Allina Health “Pauses” Dickensian Policy
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The New York Times reports (here) that “Allina Health, a large nonprofit health system based in Minnesota, announced on Friday that it would stop withholding care from patients with outstanding medical debt as it ‘re-examines’ its policy of cutting off services for those who have accrued at least $4,500 in outstanding bills. The health system will now temporarily halt this practice but will not restore care for indebted patients who have already lost access.”
“Allina Health owns 13 hospitals and more than 90 clinics in Minnesota and Wisconsin. Thanks to its nonprofit status, Allina avoided roughly $266 million in state, local and federal taxes in 2020, according to the Lown Institute, a think tank that studies health care.”
Health Affairs, Study of Charity Care
Vivian Ho and Derek Jenkins of Rice University report in Health Affairs (here) that between 2012 and 2019 “We estimated substantial growth in nonprofit hospital operating profits and cash reserves in this period but no corresponding increase in charity care.” Previous studies showed that “86 percent of nonprofit hospitals did not provide more charity care than the value of their tax exemption” and that “nonprofit hospitals have been found to have lower ratios of charity care to total expenses than for-profit hospitals.”
DOCTORS, NURSES AND OTHER HEALTH PROFESSIONALS
What Happens When No Doctors (and Possibly No Nurses) Come to Work
The Financial Times reports (here) that “Patients will face ‘significant disruption’ and thousands of cancelled appointments as junior doctors in England prepare to walk out for 72 hours in their long-running battle over pay” and that they “will strike for a minimum of three days each month throughout the summer if the government does not improve its offer of a 5 per cent salary rise,” adding to the impact of “a wave of strike action since December with nurses, ambulance workers and junior doctors walking out.”
“Consultants are now balloting on whether to take their own industrial action” and “The Royal College of Nursing is also balloting in a bid to secure a new strike mandate after nurses rejected a government pay deal.”
HOSPITALS, NURSING HOMES AND OTHER HEALTH CARE FACILITIES
Nursing Has Not Been a Priority for Hospitals
A study in Health Affairs (here) contends that “Recent revelations of systemic staffing issues and dangerously poor quality of care at two of the nations’ largest health systems, HCA and Ascension, have sparked another round of public outcry about hospitals putting profits over patients” but also that “Improving hospitals’ behavior will require changing the policies that currently allow—and even inadvertently incentivize—hospitals to increase their operating margins through inadequate staffing.”
The study notes that “Despite the glaring need to retain nurses, hospitals have long been underinvesting in nursing quality. A study of 2014–18 hospital cost reports revealed that hospitals used their higher reimbursement rates for profit and administration, with only small increases for patient care and no increase in nurse staffing,” leading to a 17% nurse vacancy rate in hospitals in 2022.
MEDICARE, MEDICAID, AND COMMERCIAL HEALTH INSURANCE
Managed Medicaid Approaches Three in Four Beneficiaries
The Kaiser Family Foundation “Managed Medicaid Care Tracker” reports that 72% of the nation’s Medicaid beneficiaries, more than 57 million people, are enrolled in “managed” Medicaid (“managed care” HMO tactics applied to Medicaid, analogous to Medicare Advantage programs in Medicare). Total national and by state figures here.
Unwinding: Kaiser, Ten Things to Know; Redeterminations Going Worse Than Expected
The Kaiser Family Foundation reports (here) on “10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision,” among them, “KFF estimates that between 8 million and 24 million people will lose Medicaid coverage during the unwinding of the continuous enrollment provision.”
Becker’s reports (here) that “Medicaid redeterminations are going worse than expected” and that “HHS has estimated that 15 million people total will lose Medicaid coverage during redeterminations.”
State Health & Value Strategies (at Princeton, supported by RWJ) provides (here) a dashboard and links for monitoring state efforts at unwinding.
DRUGS & DEVICES
The Camel’s Nose Under the Site Neutral Tent Flap
InsideCMS reports that “The House Energy & Commerce Committee unanimously passed a wide-ranging bill that would expand site-neutral payments in Medicare drug administration and potentially sets the stage for further policies, despite New York Democrats’ and hospitals’ concerns.”
The report notes that hospitals cannot count on Democrats to oppose the end of site-of-service differentials, at least partly because of voter unhappiness with facility fees. “E&C ranking Democrat Frank Pallone (NJ) said at the markup that the Congressional Budget Office estimated the proposal would reduce Part B premiums for seniors by $1.4 billion — and he called it a commonsense move. Another policy in the bill would require each off-campus outpatient department of a provider to obtain and use a national provider identifier when billing for services. It would also require off-campus outpatient departments to submit attestations of compliance with the NPI requirements to HHS.”
The Blue Cross Blue Shield Association endorsed amendments “which would apply to commercial markets, as well, and require hospitals to use specific claims forms.”
“The Energy & Commerce bill would push back Medicaid Disproportionate Share Hospital pay cuts for two years, until fiscal 2026, but hospitals and the lawmakers have raised concerns about linking the site-neutral policies and the DSH cut delay.”
Chair “McMorris Rodgers and Pallone have previously indicated more site-neutral policies are in the works. In a report released hours prior to the markup, Third Way recommended lawmakers extend site-neutral pay requirements to all hospital outpatient departments, ‘regardless of when they were built or whether they were an acquired physician practice,’ effectively removing the exceptions built into the 2015 Medicare site-neutral pay law.”
Third Way also called for an increase in physician pay. “Increasing physician payments through Medicare’s physician fee schedule would decrease incentives for selling their practice to a hospital.” The facility fee levied by hospitals which have acquired physician practices enable hospitals to pay physicians more than they would earn in their own practice, and is widely seen as enabling hospital acquisition of such practices.
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Notes to Fred Hyde, MD, JD, MBA, news@dcmedicalnews.org
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