Healthcare Bill is Dead…for now

By Ryan Kelly –

It was announced recently that leadership in the US Senate would not pursue a vote on the recently proposed healthcare bill, the Better Care Reconciliation Act of 2017,  to match the American Health Care Act passed out of the US House of Representatives last month.

It is reported that the Senate will not take up a vote because the do not have the necessary 51 votes to have the bill pass.  The Senate consists of 52 Republicans (including the Vice President) and 49 Democrats.  It is widely believed that a vote would be made down partisan lines.

So why did the bill fail to gather votes?  Essentially, it’s because we are a divided country that reflects a divided party system.  Far right Republicans do not believe that the bill went far enough to privatize insurance and move away from policies of The Affordable Care Act.  Moderate Republicans believe the legislation went too far at reducing Medicaid funding and punishing states that expanded Medicaid.

So essentially, it modified Medicaid too much and it did not open the markets far enough.  These represent two extreme issues and stances that did not work for both sides of a GOP body that needed it to work for everyone in order to pass.

What would the two bills have done in Mississippi?

The insurance marketplace would not have had the freedom needed for insurance plans to openly determine the risk of clients and assign premiums based on this risk.  The marketplace, rather would have been opened more than under the ACA but not enough to significantly reduce individual cost.

Secondly, Medicaid would have been transitioned from an unlimited federal match payment program to either a per capita rate per enrollee or a bundled payment to each state.  The greatest concern of this transition is that states would bear the greatest cost of paying for Medicaid patients, which means that most states would try to find some way to cut programs or services to save cash.  Since Mississippi receives the highest federal match of any state in the union, this would have likely affected Mississippi more than anyone else.  Although the specific impact in Mississippi has yet to be determined due to a lack of information about the specific amount of funding that would be block-granted or supplied per enrollee, the consensus is largely that it would not be good for Mississippi.  This likely would result in reduced payments for services and a reduction of covered services.  It would also likely result in a tax increase to cover the expected state shortfalls.

But, this is not done.  At the time of this writing, legislators are working on a true “repeal bill” that would take away all aspects of the Affordable Care Act.  No details have been released at this time, and many believe that such an effort would fail for the same reason that the afore mentioned legislation failed.  There is also rumor of additional healthcare legislation being crafted that attempt different ways to reform the ACA or replace it with alternative ways to care for patients.

There is large consensus on one thing – the Affordable Care Act was not perfect and further reform is needed.  Whether that involves repealing and replacing or simply modifying the ACA is open for debate.  As the Association is a 501(c)3 organization that does not take a partisan stance, our desire is to see a bill that improves healthcare for all rural citizens and providers.  We want expansion of markets, reduced cost, greater access, and financial stability of the healthcare system.
It seems like the pieces are in place, we just need to find a way to make smart reforms and bring everyone to the table for a consensus on our direction moving forward.

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