With an audience made up of national, state and local leaders, Fayette Regional Health System CEO Randy White outlined on Friday a growing list of grievances with the current healthcare climate that could ultimately threaten the existence of the hospital.
The occasion was a stop by United States Congressman, Dr. Larry Bucshon (IN-8th) as a continuation of the Hoosier Healthcare Tour, a statewide tour launched last year by Dr. Bucshon and Indiana Ways and Means Chairman, Dr. Tim Brown, to discuss the status of health and healthcare in Indiana.
As its association with an accountable care organization dictates, FRHS must continuously stay on top of burdensome government-imposed regulations or risk penalties while not receiving the same amount of reimbursements as other hospitals in the ACO.
“We have 1,800 people designated in our market that we will serve,” White said, “but we have a disproportionate number of elderly and uninsured. We do not have economies of scale so when rules are made in D.C. or Indianapolis and they’re pushing down regulations on us, I don’t have a department that can keep up. We’re doing what we’re asked to do; the government doesn’t know what it’s putting on our back.”
The Centers for Medicare and Medicaid Services (CMS), under the Affordable Care Act, are authorized to establish a Medicare Shared Savings program that gives financial incentive determined by an organization’s costs relative to CMS-established benchmarks.
“Mandatory requirements in ACA have to be loosened up,” said Bucshon, a former cardiovascular surgeon. “Profitability of state exchanges is not there. They continue losing money because people signing up are older and sicker and young people are not signing up. The premise was younger people won’t require a lot of healthcare so they’ll basically fund care for older people. That’s just not happening; that’s not my opinion, that’s the data. At some point, everybody’s priced out of the market due to increasing premiums. Literally, you can’t deliver insurance at an affordable price under the regulations. But high premiums and deductibles are not going away.”
Thanks to Healthy Indiana Plan 2.0, the state’s expansion of Medicaid, many more eligible Hoosiers are now able to acquire insurance. Approved earlier this year, HIP 2.0’s presence has been felt in the recent Scott County HIV crisis and will play a large role in the needle exchange program approved in Fayette County.
“Everything hinges on getting signed up for HIP 2.0,” said county commission president Frank Jackson. “That provides $100,000 per person and pays for Indiana University specialists who will be coming here.”
According to White, that presents a problem.
“I want everyone to have insurance but addicts are not coming to this hospital until they overdose,” he said. “I employed someone to sign them up but when they leave, they don’t see a claim rep, they see their dealer. They’re not leaving the lifestyle to get HIP.”
Bucshon said he is a big supporter of HIP 2.0.
“I didn’t support traditional Medicaid expansion because most doctors won’t take it but HIP is a different story,” he said. “It’s turning out to be a very good program for low-income Hoosiers.” He went on to say, though, that the trend of uninsured Americans will continue despite such state exchanges.
“The Congressional Budget Office said by 2025 or 2030, there will still be as many as 30 million uninsured in the U.S. The two groups will be people who don’t qualify for traditional Medicaid or who have chosen not to purchase insurance.”
White and Bucshon were in agreement on the current disconnect between the federal government and local hospitals. One item is ICD-10, the 10th revision of a medical coding list required by the World Health Organization.
“We’re spending more time proving that we did it the way somebody wants it done,” White said. “Doctors are spending more time on computers than taking care of patients, then we get penalized for input errors.”
“CMS is not ready for ICD-10, everyone in D.C. knows it,” Bucshon said. “The researchers are pushing for this information.”
He then touched on the point that White took up for the rest of the meeting.
“Medicare’s in trouble financially and CMS is doing everything it can to stop expenditures of Medicare,” said Bucshon.”CMS is not all about patient care, it’s about the dollar bill and the mal-distribution of resources in a lot of ways. To help, we have to have information from people like you on exactly why this is a problem and how it affects your ability to take care of people.”
While hospitals in the Indianapolis area are benefiting greatly, FRHS is forced to struggle in many ways.
“They make money hand over fist because they’re massively reimbursed,” White said of Eskenazi Health, Hendricks Regional, Community East and Community South. “They’re leaving money in a checking account for a rainy day while I sit out here and fire people, lay people off and make decisions I shouldn’t have to in taking care of some of the poorest people in the state. You can go online to see who’s getting these dollars and it’s so few of hospitals in the state, it’s the grossest thing I’ve seen in healthcare.”
What may be needed is a federal or state designation as a Medically Underserved Area by the Health Resources and Services Administration.
“There’s more than enough money out there but it’s not getting to where it’s supposed to be,” said White. “Nursing homes are overseen by hospitals an hour away. I’m taking care of (the homes) but these guys are getting paid for it. If you’re county or city-owned, that allows you to work with nursing homes. I could step in and play the game.”
“If the county or city can say ‘we don’t want to lose our hospital, we’re going to make it a (municipal) hospital,’ why aren’t we doing this?” asked Indiana State Representative Cindy Ziemke (R-Batesville).
Jackson agreed.
“The commissioners have spoken privately and we are more than willing to do whatever we can as long as taxpayers and the county are protected,” he said. “You’re one of our largest employers and invaluable to the county. We’re not going to stand by and watch you go down if we can help it. And you may decide the city’s a viable entity to approach, that’s strictly up to you.”
There are different methods of becoming municipally owned, White said. On one end, the entity would designate the board and everything else or, the entity wouldn’t officially run the hospital but lease it back to existing operations.
“USA Today called us the dinosaur hospital that’s short to live because we don’t have the designation we need,” said White. “I’m constantly chasing my tail and moving the shells around instead of addressing patient care which is what we’re here for. It’s constantly bailing water to net nothing. 183 hospitals in the nation are at risk of closing. If cash flow is interrupted, it speeds a lot of that up.”
“We have to figure something out, it’s too large an area to go underserved with no hospital,” said Ziemke.
“It’s difficult to change the ACA but we’ll get some changes,” Bucshon added. “What’s happening on the ground, we have to do something about this. There’s some hope.”
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