For patients at Memorial Health System it will be business as usual despite several hut-button issues discussed at MHS’ Tuesday board meeting.
MHS CEO Mark Miller touched on topics ranging from the recent governmental shutdown to health care exchanges just launched under the Affordable Care Act. He also briefed the board on a recent American Hospital Association regional policy board meeting he attended.
Miller told the board the government shut down affected the hospital but the shutdown’s current perimeters will not significantly impact patients.
“Interestingly, and tied to the shutdown because of the Republican Party, at least as the news reports it, they are really trying to affect the funding on the Affordable Care Act,” Miller said.
“I think everybody that’s been listening to the news also realizes there is yet a second issue looming, I believe it’s Oct. 18: the debit limit scenario,” Miller said. “It’ll be interesting to see how this plays out. I have been in the Army during previous shutdowns. I’m familiar with this.”
Miller said partial governmental shutdowns occurred once during President Jimmy Carter’s tenure and twice - for various reasons each time — during President Bill Clinton’s tenure.
“We did just receive an email today (saying) the Centers for Medicare & Medicaid Services have said that the MAC’s — the Medicare Administrative Contractors, the ones that actually execute Medicare for them — are going to continue to process claims and pay,” Miller said. “So they’re staying on the job.”
Miller said a portion of the Affordable Care Act “went live” on Tuesday.
“The insurance exchange, in their minds (the minds of people who promote insurance exchanges), is an awesome idea, and hopefully it will work out that way,” Miller said. “Those people that don’t have insurance will have an options of obtaining insurance. Of course, there’s an individual mandate that goes along with that: Fines that come back to those individuals through their taxes if they do not obtain insurance.
“There is a group of folks that are not covered under the Affordable Care Act.
“There’s also a number of people that are exempt from the original mandate,” Miller said. “Those people don’t make enough money to file an income tax return.”
Miller said he did not want to project only dismal forecasts in regard to the act. Rather, he said he wanted to look at each element from all angles.
“Now, on the other hand, it doesn’t mean things won’t be better,” Miller said. “However, one of the concerns that I would have is that those people that have not traditionally had insurance would be forced to get it in order to avoid the penalty, will select those plans that have the highest deductible.”
If so, Miller said, his concern is that the act would put the system right back where it started: bad debt.
“Assuming that an individual that is mandated to get insurance, gets insurance, and they stay healthy, all of their care will continue to be bad debt or for free, and only if they were to have an episode that takes them beyond their deductible would the insurance kick in,” Miller said. “So essentially what we’re talking about is catastrophic insurance.”
Miller said catastrophic-style insurance can be valuable in certain circumstances.
“I’m kind of painting a negative but I tried to also say that it’s not necessarily all negative,” Miller said. “It remains to be seen so we’ll have to see where it all ends up.”
Miller said he has seen a reversal in trends for how medical doctors are employed.
“There was a blip a while back, 20 years ago, where a lot of hospitals were buying physician practices and frankly, were paying top dollar for them,” Miller said. “That all tanked.
“The whole thing tanked and we went the other way,” Miller said. “Then we started getting more physicians back into private practice again. When that occurred that was very popular in the managed care areas of the country, like Minnesota, the coasts and so on, and I think not so popular here in he Midwest.
“If in fact that national average is low compared to Kansas, it’s kind of the opposite of that,” Miller said. “I’m not sure what to make of that, but it’s kind of interesting.”
Another issue Miller said he wanted to touch on was that of KanCare.
“There’s recently an article where a hospital CEO offered that things weren’t going quite as smoothly as a lot of the reports would have you believe. I won’t comment how accurate or inaccurate that was,” Miller said. “I will tell you that we continue to have challenges with the KanCare Program and with delayed payment. In that particular article, that hospital had a nursing home and said that of the three contractors, one hasn’t paid them a single dollar yet, for any of their long-term care patients in their nursing home. So that might be an anomaly, but certainly we are aware of some issues that we’re still working through in regard to KanCare.”
Miller described his next update item as “another thing that’s really hot and heavy.”
“There’s always been an issue with regard to CMS (Centers for Medicare and Medicaid) and how you determine what is an observation patient,” Miller said. “It’s a status when you’re not an in-patient but you’re not just an out-patient. ‘Is it indigestion or are they actually having a heart attack?’”
In their attempts to clarify the “observation patient” designation, CMS came up with the Two Midnight Rule. According to the Healthleaders Media Council, the rule “states that if a patient is in the hospital for a stay that does not span at least two midnights, ‘the services are generally inappropriate for payment under Medicare Part A, regardless of the hour the patient came to the hospital or whether the patient used a bed.’”
Miller and the HMC article seemed to come to a similar conclusion: few, if any, hospitals are wholeheartedly in favor of the rule.
“The Two Midnight Rule seems to not be working really well at the clarifying aspect of the goal so there’s a lot of confusion about the rule,” Miller said. “That was a big topic of discussion.”
The next rule Miller shared was not a new rule but rather an old rule recently found. Or, re-found. This rule served to regulate physician supervision.
“CMS was not enforcing a rule but it had been on the table for many, many years with regard to having a physician present for many outpatient procedures,” Miller said. “Somebody discovered the rule again and started trying to enforce it,”
That suspension is scheduled to expire soon, and Miller said there is nothing in place to correct its expiration.
“That’s another big thing that AHA (American Hospital Association) has taken on or is trying to,” Miller said. “Frankly, it would mean likely that we would have to stop some of our outpatient procedures because it just isn’t cost-effective to have a physician present for those procedures and to pull them out of the clinic.”
Whether or not the suspension will expire without renewal remains to be seen. Until then, the hospital continues to practice its services in the same manner it has provided them for years.