No system invented by humankind is perfect. However, some systems work better than others.
Monday is Feb. 29 because 2016 is a leap year. Unless you celebrate a birthday on Monday, the fact that there is an extra day every four years isn’t really a problem.
Adopted initially by the Catholic Church in 1582, the Gregorian calendar has stood the test of time. Leap years are just a quirk of the system that we otherwise credit with doing a good job of organizing time.
Not all systems hold up that well. For example, our nation’s health insurance system is arguably less than perfect. Some would argue that it’s a mess.
Earlier this week, Bloomberg carried a story about the bad debt costs that are weighing heavily on the nation’s hospitals. As it turns out — and this isn’t a surprise — health insurance is only as good as enrollees’ ability to access the plans’ benefits.
Two weeks ago we released the annual Community Investment Report for Missouri hospitals. Same story. Bad debt continues to grow in Missouri increasing to more than $593 million in 2014.
Part of the problem is the proliferation of high deductible health insurance plans. The Bloomberg article cites patients’ lack of ability to fund deductibles, as well as patients dropping plans, as key drivers in the increase of bad debt. That’s a trend we’ve been seeing for years. However, with the expansion of access to commercial insurance through the marketplace created by the Affordable Care Act, a much larger segment of the insured population has low premium, high deductible coverage. It’s been called the “Bronzing of America,” a reference to the lowest cost “medal plan” that is now being offered on the health insurance exchanges. And, for many lower-middle and working class Missourians, the deductibles in these plans are out of reach.
Earlier this month, with the help of hospitals throughout the state, we were able to stop the progress of a bill that would have allowed some insurers to increase plan co-payments to more than 50 percent of the cost of a service. As with any issue before the General Assembly, nothing is certain until the final gavel. However, we’ll continue to fight legislation that prices Missourians out of access to coverage.
There’s significant evidence that cost influences health care decisions. Delaying care because of a high deductible can lead to higher costs, and poorer outcomes in the long term.
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Speaking of messes, last year federal policymakers resolved the annual Sustainable Growth Rate-driven Medicare physician pay crisis through the Medicare Access and CHIP Reauthorization Act. The new program creates two incentive structures for physicians designed to improve quality and accountability.
As the number of hospital-employed physicians grows, physician pay systems are having a greater impact on hospitals’ financials. Moreover, how these systems integrate with hospital performance and quality systems will influence both physicians’ and hospital organizations’ success.
Tuesday, March 1, MHA is offering a webinar, “After the SGR: Learn the Basics of MACRA.” Each MHA-member hospital can receive a complementary registration if confirmation is received by Monday, Feb. 29.
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When a system is broken, it’s appropriate to work to fix it. However, it’s important that the “fix” works better than the system it’s replacing.
Not every problem in health care can be solved by giving patients more financial “skin in the game.” In fact, that approach can harm the system more than help it in some cases.
It’s too early to know how the SGR replacement will work. However, it’s hard to imagine a system that would cause as many problems as the SGR — especially because the MACRA promises better alignment of provider pay and incentives.
Nonetheless, if your birthday happens to be Monday, you may have a legitimate gripe with the Gregorian calendar. There’s the present need for a leap year, and the fact that a day will need to be dropped in about 3,000 years. Those are fair points. But, it’s a system that works, despite these problems.
And, there’s good news for the leap year babies. Unlike the rest of us, they reach Medicare eligibility by their 17th birthday!
Have a good weekend. Email me with your thoughts.
Herb B. Kuhn
MHA President and CEO
In This Issue
MHA Requests Hospitals Contact Lawmakers Regarding Prescription Monitoring Bill
Hospital Construction Regulatory Relief Legislation Advances To House Floor
CMS Issues Program Integrity Enhancements Proposed Rule For Provider Enrollment Process
WPS Denying Claims In Error Due To LCD Edits
TJC Updates Specifications Manual