Nationwide, more than 110 rural hospitals have closed since 2010, with profound social, emotional and medical consequences for the communities they served, according to Kaiser Health News. In Fort Scott, Kansas, ambulances responded to more than 80 calls for service and drove more than 1,300 miles for patients to get care in other communities during an 18-day period when the local emergency department was closed. In addition to delaying treatment for patients needing emergency care, the travel time prevented the crews from serving local needs and caused expensive emergency vehicles to wear out faster. Increased reliance on air ambulances also causes problems for rural communities. Although they can transport patients quickly, the dispatch system is not coordinated in many states and regions across the country. Moreover, many air ambulance companies do not participate in insurance networks, which can costs patients tens of thousands of dollars.
Seattle’s City Council adopted the Sweetened Beverage Tax in June 2017 to improve the health of the city’s residents, and address persistent health and education inequities, reports The Seattle Times. Learnings to-date suggest that the tax is growing programs that increase healthy food access and support for child health and early learning. However, its impact on reducing sales of sugary beverages is currently unknown. Nevertheless, evaluations of similar taxes imposed in Berkeley and Philadelphia revealed that sales of taxed beverages dropped substantially — by 9.6% and 38%, respectively.
Poplar Bluff Regional Medical Center has filed more than 1,100 lawsuits for unpaid bills in a rural corner of Southeast Missouri, where emergency medical care has become a standoff between hospitals and patients who are both going broke, according to The Washington Post. Three nearby hospitals closed for financial reasons in the past few years, leaving Poplar Bluff Regional as the last full-service hospital to care for five rural counties, treating more than 50,000 patients each year. As a result, the hospitals’ uncompensated care costs have risen from about $60 million to $84 million. Community residents are similarly at-risk of financial ruin. Over 35 percent have unpaid medical debt on their credit report, about double the national rate. The resulting lawsuits have become so routine that some people derisively refer to it as the “follow-up appointment.”
California is facing a growing shortage of primary care physicians, one that is already afflicting rural areas and low-income inner city areas, according to Cal Matters. By 2030, the state could be short as many as 10,000 primary care professionals, including nurse practitioners and physician assistants. Some areas — the Central Valley, Central Coast and Southern Border region — will be hit especially hard. So too will be remote rural and inner-city residents, communities of color, the elderly, people with mental illness or addiction and those without health coverage. This could result in longer wait times and travel distances for doctor visits and a reduction in preventative care and care for chronic conditions until emergency treatment is necessary.
California’s 2017 law addressing surprise medical billing for out-of-network (OON) non-emergency physician services at in-network hospitals is effectively protecting patients from surprise medical bills, according to a study in The American Journal of Managed Care. However, the law is also exacerbating provider consolidation, as a result of increasing insurers’ bargaining power in their negotiations with physicians. Specifically, an OON payment standard set at payer-specific, local average negotiated rates give insurers leverage to lower or cancel contracts with rates higher than their average as a means of suppressing OON prices. California’s experience demonstrates that OON payment standards can influence the payer–provider bargaining landscape, affecting network breadth and negotiated rates.
Kansas has threatened to cancel insurer Aetna’s Medicaid contract if the company fails to resolve a number of long-running problems, reports KCUR. The state’s written complaint to Aetna in July stated that doctors and others struggle to secure provider credentials from the insurer, and that discrepancies in Aetna’s records mean Kansas can’t judge the adequacy of the company’s provider network for the state’s 100,000 Medicaid recipients. Additionally, providers say they sometimes don’t get paid because Aetna demands advance permission for certain basic procedures and complain that the company hasn’t put together a complete directory of physicians and specialists that it covers. Aetna has reported that it has fixed several issues and that many of the other problems “are well on their way to compliance.”
California hospitals provide significantly less free and discounted care to low-income patients since the Affordable Care Act (ACA) took effect, according to Kaiser Health News. As a proportion of their operating expenses, the state’s general acute-care hospitals spent less than half on charity care in 2017 than they did in 2013, with the biggest decline occurring from 2013 to 2015. Experts believe that the ACA is largely responsible for the drop in charity care spending – With fewer uninsured patients, fewer patients seek financial assistance through the charity care programs. Currently, the state and federal governments do not impose minimum requirements for charity care spending by hospitals, although the California Attorney General has created standards for a few nonprofit hospitals that have changed ownership in recent years.
Dozens of Oklahoma hospitals have filed more than 22,000 lawsuits against their former patients over unpaid medical bills since 2016, according to Oklahoma Watch. These billing practices highlight a heated debate in the medical community across the country. Consumer advocates argue that hospitals, especially those that are nonprofit, sue too often and should prioritize their moral obligation to their patients. Hospital officials say they already offer millions of dollars in charity care for those who meet certain income standards and that they only take legal action when necessary. In Oklahoma, larger hospitals or hospital systems sue more often, but some smaller hospitals may also go to court frequently. Patients sued are at a disadvantage in court because few people in these situations can afford a lawyer or know what steps to take.
Connecticut’s Office of Health Strategy launched a free online tool intended to help consumers, businesses and healthcare providers navigate the state’s vast system of care, reports The CT Mirror. The website’s two key elements – a quality scorecard and a cost estimator – will allow users to compare the quality and cost of medical care at 19 of the state’s healthcare organizations. Organizations are also evaluated on patient experience in four categories: office staff, provider communication, timely care and overall patient experience. In addition, users can compare the overall performance rating of provider networks against other networks across all quality measures. Connecticut is one of the first states to create a rating system that evaluates the performance of provider networks rather than individual providers.
Oklahoma’s legislature enacted HB 2351, entering the state into the Interstate Medical Licensure Compact (IMLC), effective November 1, 2019, reports The Oklahoman. The IMLC is an agreement among more than 25 states that allows qualified physicians to obtain expedited medical licenses in any compact-member state, reducing barriers to the provision of telemedicine services across state lines. This flexibility expands access to specialists for patients living in rural, frontier and other underserved areas.