President Trump’s Budget Takes Too Much from Rural

by Ryan Kelly –

The recently released budget from the Oval Office appears to do too much in the way of cutting important programs for rural health.

Taken from an article from ModernHealthcare, several items are targeted.

The Rural Hospital Flexibility Grant, at $42 million, is proposed for elimination. The Obama administration previously had recommended cutting the program, saying it was duplicative.

The new budget also zeroes out grants to state offices of rural health, a $9 million program.

The Rural Hospital Outreach Grant, which helps small rural hospitals get resources to create collaboratives with long-term care facilities or with ambulance services, is slated for a reduction of $13 million, to $51 million annually.

The total savings for eliminating these funds are very minimal…essentially a rounding error in the federal budget.  But the impact on their elimination could be big, cutting out needed training, education, and support services to assist our rural facilities around the country, including Mississippi.

As an Association, we will wait temporarily to see how the president’s budget plays out. It’s likely that as in years past when these items were on the block for cuts, they will be replaced by the House and Senate who realize their essential nature in their districts.  If they don’t restore these proposed cuts, though, we’ll be sure to weigh-in…

Ransomware Concern with Hospitals

By Ryan Kelly –

Recently, a major ransomware “worm” has infected computers throughout the world, notably those in the healthcare system.  Hospitals were a huge target of this software.

There is a growing concern that healthcare facilities are a prime target because of the outdated hardware and software in many facilities.  Particularly a problem with rural facilities, machines are running software that is 15 years old or more and have not been serviced in 5 years or more.

If you have computers that are running old versions of Windows (Vista, Windows 2003 or 2005) or other old software models, you need to look into updates immediately.  New computers are relatively inexpensive and can be installed with your preferred software and files quickly.   If you do not make this switch, you are prime for a data breach and may be liable for significant problems as well as fines.

Additionally, please instruct all staff to not open suspicious files even if they are sent from a trusted source.  These files (data files, pdfs etc) can contain malware and ransomware files and can infect an entire healthcare system.

In summary, stay updated and be smart with what you open.  You can control your data if you get out in front of the problems early and often!

MRHA Members Needed for New Groups

The MRHA has been planning to expand work in four key areas as required by the identified needs of our members.  This work will include two new task forces and two new user groups.

EMR Task Force

This group is designed to be a temporary meeting of any facilities or providers in Mississippi interested in switching to a new electronic medical record system and who would like to work with others also looking to switch.  The goal of the group is to identify the top needs that they have with a new EMR and to identify bundled purchase options for reduced cost and maximum impact.

Delegated Credentialing/Provider Enrollment Task Force

This group is designed to bring together clinic and hospital staff working to improve their credentialing and provider enrollment services.  This is one of the most common issues that our members face, and improvement is needed.  This task force will investigate several delegated credentialing and provider enrollment options to see if they will help to improve each facilities’ processes.  

Accountable Care Organization User Group

The ACO User Group is designed to unite members of Mississippi’s ACOs into a central location for monthly learning sessions.  This user group will meet once per month to share updates and best practices on what has helped them to achieve reduced cost and increased quality in the nation’s new population health model.

Telehealth User Group

The Telehealth User Group will combine efforts with the Mississippi Telehealth Association and unite providers, users, and technology companies together to discover better ways to deliver telehealth and improve access to quality healthcare and increased profitability of telehealth.  In addition, the user group will work to complete a new manual for telehealth implementation in the state.

We encourage all members to be a part of these groups.  Contact us at to sign-up.  Work will begin soon, so don’t delay!

AHCA, Part 2 – Vote Expected Today

By Ryan Kelly –

It was announced just yesterday that there is an anticipated vote in the US House of Representatives for the American Health Care Act (AHCA).  I dub this as “Part 2” because I expect for this to either narrowly pass, or narrowly fail.  But, if it narrowly passes the House, the major battle will be in the Senate.

This is where the MRHA will really kick-in and start working with Senator Thad Cochran and Roger Wicker on the changes needed to fit our state needs.  It’s a more logical place to tackle state-based concerns such as our great need for continuing enhanced Medicaid payments for RHCs.

As identified from, here are key elements of the revised bill:

  • Ends the tax penalty against people without coverage.
  • Ends the Medicaid expansion funding.
  • Changes Medicaid from an open-ended program to one that gives states fixed amounts of money per person.
  • Replaces the ACA’s cost sharing subsidies based mostly on consumers’ incomes and premium costs with tax credits that grow with age.
  • Repeals taxes on the wealthy, insurers, drug and medical device makers.
  • Consumers who let their coverage lapse for more than 63 days in a year would be charged 30% surcharges to regain insurance. This would include people with pre-existing medical conditions.
  • State waivers would allow insurers to charge older customers higher premiums by as much as they’d like.
  • States get $8 billion over five years to finance high-risk pools that cover those with pre-existing conditions.
  • States get $130 billion over a decade to help people afford coverage.
  • Keeps ACA provision that children can remain on their parents’ insurance plans until age 26.

The Healthcare Pricing Games Must Stop

By Ryan Kelly –

It has long been a concern of mine that healthcare facilities, mainly hospitals, have a “secret list” of charges for each procedure that is never published, never printed, and never known to the consumer prior to entry.  Now, I certainly get the anti-trust aspect of not publishing this list, known to those in the medical community as the ‘chargemaster’ and there is certainly a competitive reason for not publishing.

The chargemaster is a list of negotiated rates for various procedures between the facility and the insurers.  But, since the 90s, the chargemaster has no longer been based on a percentage increase above actual cost for procedures, and it has now been elevated to a semi-fictitious assortment of prices that are based only on what the facility “needs to make” on a procedure to make their bottom line.  Again, I get why it occurs and I would honestly do the same thing if I were them.

Here’s the problem.

The reason facilities are doing this is because the amount of negotiation for their “bottom line cost” is being skimmed down more and more.  So, they must raise their “bottom line cost” up to allow them to still make a profit on procedures.  It is imperative that even non-profit facilities make a profit on procedures, as there are much cost burdens on these facilities that do not properly factor-in to the actual cost of a procedure.  That cannot be underscored enough.

But, when the chargemaster is constantly increasing, and insurers are constantly bargaining for less and less of a percentage of the cost, it both distorts an already messy system and it ends up raising the cost for everyone.

There is a very good article by Modern Healthcare, published just last week, that details this very situation and how the burden of an unrestricted chargemaster inflates the overall cost of the healthcare system tremendously. This article is also linked from our Rural Health News newsletter published today.  Click here to view.

I think that one could argue that both neither side is to blame, and both sides are to blame.  What I would like is to find a common sense solution to the problem.  My dream has been to walk into a hospital in Mississippi, see a list of charges for every procedure possible, and then give them my insurance and see what my actual charge would be BEFORE I elect to undergo a procedure.  This would allow any patient to make an informed decision on which facility they use and to take better control of their own healthcare.

As someone who sees all three sides of the debacle – provider, patient, insurer – I know that a solution that benefits everyone is not easy given the complex healthcare web that we have created.  But, I think if we can work together and find solutions that involve minor sacrifice for the greater good and we can think outside of our pre-set boxes of procedure, we might actually be able to simplify healthcare and make life better for everyone.



More Opportunities for Rural Health Education

By Ryan Kelly –

This is one of the very few “quiet” times of the year for us in the MRHA, so I would like to take a pause and encourage you to look at our upcoming events through the summer and fall.

We have some excellent webinars and workshops coming up soon, featuring a workshop in Vicksburg on May 19th with RHC expert Patty Harper with InQuiseek. Patty will discuss an elaborated MIPS/MACRA update and Revenue Cycle Management.  You’ll be sure to want to make that one!

Several new webinars will be announced next week that are very low cost or free to members.  And, remember that all of these events will earn you credit for your Mississippi Rural Health Fellow!

Lastly, make sure to go ahead and mark the date / register for our 22nd Annual Conference on November 16-17 in Jackson.  We are beginning to work on the agenda now, and I assure you that it will be strong in speakers and pointed in focus.  And of course, it’ll be fun!

You can learn more about all of these events and register online at

Will 2018 Bring New Hospital Funding?

By Ryan Kelly –

According to recent reports, CMS is proposing a $3 billion increase in payments to inpatient hospitals beginning in 2018.

Long promoted by groups like the MRHA and NRHA, increase funding for hospitals is critical in order to properly support the struggling safety net in our rural areas.

Along with increased payments, CMS is also looking to alter the funding formulas.  The Medicare Payment Advisory Commission suggested the idea of changing these formulas, saying the change would distribute the funds in a more equitable fashion.

According to ModernHealthcare, ‘the agency will distribute roughly $7 billion in uncompensated care funds in fiscal year 2018. That’s a bump of approximately $1 billion from the prior year. This change reflects the CMS’ proposal to use new data to estimate the rate of uninsurance which calculates the total amount of uncompensated care payments available.’

Safety net hospitals would also see a change in the way they receive DSH payments (disproportionate-share payments). The new formula will lean mostly on the amounts of uncompensated care and charitable care each hospital claims on its Medicare cost report. The current formula uses a formula based on the number of Medicaid, dual-eligible and disabled patients each hospital served.

I have not yet calculated what impact this would make in Mississippi for our facilities, but it is believed that the change would disproportionately benefit non-Medicaid expansive states like ours.  If we receive new data on this proposed change, we will be sure to send it out soon.  For now, though, this appears to be good news for our rural hospitals.