But since President Obama would veto such changes, the GOP program is almost entirely to please the right-wing of the very conservative party. Because of gerrymandering of congressional districts, members of the House GOP tend to be more conservative than Republican senators.
It is unclear how all this will play in next year’s presidential election campaign.
Reuters reports that federal government ”will roll back a widely criticized approach to public health, in which the ‘lost pleasure’ people might suffer if they quit smoking or chose to eat healthier foods was used to reduce the projected benefits of new regulations.”
U.S. Food and Drug Administration economists incorporated lost-pleasure calculations last year “in analyzing proposed rules for e-cigarettes and the posting of calorie counts on restaurant menus. The agency said the analysis provided a more accurate picture of the estimated benefits of a regulation.”
But public-health advocates, legislators and other economists criticized the agency’s approach, asserting that it was applied incorrectly and “sharply undercut the projected benefits of regulations meant to improve public health. Some feared it would weaken the government’s ability to defend such rules in court,” Reuters reported.
The original Cleveland Clinic Building, put up in 1921.
While it has traditionally relied on its internationally known ability to provide high-priced specialty care, the system, “along with every stand-alone community hospital and large academic medical center, is being forced to remake itself,” The New York Times reports. “Patients are increasingly seeking care outside the hospital — in a family health center, a doctor’s office, a drugstore or at home. Medicare and other insurers are moving away from volume-based payments to new models, to pay less for better care.”
The New York Times reports that “to avoid becoming marginalized in an environment where insurers are looking to health systems that can manage all of a patient’s medical needs, the clinic — long known for treating the ‘sickest of the sick’ — is trying to become as good at primary care and treating chronic disease {including for poor communities} as it is at performing complicated heart valve repairs. ”
But “the clinic has been slow to experiment with some new payment models like a Medicare program for so-called Accountable Care Organizations, which offer systems a share of the savings if they can keep costs low while meeting assorted quality goals. The models seek to push health systems to become better at caring for large groups of people who have a wide variety of medical needs.”
“We’re so far behind that we can be ahead,” said Ann Huston, Cleveland Clinic’s chief strategy officer, told The Times.
The peacock flounder changes its appearance to avoid predators.
For a JAMA Internal Medicine study, researchers Alex John London, of Carnegie Mellon University, and Yael Schenker, of the University of Pittsburgh, studied online ads for transaortic valve replacement, or TAVR, a minimally invasive procedure to treat the narrowing of the aortic valve common in older adults, particularly men.
The study reviewed the online ads of all 317 U.S. hospitals that offer TAVR and found that all of them cited the procedure’s benefits — but only a quarter said that it had any risk, which of course it does. Further, fewer than 5 percent of the hospitals quantified the risks so that the average consumer could make intelligent decisions.
And basically promotional material is camouflaged using graphs, diagrams, statistics and physician testimonials to look like a rigorous and scientific presentation.
Tighter restrictions needed on these ads?
It refers to studies of 15 primary-care and multi-specialty centers that “improved their operational and/or patient-care outcomes by investing in” additional medical-assistant training.
“These advanced MAs added significant value to care teams and, through career ladders, bonus pay, and other methods, received higher compensation in return. In some cases, these improvements were quite dramatic.”
Forget your anxiety about the Medicare-SGR formula for a minute, Consider the 10 percent Medicare cut to primary-care physicians that would take effect next Jan. 1 unless Congress acts.
Bob Doherty, a vice president of the American College of Physicians, notes that if Congress lets Medicare primary-care payments be cut on Jan. 1, it would be the second straight year when such payments to primary-care physicians — and only those physicians — would be cut by double-digits.
“Medicaid payments to primary-care doctors were cut in most states by an average of 40 percent at the start of this year because Congress failed to reauthorize a federally funded program, called the Medicaid Primary Care Pay Parity program that, in 2013 and 2014, raised Medicaid payments for office visits, vaccines, and other primary care services to no less than the applicable Medicare rates.”
Because the elderly vote at much higher levels than do poor people, Medicaid tends to get much harder hit than Medicare in funding cuts.
Mr. Doherty notes that “Republicans wouldn’t sign on {to continuing the primary-care incentives} were varied, but were mostly due to the fact that since Medicaid Primary Care Pay Parity was created by Obamacare, which they loathe and vowed to repeal, they couldn’t see their way to supporting a program created by it. Plus because many of them believe the Medicaid program is fundamentally flawed, they couldn’t see putting federal dollars to prop up its reimbursements to primary-care physicians.”
By GUY GUGLIOTTA, for Kaiser Health News
MOUNT VERNON, Texas
Despite residents’ concerns and a continuing need for services, the 25-bed hospital that served this small East Texas town for more than 25 years closed its doors at the end of 2014, joining the ranks of dozens of other small rural hospitals that have been unable to weather the punishment of a changing national healthcare environment.
For the high percentages of elderly and uninsured patients who live in rural areas, closures mean longer trips for treatment and uncertainty during times of crisis. “I came to the emergency room when I had panic attacks,” said George Taylor, 60, a retired federal government employee. “It was very soothing and the staff was great. I can’t imagine Mount Vernon without a hospital.”
The Kansas-based National Rural Health Association, which represents around 2,000 small hospitals throughout the country and other rural care providers, says that 48 rural hospitals have closed since 2010, the majority in Southern states, and 283 others are in trouble. In Texas along, 10 have changed.
“If there was one particular policy causing the trouble, it would be easy to understand,” said health economist Mark Holmes, from the University of North Carolina, whose rural health research program studies national trends in rural healthcare. “But there are a lot of things going on.”
Experts and practitioners cite declining federal reimbursements for hospitals under the Affordable Care Act as the principal reason for the recent closures. Besides cutting back on Medicare, the law reduced payments to hospitals for the uninsured, a decision based on the assumption that states would expand their Medicaid programs. However, almost two dozen states have refused to do so. In addition, other Medicare cuts caused by a budget disagreement in Congress have also hurt hospitals’ bottom lines.
But rural hospitals also suffer from multiple endemic disadvantages that drive down profit margins and make it virtually impossible to achieve economies of scale.
These include declining populations; disproportionate numbers of elderly and uninsured patients; the frequent need to pay doctors better than top dollar to get them to work in the hinterlands; the cost of expensive equipment that is necessary but frequently underused; the inability to provide lucrative specialty services and treatments; and an emphasis on emergency and urgent care, chronic money-losers.
‘Another Disaster’
Rural healthcare experts caution that national and state officials need to address the problems for rural hospitals or they could face a repeat of the catastrophic closings that followed changes in the Medicare payment system 30 years ago. That 1983 change, called the “prospective payment system,” established fixed reimbursements for care instead of payments based on a hospital’s reported costs. That change rewarded large, efficient providers, but 440 small hospitals closed before the system was adjusted in 1997 to help them. Those adjustments created the designation of critical-access hospitals for some small, isolated facilities, which are exempted from the fixed payment system.
“And now, beginning in 2010, we’ve had another series of cuts that are all combining to create another expansion of closures just like we saw in the ‘90s,” said Brock Slabach, senior vice president of the Rural Health Association. “We don’t want to wake up with another disaster.”
The current surge in closures means federal officials need to come up with new legislation to halt the recent cuts to small hospitals in order to “buy time” to figure out how rural hospitals should effectively operate in the future, said the association’s chief lobbyist, Maggie Elehwany. “It is important to stop the bleeding right now.”
In Mount Vernon, a town of 2,678 people nestled in grassland and dairy country about two hours east of Dallas, family practitioner Jean Latortue has taken out a lease on the now-vacant hospital building to convert it into an outpatient and urgent care clinic at his own expense. Reopening may be a risky move, he acknowledged, but the need is there.
“The community went into panic mode,” he said. “I figured I had to step up.”
The non-profit ETMC Regional Healthcare System, based in Tyler, Texas, closed the Mount Vernon hospital and two others of its then-12 rural hospital affiliates because it could no longer sustain operating losses that had persisted for five years.
“There was no ill will,” Franklin County Judge Scott Lee said in an interview from his Mount Vernon office. “They were losing money. We had a good working relationship for years, and they had a business decision to make.”
Mount Vernon’s Issues
Perry Henderson, senior vice president of affiliate hospitals for ETMC, a major healthcare provider in East Texas, noted that rural hospitals have many uninsured patients, and Medicare accounts for “60 to 70 percent of the business,” while in “Dallas or Houston it’s a fraction of that.”
Mount Vernon, with lakefront properties that are attractive to retirees, has its share of elderly patients. Henderson also noted that many rural hospitals also have to deal with large numbers of agricultural accidents. Farming, another Mount Vernon staple, is one of the country’s most dangerous occupations. Finally, he added, country roads bring many traffic accidents. When there’s no hospital, emergencies mean longer trips to get help.
Henderson and other experts cite three reasons for the rash of closures nationally. Sequestration, the across-the-board federal budget cut that arose out of the legislative impasse between the Obama administration and congressional Republicans, has resulted in a 2 percent reduction in Medicare reimbursements since 2013.
“If Medicare is 50 percent of your revenue and you lose two points,” North Carolina’s Holmes said, “it can be a killer.”
Rural hospitals took a second hit from the federal health law’s reductions in “disproportionate share hospital” payments to hospitals with large numbers of indigent and uninsured patients. Federal officials made the cuts assuming that the law would assure that more patients had insurance.
It hasn’t worked well in rural areas, the Rural Health Association’s Elehwany said, because annual deductibles for the new insurance plans, which come out of consumers’ pockets, “are running between $2,500 and $5,000,” and people can’t pay them.
And in communities such as Mount Vernon, this problem is exacerbated because Texas, along with 22 other states, has refused to expand Medicaid, a key provision of the Affordable Care Act.
“That’s a big deal,” ETMC’s Henderson said. “That’s when we had the hurt.”
Latortue, who came to Mount Vernon as an ETMC hospital doctor in 2008, appears undaunted by the challenges of reinventing the hospital, which was treating an average of eight inpatients a week when it closed. Still, he said, “I’m very busy, and patients need to be seen—we’ll be all right.”
He intends to provide both outpatient services, including lab work, at the new clinic, and emergency care, stabilizing patients until they can be transferred to the Titus Regional Medical Center, in Mt. Pleasant, 16 miles away, or to a smaller facility in Winfield, eight miles away. He also plans a wellness clinic to treat obesity and will offer Botox and laser cosmetic services. A cardiologist and a gastroenterologist will make weekly visits, and he is also looking for an ob-gyn.
Latortue got a favorable lease from the town of Mount Vernon and inherited an X-ray machine and other equipment from ETMC, but he still took out $150,000 in loans for remodeling and needs another $60,000 to $70,000 for equipment.
Still, none of this will replace the hospital, and his patients know it. “I live right behind the building,” said Mary Hunter, a very fit grandmother of 73. “I’ve had very good health until my blood pressure spiked last week,” she said. “We retired in 2006 and moved here, partly because of the hospital. And now it’s gone.”
“A nurse practitioner, medical assistant and other staff from NFP will provide primary care to children at the school one morning per week, bringing to 12 the number of Cleveland schools that now provide the service,” the Cleveland Plain Dealer reported.
The Cleveland Clinic had already launched a school-based mobile health unit, which began serving inner-ring suburbs in December.
The Plain Dealer reported that the NFP program ”will also be run out of a mobile unit — the city of Cleveland is providing its MomsFirst mobile unit to NFP for the clinic for a nominal fee — though the health center is looking for permanent space at the school. NFP plans to offer a second clinic to students” next fall.
“With parent or guardian consent, kids at schools served by the mobile clinics can receive primary and preventive healthcare — services like vaccinations, well-child visits, help managing medications for conditions such as asthma and diabetes, and referrals to other services.”
