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HCCD Report Alabama 35360

Minutes
Northwest Alabama Community Healthcare Forum
Monday, December 29, 2008
Shoals Chamber of Commerce
Program Moderator - Steve

Twenty-seven participants representing a wide-range of community and political leadership positions attended the two hour session.

The program moderator began by asking two area hospital administrators to address their current concerns and issues that have a direct impact on healthcare in northwest Alabama. After sharing their comments, other participants responded with additional questions and other specific concerns regarding the cost, availability and shortfalls of our local and national healthcare systems and services. Below is a priority list of issues discussed during the forum, followed by a list of other issues that the group felt should be submitted for your consideration.

Development of a fair and equitable system of Medicare reimbursement that allows northwest Alabama to receive dollars that should be allocated to our community. These dollars are currently distributed to communities in larger metropolitan areas with more political influence and small rural facilities that have regulatorial ways to reclassify that are not available to our hospitals.

The group voiced concerns that CMS is not willing to follow the recommendations submitted by their own advisory committee – MEDPAC, which issued a report in 2007 seeking a more equitable distribution of Medicare dollars. MEDPAC’s recommended redistribution would bring $38 million to Alabama and over $7 million to northwest Alabama. Since the wage index component is budget neutral, for our state to receive the recommended and fair amount, the dollars would have to be redistributed from communities with more political clout.
Even though the wage rate for healthcare providers in northwest Alabama is higher than many surrounding communities, our reimbursement remains lower due to the Florence MSA’s inability to re-classify to a larger market.
The group’s recommendations for possible solutions includes:
- Recommend to the new administration that CMS follow the proposed MEDPAC guidelines, despite the anticipated political objections.
- special rule exemption from CMS that provides wage index relief for the Florence MSA.
- legislative relief that addresses the inequity of the Medicare wage index within our local community.
- Seek a new classification for small urban MSAs, similar to the rural classification, which would allow small urbans the ability to reclassify for equitable reimbursement.

2. Development of programs that assist with the recruitment of both primary and specialty care physicians to provide services in medium sized markets.

Discussions centered around the difficulty in recruiting and maintaining a quality physician base in markets under 200,000 in population.
Federal assistance is needed to assist new graduates to locate in smaller markets by providing them with education loan forgiveness, relocation expenses and practice establishment in markets that could otherwise support their practices.
Many communities, similar to ours, have an aging population of physicians with little promise of new physicians to provide services as our aging physicians retire. A large segment of our community could soon be without any physician coverage due to this rapid development.

3. Access and availability of healthcare services

Discussions centered on the increases seen in our community, of residents with no insurance as well as those that now fall in the category of underinsured.
- Our community is primarily composed of small business owners who are having a difficult time providing adequate or any insurance coverage for their employees. This in turn places a greater burden on our hospitals and physician practices who continue to provide services with no mode for reimbursement. Everyone seems to see and understand the problem but no one accepts responsibility for solving this important issue.
- We see more and more local residents postponing healthcare services due to high cost and their inability to pay. They ignore preventive care, neglect their medication needs and reach a crisis situation before seeking help. This is illustrated by full critical care units with available beds in general acute areas of our hospitals.
- Another voiced concern was limited access to free care clinics within our community, as well as no physician and CRNP availability (primarily due to reimbursement issues) at several rural clinics in northwest Alabama.
- The need to expand funding and accessibility for child healthcare through programs similar to SCHIP – Children’s Health Insurance Program. The program provides coverage for children who would normally not qualify for Medicaid services, yet have no other access for healthcare.

Develop programs that assist with uncompensated reimbursement for individuals who while not eligible for state Medicaid programs, have no other affordable access for healthcare coverage.

4. Developing new and innovative educational programs to initiate preventive care within our local communities.

Our communities in northwest Alabama have very high incidents of diabetes, obesity, heart disease and strokes.
There was an identified need to expand programs for community education, starting with children, with a goal to promote lifestyle changes.
Additional funding for public health to support the development and presentation of these new programs

Other addressed concerns include:

Advantage plans which take dollars away from healthcare providers yet has resulted in billion dollar profits for intermediaries. These increased profits should be used to provide care and services, not profits for insurance companies administering the program.
Implement an IT system that links providers, thus reducing redundancy of tests and medications. The question remains who bears the expense of required equipment and the cost of implementation.
Reevaluating the use of our healthcare dollars. Currently the majority of dollars, some estimate 80%, is spent in the last year of life.
Better research on treatment protocols and outcomes prior to policy making. There is too much waste generated when protocol is legislated and implemented nationwide and then further research reveals that the initial findings were incorrect.
New caps on Hospice care providers, resulting in large monetary take backs. Hitting the caps requires repayment to Medicare for covered services already provided to beneficiaries. Providers are seeking a three year moratorium to allow Congress to review and develop alternative solutions to this process that is forcing many Hospices to close their doors.
The need for catastrophic healthcare for all
Development of a long range plan for healthcare within our local community that addresses duplication of services and the possible development of one healthcare system to serve northwest Alabama.
Medicare, at their discretion, delaying payments to providers. This causes severe cash flows problems for many smaller providers.
Recommendation for reforms regarding documentation requirements and red tape that result in slower access to healthcare.
The rising cost of healthcare liability. Expensive and needless tests and procedures are often performed simply as a means to avoid malpractice issues.
In 2008 Medicare (CMS) made a reduction of .6% to the DRG weights to compensate for perceived over coding by hospitals. Now under the RAC program Medicare is auditing hospitals to recapture these same dollars. This seems to be double dipping from hospitals that are already underpaid.
A national decision to the question – “Is healthcare a right or a privilege in this country.”

Additional Quotes by Attendees

“The Senior Rx program is way too complicated. It needs to be simplified. Because the process is so complicated, there are local seniors who have mistakenly signed up for Medicare supplements with companies that don’t have contracts in our area.”

“Lifestyle educational and motivational programs should be developed to encourage individuals to take responsibility for their own preventative measures. As an example, type two diabetes is sweeping the United States and accounts for billions spent in medical costs each year.”

“The state of the economy is moving paying patients away from healthcare. People are putting off healthcare until they reach a critical stage at which point it becomes very expensive.”

“Paramedics are seeing an increase in situations where 911 is called and an ambulance is dispatched to the scene. The patient is stabilized and then refuses transport to the hospital as they have no means to pay for hospitalization.”

“We have to take the communication to the average people. Average people don’t really understand the problem. Making average people part of the solution will draw communities back together.”

Respectfully Submitted:
Julia
Tom
Program note takers