Buckle your seatbelts, it's going to be a bumpy ride

Oh, boy...hang on to your hats!
It looks like it is going to be a bumpy ride for healthcare providers as the federal government wrestles with the deficit. President Obama recently released his recommendations for reductions over the next ten years and compared to MedPAC (the advisory board to Congress on Medicare issues) and the Congressional Budget Office, the President's proposal is the most moderate. But that said, he is still recommending a cut of $320 billion on top of the $155 billion that was already part of the Affordable Care Act. Ouch! This would mean massive reductions in staff and services in the nation's hospitals as a result.
There is no question that if you are going to make a meaningful reduction in the federal deficit you are probably going to have to look at Medicare and Medicaid since they make up such a big part of the deficit. At the same time, when the economy continues to be on the rocks, these cuts will most certainly mean big reductions in jobs in the healthcare sector. This is going to be a tough decision for lawmakers and given the unbelievable partisanship going on in Washington right now, I really don't think an agreement is likely.
Are there any other answers to reducing the costs in Medicare and Medicaid in this country? Sure. There were several huge disappointments in the Affordable Care Act including a total lack of personal responsibility for people to take care of themselves. There is a lot of money in the law for improving health, but little incentive for individuals to be accountable for their own health. Think about it - the law really starts shifting the financial responsibility for improved health to the providers. One of the centerpieces of the law is the Value Based Purchasing (VBP) which incents providers to improve care and reduce costs for Medicare beneficiaries by holding back some of the payment at the front end and letting hospitals compete on improved quality and patient satisfaction scores. The quality measures are moving toward looking at outcomes for Medicare patients and will reward those providers with the best outcomes.
I fully support the government buying healthcare based on value. We actually expect that Iowa providers will do very well with this provision of the law given our high quality scores and lower expenses compared to other parts of the country. However, why not also incent the beneficiaries to be partners in their health? The physician can provide all the right advice to his or her diabetic or hypertensive patients, but if they won't improve their diet or take their medication, the provider gets punished by the system and ultimately there will be no cost savings.
I just got back from Mississippi where the obesity rate is the highest in the country. No offense, but folks there appear to really like their fried food. While I was there, I heard a local doctor on a panel of presenters. He did some of his training in Colorado where they have the lowest obesity rates. He said many Colorado residents like to hike in the mountains and eat granola. It is a concern if Mississippi doctors are going to be evaluated then punished for how well their patients control their diabetes compared to his medical counterparts in Colorado. Shouldn't the patient take some responsibility to be compliant and accountable for their health and the recommendations their doctor makes?
I realize it is going to be extremely difficult for a politician to stand up in front of voters and say, "I am going to work on legislation that will likely have an impact on the lifestyle choices people are making."
The largest and fastest growing part of the federal budget is related to Medicare and Medicaid. I believe it is time for us all to realize that if through taxes we are going to pay for the care of seniors and the poor, we will never afford it if beneficiaries are not required to take some responsibility for living a healthy lifestyle.
In the meantime, if the federal budget is going to be balanced by slashing reimbursements to hospitals and physicians for providing Medicare and Medicaid to a growing population and one that seems to be less healthy, I do believe we are indeed headed for a very bumpy ride.

A Mighty Band Travels to DC

On April 25, a mighty band of GRMC advocates made our way to our nation's capitol to fight for fair and equitable Medicare and Medicaid payment as part of the American Hospital Association's Annual Meeting. Susan Witt (board chair), Ed Hatcher (board chair-elect), Michelle Rebelsky, MD, (physician board member), Rachel Cain (UI graduate student and our summer intern), and I all left Iowa on a gloomy day hoping to get our voices heard.

We arrived to 90 degree weather in Washington, D.C. The temperature was the perfect metaphor for the red hot debates on healthcare reform and sizzling presentations from some Beltway insiders we witnessed. By now, anyone who reads my blog knows GRMC is a so called "tweener" - too big to be a critical access hospital and receive cost based reimbursement and too small to be a rural referral center, which also has better payment levels. As for GRMC, we got paid some $7 million below our costs last year for providing care to Medicare and Medicaid patients. Our simple goal is to push for legislation that would level the playing field and improve payment so we can continue to provide the care our patients have come to expect and deserve.

The highlights of our trip included a meeting of tweeners from around the country pledging to work together to coordinate our efforts and build a stronger voice to get our message heard. We also got educated on the latest efforts by our law makers and the Obama administration to reform healthcare. There seems to be a great deal of optimism that we will see legislation yet this year that will fundamentally change the way healthcare is delivered and paid for in our country. As we heard over and over again, "the devil will be in the details." We wait to see just exactly what Congress will develop.

When talking to many Congressional leaders specifically about GRMC's payment issues, we were heartened to hear not only a thorough understanding of the unfair payment we receive, but a strong commitment to get the issue addressed this year. We had the great fortune to have dinner with Congressman Boswell on Monday evening and lunch with Congressman Braley on Tuesday. We also meet with both Senators Grassley and Harkin later that afternoon. There is no question that our congressional delegation is leading the effort to both reform healthcare and also address this specific issue that plagues GRMC. I am grateful for their efforts. I took along stories from more than 40 GRMC patients. You can read them here.

I also want to assure everyone that GRMC leaders are watching our pennies as we push for payment improvements. I am willing to bet that members of our delegation were the only ones attending the AHA annual meeting who shared hotel rooms - the ladies in one room, the gentlemen in another. Best of all, there was a power outage in our hotel Sunday night for eight hours. After we asked, the hotel agreed to not to charge us for that day. We took turns covering meals and taxis, and several of the board members covered their own costs. I believe this is going above and beyond, given these individuals are donating their time to go and advocate for the patients served by GRMC. Finally, I personally paid the cost for our intern to attend the meeting and will also cover her summer stipend. The legislation we are pushing for would increase GRMC's Medicare payment from between $800,000 and $1.6 million per year - so obviously the investment in travel to Washington is worth it if we can make it happen!

We managed to do some sightseeing between meetings and visits on Capitol Hill. Here are a couple photos of interest:


Standing in the "Soup Line" at the FDR Memorial hoping for a little relief from our lawmakers on our Tweener issue.


Ed and Michelle contemplating the day standing at the foot of Abraham Lincoln looking at the Washington Monument in the distance.


Taking our message to Capitol Hill.


We even stopped by the "Senate ATM" to try to get our share of the Federal stimulus funds, to no avail.


Finally, Ed thought maybe he could just jump over the fence at the White House to talk directly to President Obama. We talked him out of that idea!

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