MHA Press Room

MHA Official Statement: President Obama's Budget Proposal and How It Affects Mississippi Hospitals

The Mississippi Hospital Association is pleased that President Obama, in his budget proposal, realizes the problems that reducing disproportionate share hospital (DSH) payments to hospitals will cause and aims to delay the hundreds of millions of dollars in cuts to our Misissippi hospitals. While delaying the Affordable Care Act’s Medicaid DSH reductions by one year, to 2015, it would deepen the cuts in subsequent years and extend them through 2023.

Upcoming DSH cuts are not hospitals’ only concern. Obama’s proposal also contains troubling reductions to assistance to hospitals to help defray some of the cost of caring for low-income seniors who cannot pay their required share of Medicare costs. This is known as “Medicare bad debt” and support is reduced to 25% from 65% over three years starting in 2014. This will lead to a loss of $258 million for Mississippi hospitals alone over 10 years. At the same time, the proposal is imposing increased cost-sharing on our nation’s seniors, so hospitals will be shouldering a higher dollar percentage of bad debt with drastically decreased support.

Mississippi is a largely rural state, and almost one-third of our hospitals have attained critical access hospital (CAH) status. The President’s proposal — starting in 2014 —reduces reimbursement from 101% of cost to 100% and would eliminate CAH designation for hospitals less than ten miles from another hospital. This will lead to a loss of $21 million for Mississippi’s CAH hospitals over 10 years and will jeopardize the CAH status for some.

Attached below is a complete breakdown of the cuts proposed to our nation’s hospitals. It is easy to see the precarious financial position this will put our hospitals in, as almost half of the hospitals in our state already operate at a loss.

Download FY 2014 PresBud - Major Medicare and Medicaid Proposals Affecting Providers

Report: Sicker Medicare patients driving up intensity of ED care

Sicker, more complex Medicare patients are driving up the intensity of emergency department care, according to an American Hospital Association report released May 2. The report, which is based on an analysis of Medicare claims data conducted by The Moran Company, found that the number of ED services provided to Medicare beneficiaries is growing and patients’ needs are shifting toward services that demand the use of more resources.

“The reality is that seniors who come to the hospital ED are sicker and have more chronic illnesses,” said AHA President and CEO Rich Umbdenstock. “Hospitals are striving to meet their communities’ needs, which means caring for patients who need more – and more intensive – services than ever before.”

While some policymakers have raised concerns that the shift toward ED services that require more resources is leading to higher Medicare spending, the report shows that the overall use of ED services is also increasing, and EDs are serving more Medicare patients with behavioral health diagnoses and more patients enrolled in both Medicare and Medicaid.

SAMHSA reports sharp rise in ED visits involving sleep medication

The number of emergency department visits involving adverse reactions to the insomnia medication zolpidem rose nearly 220% between 2005 and 2010, according to a new report by the Substance Abuse and Mental Health Services Administration. Patients 45 and older accounted for three-quarter of the 19,487 visits in 2010, and women for two-thirds. Half of the visits involved other medications combined with zolpidem, the active ingredient in Ambien, Ambien CR, Edluar and Zolpimist.

In January, the Food and Drug Administration required makers of drugs containing zolpidem to halve the recommended dose for women and suggested reducing the recommended dose for men. Adverse reactions associated with the medication include daytime drowsiness, dizziness, hallucinations, agitation, sleep-walking and drowsiness while driving. When combined with other drugs that depress the central nervous system, the sedative effects of zolpidem can be dangerously enhanced, the report adds.

“Although short-term sleeping medications can help patients, it is exceedingly important that they be carefully used and monitored,” said SAMHSA Administrator Pamela Hyde.

ED Cost of Care Greatly Underreported, Researcher Says

A Brown University researcher says the true cost of emergency department care may account for 10% of total healthcare spending, not 2% as a widely accepted federal report claims. Read a summary of the findings from HealthLeaders Media here.

2012 prescription spending: $2262 per Medicare patient

In 2012, this was the breakdown of overall prescription drug spending by patient’s type of coverage:

• $2262.32 Medicare (notice that this is about 2.5 times commercial patients) 
• $ 846.85 Commercial 
• $ 450.58 Medicaid

Read more from the AHA Resource Center blog here.

Insuring the Future: Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act

Nearly half of all working-age adults, about 84 million people, went without health insurance at some point in 2012 and another 30 million people had out-of-pocket costs that were so high, they were underinsured, a survey released by The Commonwealth Fund shows.

The results found in the survey, Insuring the Future : Current Trends in Health Coverage and the Effects of Implementing the Affordable Care Act, were not all bad, however. For example, the proportion of adults ages 19–25 who were uninsured fell from 48% percent to 41% between 2010 and 2012, reversing a near decade-long increase in uninsured rates for that age group.

Heart failure patients, costs projected to rise

Direct and indirect costs to treat heart failure could more than double in the U.S. by 2030, to $70 billion, according to an American Heart Association policy statement published online April 24 in the journal Circulation. The statement predicts the number of Americans with heart failure could climb 46% by then, to 8 million people, fueled by an aging population and increase in the number of people with conditions such as ischemic heart disease, hypertension and diabetes.

“If we don’t improve or reduce the incidence of heart failure by preventing and treating the underlying conditions, there will be a large monetary and health burden on the country,” said Paul Heidenreich, M.D., professor of medicine at Stanford University School of Medicine and director of the Chronic Heart Failure Quality Enhancement Research Initiative at the VA Health Care System in Palo Alto, CA.

Private Insurance Payments for Hospitalizations Drop 7% as Medicaid Payments Rise

The percentage of hospital stays billed to private insurance dropped by 7 percent from 1997 to 2010, whereas the percentage of hospital stays billed to Medicaid rose by 5 percent in the same time period, according to a statistical brief from the Healthcare Cost and Utilization Project, sponsored by the Agency for Healthcare Research and Quality.

Read more here.

Report: Employer-based coverage falls by 11.5 million over decade

The proportion of Americans with health coverage through an employer declined from 70% in 2000 to 60% in 2011, or by 11.5 million people, according to a report released April 11 by the Robert Wood Johnson Foundation. The largest decline occurred in Michigan (15.2 percentage points) and the smallest in Nebraska (4.3 percentage points).

According to the report, the average annual premium for employee-only coverage doubled over the period to $5,081, while family premiums increased 125% to $14,447. “Higher costs naturally translate into fewer employers offering insurance coverage, and fewer employees accepting it, even when it is offered,” said RWJF President and CEO Risa Lavizzo-Mourey, M.D. “That is why it is so important that people have options for purchasing affordable health insurance that meets their needs.”

The report was prepared by researchers at the University of Minnesota’s State Health Access Data Assistance Center using state-level data from two federal surveys.

CDC: Teen birth rates declining, nearly 20% are repeat births

While teen births have declined over the past 20 years, nearly one in five teen births is a repeat birth, according to a report released April 2 by the Centers for Disease Control and Prevention. More than 365,000 teens, aged 15 to 19, gave birth in 2010, and about 18% of those were repeat births – a second or more pregnancy resulting in a live birth before the age of 20.

“Teen birth rates in the United States have declined to a record low, which is good news,” said CDC Director Tom Frieden, M.D. “But rates are still far too high. Repeat births can negatively impact the mother’s education and job opportunities as well as the health of the next generation. Teens, parents, health care providers, and others need to do much more to reduce unintended pregnancies.”

The report says that repeat teen births decreased by more than 6% between 2007 and 2010, and there are substantial differences based on race, ethnicity and geography.

Medicaid expansion rally at the Capitol, March 27, 2013: Remarks of Sam W. Cameron

Good morning. Thank you for having me here today. I am Sam Cameron, President/CEO of the Mississippi Hospital Association. We represent over 100 hospitals in our state and over 90,000 employees who work in our facilities.

I want to say right from the start here that the Mississippi Hospital Association supports Medicaid expansion and we have consistently said we are for Medicaid expansion. Our support is required, first, because of the compassionate healing ministries we are charged with on behalf of those among us that we see and treat every day. But we also support expansion because of the financial realities our hospitals now face.

No matter what you think about Obamacare, the federal law—the law of the land--contains reimbursement cuts to Mississippi hospitals over the next 10 years. These cuts are hard-coded in federal law and they are not subject to administrative interpretation or wishful thinking. They will occur.

To put these cuts in perspective . . . Most recent cost reports reveal that 70 of Mississippi’s 106 acute care hospitals had a profit margin of less than 5 percent. Let me repeat that. . .70 of 106 hospitals had profit margins of 5 percent or less. The federal cuts we already know about represent a negative 11.5 percent of total Medicare fee-for-service-revenues to all hospitals in the state. And that number does not include the projected Medicare DSH cuts of over $663Million in Mississippi that begin October 1st. Those cuts do not include the $200 Million Mississippi hospitals will no longer receive in Medicaid DSH reimbursements, also beginning October 1st.

It’s been suggested by some that the state will somehow make hospitals “whole” for these cuts in federal reimbursements. Those who make that suggestion are unaware that the total cuts to Mississippi hospitals—again, cuts that are hard-coded in the federal law—total over $4.2 BILLION over the next 10 years. So it’s time we put that bit of “wishful thinking” behind us.

It’s time to put People over Politics.

The first people I want to talk about work in your community hospitals as nurses, janitors, managers, medical coders, and cafeteria workers. Many of them work in small, rural hospitals that are struggling to keep their doors open already, and they face potential lay-offs if we don’t expand Medicaid eligibility.

It’s time our public officials show they care about hospital employees who may be laid off. Please, put People over Politics and allow a vote on Medicaid eligibility expansion.

I’m also here today to tell you about people who do have health insurance. An American Academy of Actuaries study recently concluded the costs of private health insurance could rise in states that opt out of Medicaid expansion. According to an analysis from Jackson Hewitt Tax Service Inc., the associated costs to employers of not expanding Medicaid could total anywhere from $876 million to $1.3 billion in the 22 states that are either opting out or are leaning that way.

And apart from the cost of care, the most critical issue is access to care. The most critical issue is that when we cut hospital staff and hospital services, we are jeopardizing access to care for all Mississippians, whether on Medicaid or not, whether you have private insurance or not. Those services aren’t eliminated just for the uninsured, but for everyone.

People over Politics. . .People over Partisanship . . . People over Wishful Thinking.

To all of our elected officials I respectfully request: Please, on behalf of all of us who serve those who serve others—have a debate and vote on Medicaid expansion as soon as possible.