Private insurance and Rural Hospital risk
Harold Miller judges that of Washington’s 39 rural hospitals, 13 are at risk of closing, one of which may be facing immediate closure. Harold heads up a national center that “facilitates improvements in healthcare payment and delivery systems.” Harold joins Shane McQuire, Columbia County Health System, Thursday evening to help us understand the complicated finances of rural hospitals.
These “complicated finances” are not just Medicaid reimbursement calculations. Harold points also to private insurance payment rules.
Join the discussion.
Don
15 November 2022
Rural Hospitals. Essential. Viable? Thursday 17 November 6:30 pm https://us02web.zoom.us/j/84093446627?pwd=VFJ3N2p3RUhRRUNFRDhYKzlTa01sQT09 Meeting ID: 840 9344 6627 Passcode: 148588
Shane McGuire
CEO
Columbia County Health System
Rural Hospitals. Essential. Viable?
Economic Driver
We started looking at rural hospitals from the selfish position of saving our lives, and those of our families. A less urgent but maybe no less selfish view is that health care is big business. And we in rural areas need the employment and property taxes.
Recall, too, that several months ago we talked about “gateway” communities and the unwanted housing, water and environment, and cost-of-living effects that come with being attractive communities. The Methow was our test case but the same holds for Omak, Chelan Leavenworth, Cle Elum, and Dayton, too.
We recognize the downsides of Puget Sound residents moving east to work remotely and recreate locally. We acknowledge, though, that they bring not only pressure on scarce housing but also purchasing power, tax revenues and innovative ideas. They bring dollars and culture.
Health care access is part of responsible planning for populations shifts, for folks moving into our communities. Access to good health care is a major factor for both young families with kids going to our schools and retirees converting their house equity to investment in our downtowns.
If “selfish” means planning for our own welfare, then we all should know about, care about, and do something about making our rural health care viable.
Join Shane McGuire in talking through these issues. Shane enjoys widespread respect in southeast Washington and has graciously agreed to help us understand what makes small hospitals work.
Don
13 November 2022
Rural Hospitals. Essential. Viable?
Who pays what?
Some years ago, ARC heard from Providence that their estimates of how the Affordable Care Act would work were thrown off by the greater than expected proportion of their patients that were on Medicaid. The expansion of Medicaid had the intended effect of increasing the number of previously uninsured residents who were seeking health care.
The statement then was that Medicaid paid less than private insurers. A current study of small rural hospitals turns that on its head. Private insurers short small rural hospitals relative to Medicaid and Medicare. What are the facts?
This quickly drops us down into the rabbit hole of health care finance. One shaky handhold is Critical Access Hospital (CAH) designation. (Here is what they are. And here is who they are in Washington.) It turns out that CAH’s are compensated differently than Sole Community Hospitals, for example. CAH status buys you compensation based on your cost of service. No other classification gets this privilege. Most hospitals are paid under Prospective Payment Systems – “pre-determined, fixed discharge payment”.
If CAH status is so good, then, why is there such a variation in payment? If Dayton’s 60 percent “weighted cost to charge” is good, then what about Pomeroy’s 553 percent? What does this mean?
| FINAL CRITICAL ACCESS HOSPITAL (CAH) | |||
| WEIGHTED COST TO CHARGE (WCC) RATES | |||
| INPATIENT | OUTPATIENT | ||
| WCC | WCC | ||
| Cascade Medical Center | 92.88% | 48.29% | |
| Columbia Basin Hospital | 155.03% | 68.40% | |
| Coulee Medical Center | 77.70% | 55.86% | |
| Dayton General Hospital | 59.70% | 46.20% | |
| East Adams Rural Hospital | 73.31% | 56.79% | |
| Ferry County Memorial Hospital | 125.46% | 36.35% | |
| Forks Community Hospital | 57.91% | 39.68% | |
| Garfield County Memorial Hospital | 553.75% | 139.84% | |
| Jefferson Healthcare Hospital | 70.58% | 42.22% | |
| Kittitas Valley Healthcare | 66.14% | 41.31% | |
| Klickitat Valley Hospital | 130.02% | 50.56% | |
| Lake Chelan Community Hospital | 47.31% | 56.49% | |
| Lincoln Hospital | 102.80% | 71.33% | |
| Lourdes Medical Center | 23.60% | 21.10% | |
| Mason General Hospital | 43.03% | 31.79% | |
| Mid-Valley Hospital | 72.62% | 47.63% | |
| Morton General Hospital | 83.89% | 54.67% | |
| Newport Community Hospital | 75.37% | 54.10% | |
| North Valley Hospital | 95.55% | 56.20% | |
| Ocean Beach Hospital | 107.28% | 54.89% | |
| Odessa Memorial Healthcare Center | 199.39% | 107.98% | |
| Othello Community Hospital | 61.12% | 42.59% | |
| PeaceHealth United General Medical Center | 38.77% | 29.01% | |
| Prosser Memorial Hospital Medical Center | 41.57% | 28.72% | |
| Providence Mount Carmel Hospital | 65.10% | 40.53% | |
| Providence St. Joseph’s Hospital | 100.02% | 49.06% | |
| Pullman Regional Hospital | 78.76% | 44.73% | |
| Quincy Valley Medical Center | 433.39% | 74.33% | |
| Skyline Hospital | 84.51% | 73.16% | |
| Snoqualmie Valley Hospital | 85.63% | 80.87% | |
| St. Elizabeth Hospital | 26.46% | 17.63% | |
| Summit Pacific Medical Center | 54.43% | 36.62% | |
| Sunnyside Community Hospital | 33.16% | 21.44% | |
| Three Rivers Hospital | 102.36% | 73.57% | |
| Tri-State Memorial Hospital | 43.84% | 39.48% | |
| Whidbey General Hospital | 73.20% | 30.00% | |
| Whitman Hospital & Medical Center | 62.22% | 56.80% | |
| Willapa Harbor Hospital | 102.47% | 57.93% |
Let’s ask Shane McGuire on the 17th, but don’t expect an easy route out of the rabbit hole.
Don
7 November 2022
Rural Hospitals. Essential. Viable?
It is commonplace that rural hospitals are important. Common, that is, until it is your father has a cardiac arrest at the Thanksgiving table, your wife wakes up in the middle of the night gasping for air, or your son catches his hand in the baler’s power take-off, working alone on the other side of the farm. Then your local hospital becomes essential.
Will your hospital be there for the next curve life throws at your family?
Is your rural hospital viable? The cost structure is simple enough: physicians, nurses, support staff, supplies…the lights. That is where the simplicity stops. What is the denominator? A rural hospital does not know from day to day who is going to present as an outpatient, inpatient.
The bigger complication is payment for services. What do you get paid for a patient? And who decides?
Join Shane McGuire, CEO of Columbia County Health System (Dayton), to get a feel for the ins and outs of managing a rural hospital.
Don
29 October 2022
Legacy News
The Lower Snake River dam system moves grain from the Palouse and the Camas Prairie to Portland. Replacing this capacity is a difficult issue. Solutionary Rail, an advocacy group, has done an exceptional job of mapping rail alternatives to the barges.
Watch the slide show.
Read the Introduction pages 1-9
The Odessa Groundwater Replacement Project is widening irrigation mainlines to deliver increased quantities of Columbia River water to replace the groundwater extraction from the Odessa aquifer. A problem, though, is finding funds to replace the existing bridges.
The Methow Valley continues to attract population growth.
One of ARC's longest standing issue is the wolf-cattle issue in northeast Washington. It does not stop. The 9th Circuit takes up wolf management
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