Jon Swiatkowski, CFO at Erie County Medical Heart in Buffalo, N.Y., believes policymakers must create a extra equitable reimbursement methodology.
“The issue is that our most weak neighborhood members, our Medicaid sufferers, are underinsured,” he stated. “That has created this two-tiered system the place the identical care offered to Medicaid sufferers that’s offered to Medicare or industrial sufferers is paid at a considerably decrease fee than Medicare or industrial payers pay.”
With 38% of its sufferers on Medicaid, Erie County Medical Heart sometimes operates at or round break-even. “We imagine that if you lead with high quality, the funds will comply with, nevertheless it’s been very difficult,” Swiatkowski stated.
In 2020, the 573-bed hospital needed to minimize its capital funds in half and lay off 70 workers member to assist cowl Medicaid and COVID-19-related losses.
Swiatkowski is worried that future Medicaid fee cuts might imply eliminating wanted applications. As an example, Erie County Medical Heart is among the solely dental suppliers for Medicaid enrollees within the space.
“Additional cuts might jeopardize a majority of these applications each right here and nationally, and it is going to be troublesome for us to face up new providers that the neighborhood needs, akin to a behavioral well being intensive outpatient service,” Swiatkowski stated.
In the meantime, with 43% of its sufferers on Medicaid, College Medical Heart of Southern Nevada, a public educational medical middle in Las Vegas, additionally struggles to cowl reimbursement shortfalls.
“Previous to COVID, we’ve been advocating to have Medicaid charges assist cowl the true prices of operating a hospital,” stated CEO Mason Van Houweling, who can also be vice chair of the Nevada Hospital Affiliation. “If you have a look at Medicaid reimbursement in Nevada in comparison with the price of delivering care, it solely covers about 71% of our prices. So it turns into very troublesome when 43% of your enterprise just isn’t absolutely coated on true prices.”
Suppliers’ advocacy work paid off when Nevada issued a 2.5% Medicaid improve for medical-surgical providers in December 2019, which raised UMC’s $1,500 per day cost to $1,538.
However then COVID hit, devastating Nevada’s tourism-dependent economic system. The state had a 9.2% unemployment fee in December, second-highest within the nation after Hawaii.
In consequence, Nevada instituted a 6% across-the-board Medicaid fee discount, efficient Aug. 15, 2020, lowering UMC’s medical-surgical cost to $1,410 per day. In January, the governor launched a proposed two-year funds that reverses the 6% Medicaid cuts; nevertheless, at deadline, it’s unknown how the ultimate funds will play out.
“It wouldn’t shock us if there are extra cuts on the horizon because the state is confronted with balancing the funds,” Van Houweling stated. “We definitely don’t envy the job that the state and governor are confronted with.”