Thursday, November 20, 2008

Called to Washington

It was a very long day yesterday. I got up at 4:30 to get to the Cedar Rapids airport to catch a flight to our Nation’s Capitol and I returned last night head hitting the pillow about midnight.

It all started last week as I enjoyed lunch with Congressman Leonard Boswell on Tuesday and Senator Charles Grassley on Thursday both here in Grinnell. Among other things, the focus was on what we could do to try to advance the legislation they both have introduced in their respective chambers. That led to a decision to call a meeting of both senators in Washington, D.C. along with Congressman Boswell. The idea was to put our three Members of Congress in the same room working together on this one issue. Well, the meeting took place this week on Wednesday in the U.S. Capitol. Congressman Boswell called and asked if I would come facilitate the meeting. In addition to the three elected officials, many of their key health staff members were there. About 11 people in all, including a member of the Iowa Hospital Association staff. Several other “tweener” hospital administrators from Iowa called in to be part of the meeting via telephone.

It was great to get our congressional delegation together and we discussed the serious state of things due to the dismal Medicare and Medicaid payment levels and the fact that there is a terrible inequity of payment. Some hospitals in Iowa and around the country paid at 101 percent of their costs and GRMC and the other seven tweener hospitals paid between 67 percent and 85 percent of costs.

We discussed two possible approaches to getting the legislation passed. The first is to wait until the Senate Finance Committee (Mr. Grassley is the highest ranking member on the committee as a Republican) works on the next full Medicare bill sometime next fall. The other option was to work with Mr. Harkin on the Appropriations Committee. Although this type of legislation would not typically emanate from this committee, both Senators agreed in this case it is worth a shot. Many of the legislative leaders in both the House and Senate would need to agree with this approach; but then again they all have tweener hospitals in their states as well. The appropriations activity likely will get back into full motion in January.

I really appreciated the efforts of our three Members of Congress coming together on a very busy day in Washington D.C. (this was the same day the CEOs of the Big Three Auto Makers were also in town to beg for financial assistance). We spent about an hour together brainstorming the best ways to try to fix this problem and help secure the future of middle-sized rural hospitals across the country.

I got a text message from Congressman Boswell as I was in a taxi headed back to the airport saying in part…”I thought we did well. We will continue to press.” I am optimistic that somehow, someway we will get this fight won!

The postings on this site are my own and don’t necessarily represent GRMC’s positions, strategies, or opinions.


Anonymous said...

I am a student with Walden University and have been looking at your site as part of my class assignment and was intrigued by your level of acitivity in trying to increase the amount of payment coming from medicare. I was wondering just how much you would like to see payments increase to as the numbers you quoted in your blog seem rather dismal.

I can scarcely imagine how hospitals can function especially the ones that receive the majority of their payments from government sources. Also, I was wondering if there are any other requests on top of payment increases that you are hoping to get passed at this time? After all if you're going to ask for one thing you should ask for others so that even if you don't get all that you want you might get more than you expected.

Todd C. Linden said...

Hi Mark,
Thanks for your questions. I've been working for this change in Medicare reimbursement for about 14 years. Tweener hospitals are not asking for a bailout, we're asking Congress to correct the unfair payment system that Medicare created. Right now, the Medicare system is unfairly penalizing tweener hospitals simply because of size and geography. Iowa hospitals that are not critical access are some of the lowest reimbursed hospitals in the nation. At GRMC, more than 60 percent of our patients rely on Medicare. Ironically, Iowa hospitals are consistantly recognized for the highest quality healthcare at the most affordable cost and the greatest access to that quality care, according to Dartmouth Inst. for Health Policy and The Commonwealth Fund. For example, our costs at GRMC are 30 percent below the national cost average. We believe that we have the cost/quality formula right and it is the direction healthcare needs to go. On average, hospitals are paid 91 cents for every dollar spent caring for Medicare patients. Tweener hospitals are paid as low as 67 percent. Bringing our reimbursement rates up to that average would be a positive development. While getting the same rate as a critical access hospital at 101 percent would be great, moving us closer to the national average would be a dramatic improvement. What I know is that we can't afford any longer to be reimbursed at the level we are right now.
That's why I work so hard for this change. Good luck with your class!