Guest Opinion: Medicare, Medicaid changes bad for rural Colorado
Potential new regulations from the Centers for Medicare and Medicaid Services (CMS) would undermine vital access to health care resources for rural Colorado communities. The proposed rule that CMS is now considering includes provisions that would increase the use of site-neutral payments, which would result in $760 million in Medicare cuts from hospitals providing outpatient care. This is an unwise policy shift that would risk access to health care for many Coloradans.
This move to a site-neutral payment policy in Medicare could threaten the efficacy and very existence of rural hospitals offering outpatient care and an array of other services for our communities, both here in Colorado and across the country. As two dedicated public servants who I know have worked to improve access to and lower costs associated with health care, I hope Reps. Mike Coffman and Scott Tipton will weigh in on this issue with CMS and urge the agency not to proceed with the site-neutral aspects of their proposed new rule.
The proposed expansion of site-neutral policies means CMS would no longer take into consideration the health care setting in which outpatient care is delivered when calculating Medicare payments for providers. Put more simply, hospitals with outpatient clinics would see their Medicare payments drastically slashed— by upwards of 60 percent — to be comparable to that of a private, standalone doctor’s office. The problem with this approach is that hospitals and physician clinics operate under completely different cost structures.
Unlike a freestanding physician’s office, hospitals are required to maintain 24-hour emergency services and standby disaster response capabilities 365 days a year. These functions contribute to higher costs, which are offset by revenue from direct patient care, a situation that doesn’t exist for any other type of health care provider. It is unreasonable to expect these facilities to continue providing the same level of care, and also accept Medicare patients, while simultaneously cutting their reimbursement rate so drastically.
Especially in rural communities, the role that local hospitals with outpatient facilities play cannot be overstated. For many hardworking farming and ranching families, the local hospital may be their only option to access the health-care services they need.
As the mother of a son living with autism, having emergency room services nearby is incredibly important. These new proposed regulations could jeopardize that access by forcing rural hospitals like Grand River Health to scale back or close their doors altogether. As it is, too many rural communities have insufficient access to health care — a situation that was exacerbated by the enormous increase in health-care costs precipitated by the “Affordable Care Act” (Obamacare), especially in our part of the country. These new regulations would only make this problem worse.
The Trump administration has made considerable progress in lowering health-care costs after the debacle that is Obamacare caused insurance premiums to skyrocket for families like mine. However, this potential CMS rule is a step in the wrong direction and would adversely affect rural and low-income communities here in Colorado and nationwide.
To continue effectively serving their communities, hospitals offering critical outpatient care must be compensated fairly for the services they provide. There is no question that Medicare and Medicaid desperately need to be reformed, as both programs are financially unsustainable, are by far the biggest drivers of our debt and deficit, and represent a growing liability to future generations. But until the needed systemic reforms are made, simply cutting Medicare reimbursements to hospitals — especially when current rates already fall short of covering the costs hospitals incur — is a knee-jerk reaction which will have terrible consequences for rural hospitals and the families that depend on them.
CMS is set to finalize this rule in November, so there isn’t much time for lawmakers to act. Representatives Coffman and Tipton have worked hard throughout their careers to protect health care for rural Coloradans. I hope they will consider this issue, weigh the impact it would have on the constituents and communities they serve, and ultimately speak out to CMS about their misguided approach.
It is vital that CMS take into account the site-specific cost differences associated with providing care when calculating Medicare payments. Until major efforts are made to restore free-market sanity to the health-care industry, simply cutting the payments made to hospitals to reimburse them for the subsidized care the government requires and expects them to provide is not a sustainable or wise approach. Let’s work on curing the disease rather than reflexively addressing the symptoms in a way that hurts the patient.
Carrie Couey is current chair of the Garfield County Republican Party.
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