Mississippi Rural Health Association

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 FierceHealthcare.com, 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.

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.

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 www.msrha.org/events.

By Ryan Kelly –

Mary Smith, nurse practitioner and administrator for the Starkville Orthopedic Clinic in Starkville, spoke at the Association’s Rural Health Clinic Conference in Jackson on April 7, 2017.  Mary delivered a presentation regarding the CMS process for submitting quality information for the Quality Payment Program (QPP) using MIPS.

Mary stated that CMS will be sending letters during the month of April to all individual providers who meet the MIPS threshold for reporting.  So, if you are a provider, be on the lookout for this letter.  If you are an administrator, make sure and notify your providers that this letter is coming.  For those designated “rural health,” your providers that submit Medicare Part B may still be eligible for MIPS even if your clinic is exempt for being in the legacy fee-for-service model.

Please contact us with any questions at 601.898.3001.

By Ryan Kelly –

It hasn’t taken long for the rumors of a bi-partisan healthcare bill to take off.  If you have viewed my previous posts, this was my hope and somewhat my expectation.

A recent news article from Kaiser Health News detailed an honest interview from Rep. Don Young from Alaska admitting that the partisan failure was the parties’ fault:

“The reason why Obamacare failed was because it wasn’t a bipartisan bill,” said Don Young, Republican of Alaska. His party made the same mistake, he said, writing their bill without Democrats. “We were very frankly guilty of that.”

But, several legislators and White House officials are already hinting at the understanding of the need for a bi-partisan bill that thinks through the complexity of our healthcare system and addresses all needs in a manner that improves the current system and doesn’t cause many if any unforeseen problems.  While there was no direction of the path forward, the conversation has already begun…which is a good thing.

I was able to visit with elected officials in DC this week and had some good conversations with them regarding the AHCA.  When discussing the bill and its failure I repeated the same thing that we told them last month…take your time and get it right.

I am hopeful that Round 2 (whenever that occurs) will be slower, more methodical, and substantially better by having the Senate and House bring together both Republicans, Democrats, and constituent groups to provide a collective approach at solving our issues.

Where the ACA somewhat failed because of its highly partisan nature, a new healthcare bill could succeed by actually listening to others.

Of course, time will tell…

By Ryan Kelly –

GOP members released new amendments to the health care law designed to replace the Affordable Care Act.  Clearly expected and not-so-long awaited, these amendments are aimed to help win votes to allow the legislation to pass.  So, what’s in these amendments and what would it do to Mississippi?

If you read mass media, you will get a hint of fact mixed in a flurry of speculation.  One of my pet peeves here lately is a lack of informed content without opinion, so take anything you read from liberal or conservative sources with a big grain of salt.

New amendments include the following:

• A possible requirement for those on Medicaid to work, participate in job training, or perform community service.
• A revised option for states to receive Medicaid funds as a “block grant” versus a per capita system, which would allow states to receive a set block of funds per year versus a set amount per enrollee per year.
• Prevention of any additional states to expand Medicaid coverage as prescribed in the ACA
• Increased tax credits older enrollees

From here, the bill with amendments goes to the Rules Committee, where additional amendments and discussion is almost assured.  But, some experts think that the bill could receive all markups as early as Thursday of this week…meaning that the process will go much faster than many of us thought.

What does this mean for Mississippi?

It’s still unclear.  As I mentioned in my last analysis of this, it all depends on the specifics of Medicaid.  One very important change that the National Rural Health Association is pushing, and we as the MRHA are supporting, is an exception for rural facilities to continue to receive the enhanced Medicaid and Medicare funding as a federal requirement for Medicaid funding to states.  This amendment would be critical for Mississippi’s many rural facilities.

What is the MRHA doing?

First, we are petitioning lawmakers to consider the NRHA amendment.  Continuing enhanced payments for rural is a blip on the fiscal radar, but it is significant for our providers.

Second, we are preparing a marketing campaign directed specifically at Mississippi lawmakers and policymakers to show the benefit of enhanced rural payments.  When a lawmaker understands how a little extra up-front saves significant dollars in the entire system, it becomes an easy sell on why enhanced rural payments are important.  Without them, our ERs in metro areas become much busier, and the cost to the state increases significantly.  No one wants this…so it’s a message that we will continue to tell.

What can you do?

Right now their may not be enough specific information to make specific asks, but contacting your lawmaker and asking them to consider rural health with this legislation is a huge positive.  This includes both federal and state legislators.

We will continue to keep everyone informed and updated as things progress.  There is certainly more to come…

By Ryan Kelly

I took a trip across rural Mississippi this weekend with my family – one of my favorite things to do!

We were driving through some country roads when I came across this metal barn in south central Lamar County.  I grew curious when I saw this barn, “how far would it be to the nearest hospital?”  With my one bar of cell service I searched the distance to the nearest facility.  It was exactly 16 miles to either Merit Health Wesley or Marion General Hospital. Then I searched for the distance to the closest clinic…8.2 miles at Hattiesburg Clinic Bellevue location.

Driving back to Hattiesburg I timed the drive to that clinic.  It took 16 minutes.  So, if someone cut themselves on rusty barbed wire and needed a tetanus shot, or if they were bitten by a rattle snake, it would take them almost 30 minutes to reach a hospital or 16 minutes to reach a clinic.  Such could be a dangerous proposition.

This is a very common example of the distance between medical providers in rural Mississippi.  In many areas, the distance is much, much further.

This is why rural health is so important.  Most Mississippians live in rural areas, and the distance to their nearest medical provider can be great.  This is usually fine for normal procedures or visits, but for emergencies, it can be the difference in life and death.

So keep supporting rural health.  For our providers, know that you are serving a population that needs you.  For patients, trust in your providers that are here for you and use your local services.  For insurers and lawmakers, know that your investment in rural health pays huge dividends in the lives of Mississippians.  Together we will keep Mississippi’s health strong.

#OneRural