and must meet other eligibility requirements.
Kansas, Michigan, Nebraska and South Dakota already enacted law Establishment of licensing rules for local emergency hospitals.
“of [rural hospitals] In areas with a large number of Medicare-entitled residents over the age of 65, this model could help those hospitals and perhaps help offset the losses of former Medicaid patients going uninsured. ” Management and Policy at the Colorado School of Public Health at the University of Colorado.
Pink, of the North Carolina Rural Health Research Program, says the new model isn’t “a panacea for rural health.”
“It is really aimed at small rural hospitals that are in imminent danger of closing. It’s not designed … we won’t see 1,000 rural acute care hospitals in the country anytime soon, far fewer are interested in this,” he said.
Floyd said ECU Health is investigating whether the designation is appropriate for some cases.
“There is the trade-off of a higher per-patient payment plan, but you have to meet the 24-hour day requirement. Will there be? Is there access to other places…because they are?” he said.
Lloyd said the Kentucky hospitals served by St. Clair Healthcare could change to new designations that could affect his healthcare system.
“Obviously, we’ll have more capacity to handle the inpatient admissions for these facilities, but we’re ready to handle it if needed.
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