McInnis seeks Medicare relief for rural providers
Local hospitals would be temporarily inoculated from Medicare budget cuts under a new bill being proposed by U.S. Rep. Scott McInnis, R-Grand Junction.Valley View Hospital in Glenwood Springs and Clagett Memorial Hospital in Rifle are among the institutions that would benefit from McInnis’ rural health care legislation.It would exempt these and other “sole community” hospitals for two years from any cuts in Medicare reimbursements. It also changes rules applying to other hospitals, deemed “critical access” rural facilities. They could continue to receive a higher level of reimbursement of costs by Medicare, even though they occasionally exceed bed limits applying to such facilities.Besides benefiting hospitals, the measure would come to the aid of home hospice and home health care operations in rural areas.McInnis’ Rural Medicare Access Preservation Act of 2002 – H.R. 4112, introduced last month – would assist rural providers across the country. But he said the inspiration for the measure comes from the problems he is seeing in rural Colorado. His 3rd Congressional District includes the largely rural Western Slope.”When I travel through Colorado, an area of growing concern amongst constituents is having quality access to health care,” McInnis said in a press release. “Because of this feedback, I sat down and worked to create a reasonable proposal that will address these important safety net issues in rural Colorado.”Gary Brewer, chief executive officer at Valley View Hospital, said the legislation “is tremendous for us, it really is.”Cuts in Medicare reimbursements have been “a running battle for Valley View Hospital already,” and more cuts are anticipated, he said.”They’re continually tweaking Medicare and it seems every time they do it we get paid less,” said Brewer, who added that doctors are encountering the same problems.”I appreciate Rep. McInnis. I think it’s a good starting point,” Brewer said of the legislation. “He’s at least stepped up and done something about it.”The Colorado Hospital Association and Club 20, an organization that lobbies on behalf of governments, chambers of commerce and other interests in western Colorado, have both come out in favor the measure.`A consensus approach'”When drafting this legislation, I sat down and worked to create a reasonable proposal that could represent a consensus approach,” McInnis said. “I appreciate these organizations and their membership stepping forward with their support for my legislation. Their support brings us one step closer to making these proposals happen.”He added, “These endorsements confirm how big the need is to secure the safety net this legislation provides Colorado’s rural communities. … This legislation ensures that the access and care will be there when it’s needed.”Specifically, the measure targets three areas:-Sole community hospitals in many instances are the only hospitals providing health care to certain areas.McInnis proposes to temporarily hold them harmless from reimbursement changes, while allowing for better data to be collected to determine reasonable reimbursement rates. Colorado has 26 such hospitals.-Critical access hospitals were designated in 1998 by Congress to help improve the delivery of health care in rural areas. These hospitals, of which there are currently 13 in Colorado, provide vital services to rural communities but lack the volume and economies of scale that urban hospitals benefit from under Medicare reimbursement.Unlike other facilities, critical access hospitals are guaranteed full reimbursement from Medicare for the costs of the health care they provide.To maintain critical access status under Medicare, such hospitals are prohibited from exceeding 15 acute care patients or beds at any time. But flu seasons sometimes causes some of these hospitals to briefly exceed that limit. Instead of determining the status of such hospitals based on their usage in any one day, McInnis would let them qualify as critical access facilities as long as they don’t exceed a 12-patient or 12-bed per-day average over a year.-Home health and home hospice programs currently receive Medicare reimbursement rates at the lowest levels. However, McInnis says these providers often incur costs not typically associated with urban home health and home hospice care, such as long distances traveled to visit a patient.He is seeking to grant a 15 percent increase above the current per-diem rate to rural home hospice providers, and a 20 percent increase in the case of rural home health care agencies.Common-sense reform?McInnis also is calling for a study to ensure Medicare is being implemented as Congress intended. His spokesman, Blain Rethmeier, said this request arises from instances in which patients died and their families were later told the patients weren’t eligible for Medicare-covered hospice care because their conditions weren’t terminal.Rethmeier said the bill aims at adding some common sense to the handling of such cases and sparing families from the additional emotional trauma they have faced in these situations.From Brewer’s perspective, it also injects some common sense into the treatment of rural hospitals that have long suffered from the mindset that it is cheaper for them to provide health care than it is for urban facilities.That’s not true in western Colorado, where it’s harder to find staffing and expensive to pay a fair wage that reflects the high cost of living, said Brewer.Meanwhile, such facilities don’t enjoy the economies of scale that big-city ones do. They must remain open around the clock, even if their intensive care units or emergency rooms have almost no one in them.Typically, Brewer said, Medicare reimburses rural facilities at 95 to 96 percent of what it costs the facilities to provide care.Medicaid reimbursement has been at an even lower percentage, creating a bigger problem for Valley View.Still, the Medicare problem is a big one. Because Medicare covers senior citizens, it applies to a high proportion of the hospital’s patients, and that proportion is growing because of the nation’s aging baby boomer population.McInnis is pinning his hopes for his bill partly on the fact that he is a member of the influential House Ways and Means Committee, which plays a crucial role in dealing with fiscal issues. Four of the co-sponsors he has found for the measure also serve on the committee.Rethmeier had no estimates last week on what the bill would cost.
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