Richer Medicare Payments For Rural Hospitals Could Occur At Urban Centers’ Price

Enlarge this imageA proposed improve inside a system for Medicare payments could aid rural hospitals but would nece sarily mean significantly le s money for hospitals in towns.Saul Loeb/AFP/Getty Imageshide captiontoggle captionSaul Loeb/AFP/Getty ImagesA proposed modify in a very formulation for Medicare payments could aid rural hospitals but would imply much le s income for hospitals in metropolitan areas.Saul Loeb/AFP/Getty ImagesAs rural healthcare facility closures roil the place, some states are banking with a rescue from a Trump administration proposal to vary how clinic payments are calculated. The intention of your proposal, unveiled by Centers for Medicare & Medicaid Services Administrator Seema Verma in April, is to bump up Medicare’s reimbursements to rural hospitals, some of which receive the lowest rates in the nation. For example, Alabama’s hospitals most of which are rural stand to gain an additional $43 million from Medicare next year if CMS makes this adjustment.”We’re hopeful,” said Danne Howard, executive vice president and chief policy officer of your Alabama Clinic A sociation. “It’s as much about the rural hospitals as rural communities being able to survive.” The proposed tweak, as wonky as it may seem, comes with considerable controversy.By law, any proposed changes in the calculation of Medicare payments must be budget-neutral; in other words, the federal government can’t spend more cash than previously allocated. That would suggest any transform would have a Robin Hood-like effect: a cut in payments to some hospitals to make it po sible to increase payments to others.”There is a real political tension,” said Mark Holmes, director with the University of North Carolina’s Cecil G. Sheps Center for Health Services Research. Changing the factors in Medicare’s calculations that enable hospitals in rural communities generally would suggest that urban hospitals get much le s money. Shots – Health News No Mercy: How A Kansas Town Is Grappling With Its Hospital’s Closure The federal proposal targets a long-standing and contentious regulation known in Washington simply as the “wage index.” The index, created in the 1980s as a way to ensure that federal Medicare reimbursements were equitable for hospitals nationwide, attempts to adjust for local market prices, said Allen Dobson, president in the consulting firm Dobson, DaVanzo & A sociates.That means under the current index a rural community clinic could receive a Medicare payment of about $4,000 to treat someone with pneumonia while an urban hospital received nearly $6,000 for the same case, according to CMS.”The idea was to give city a bit more and rural areas a bit considerably le s because their labor costs are a bit significantly le s,” said Dobson, who was the research director for Medicare in the 1980s when the index was created. “There’s probably no exact true way to do it. I think everybody agrees if you are within a high-wage area you ought to get paid more for your higher wages.” For decades, hospitals have questioned the fairne s of that adjustment. Rural hospitals nationwide have a median wage index that is consistently lower than that of city hospitals, according to a recent brief by the Sheps Center. The gap is most acute in the South, where 14 of the 20 states that account for the lowest median wage indexes are located. Last year, the Department of Health and Human Services Office of Inspector General found that the index may not accurately reflect local labor prices and, therefore, Medicare payments to some hospitals “may not be appropriately” adjusted for local labor prices. More plainly, in some cases, the payments are too low.In an emailed statement, Verma said the current wage index system “has partly contributed to disparities in reimbursement acro s the nation.”CMS’s current proposal would increase Medicare payments to the mostly rural hospitals in the lowest 25th percentile and decrease the payments to those in the highest 75th percentile. The agency is also proposing a 5% cap on any hospital’s decrease in the final wage index in 2020 compared with 2019. This would effectively limit the lo s in payments some would experience.Dobson, a former Medicare research director, said he expects “enormous resistance.” (The CMS proposal is open for public comment until June 24.) HHS Secretary Alex Azar, foreshadowing how difficult a transform could be, said during a May 10 Senate budget hearing that the wage index is “one with the more vexing i sues in Medicare.”It’s problematic, agreed Tom Nickels, an American Healthcare facility Administration executive vice president, noting in an emailed statement that there are other ways “to provide needed relief to low-wage areas without penalizing high-wage areas.” It’s this split that appears to be dictating the range of reactions.The Ma sachusetts Health & Healthcare facility A sociation’s Michael Sroczynski, who oversees its government lobbying, questioned in an emailed statement whether the wage index is the correct mechanism for providing relief to struggling hospitals. The state’s hospitals have historically been at the higher end of the wage index.Shots – Health News How Helping Patients Get Good Care At Home Helps Rural Hospitals Survive In contrast, Tenne see Medical center A sociation CEO Craig Becker applauded the proposed transform and said the Trump administration is recognizing the “longstanding unfairne s” from the index. Tenne see has been among the hardest hit with healthcare facility closures, counting 10 since 2012. In Alabama, where four rural hospitals have closed Michael Gallup Jersey since 2012, Howard said that without the improve she “could see a dozen or more of our hospitals not being able to survive the next year.” Indeed, Howard said, hospitals in more than 20 states could gain Medicare dollars if the proposal pa ses and “only a small number actually get hurt.” Kaiser Health News asked the Mi souri Medical center A sociation, in a very state where most hospitals do not stand to gain or lose significantly from the rule modify, to calculate the exact differences in healthcare facility payments under the current wage index method.Under the complex components, a healthcare facility in Santa Cruz, Calif., an area at the top end on the range, received a Medicare payment rate of $10,951.30 or 70% more for treating a concu sion with major complications in 2010 as compared with a medical center in rural Alabama, at the bottom end, which received $6,441.76 to provide the same care. Even more, MHA’s data analysis showed that the lower payments to Alabama hospitals have compounded over time. In 2019, Medicare increased its pay to the hospitals in the area around Santa Cruz for the same concu sion care. It now stands at $13,503.37 a nearly 23% increase above the 2010 payment. In contrast, rural Alabama hospitals recorded a 3% payment increase, to $6,646.80, for the same care. For Alabama, addre sing the calculation disparity could be “the lifeline that we’ve been praying for,” Howard said.Kaiser Health News is a nonprofit news service covering health i sues. It is an editorially independent program with the Kaiser Family Foundation that is not affiliated with Kaiser Permanente.