A recent New Hampshire Public Radio (NHPR) story by reporter Jack Rodolico, "Lack of Transparency Leaves Some Medicare Patients in Dark at Half of N.H.'s Hospitals," was picked up by a local writer to the editor of the Laconia Daily Sun. As in the NHPR story, the author misses the mark on the value that New Hampshire's Critical Access Hospitals (CAHs) provide to the patients and communities they serve, and encourages unfortunately the spread of information that is inaccurate.
Quoting from a recent blog of the N.H. Hospital Association President Steve Ahnen . . ."(a)ll of New Hampshire's hospitals, including our 13 CAHs, take very seriously their responsibilities in sharing information with their patients about their hospital bills and the patient's portion of that bill. The story further misses the point by implying that CAHs get reimbursed anything more than the actual cost of care. They do not. The final payment received by a CAH is a reflection of their allowable costs that are paid by Medicare and the beneficiary. The story further implies that those Medicare beneficiaries without supplemental insurance don't get substantial financial assistance for what they can't afford. " (for the full blog, see http://www.nhha.org/index.php/blog/1157-nhpr-story-misses-the-mark-on-the-value-of-new-hampshire-s-critical-access-hospitals)
Here are five key points:
1. The financial difference to the patient cited in the letter and story is only for those who don't have secondary/supplemental insurance. Statewide that applies to about 26,000 people according to the NHPR story; that is out of an estimated 231,444 Medicare beneficiaries (http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/).
2. The reality is that most of those who can't afford secondary/supplemental insurance get help from hospitals, including CAHs, in the form of charitable care or they don't pay. Medicare patients who don't have secondary/supplemental insurance in actuality pay Franklin Regional Hospital $0.07 on a dollar of the charges, a figure we suspect is similar for most of N.H. CAHs.
3. By federal statute and via audit by the Federal Government, a CAH's reimbursement is limited to cost; CAHs can't, and don't, inflate billing to get more than their actual cost.
4. A patient might wrongly infer from the billing accusations that they should avoid seeking care from a CAH. If people delay or avoid treatment, it can have greater costs to themselves and society in the form of greater illness, injury or even shorter lifespan.
In the Federal Government's budget, the funds spent on the CAH program are minimal, compared to the overall Medicare budget, but the benefits to rural communities are substantial by ensuring access to high quality of care for their residents.
No comprehensive research has been has been done to date that would support the potential savings to the government of eliminating the CAH program without negatively impacting our rural communities. The CAH program has ensured continued necessary hospital-level services to rural communities throughout the country and it is a program that should be maintained into the future.
5. Franklin Regional Hospital and Lakes Region General Hospital have a staff member dedicated to provide written price estimates for services that we will guarantee within a narrow range. Moreover, we have multiple staff to help patients obtain financial assistance readily for those patients who need help with covering the cost of their care.
In closing, we as a community (quoting from the N.H. Hospital Association's President Steve Ahnen's blog post) ". . . can't expect rural access without the real cost of care coming from a combination of payment from Medicare and beneficiaries. The allocation between the two is the real public policy issue." And we welcome the opportunity to find solutions that address concerns of patients and that protect access to care in our rural communities.
Moreover, we would submit that for our regions' Medicare beneficiaries, assuring and preserving that the right care at the right time and the right place is available is the more substantive issue to the vast majority of Medicare beneficiaries both in terms of their health and finances.
The community at large should also see the CAH program as an important source of economic development to attract businesses and industry to open or relocate to New Hampshire.
Please spread this important information!
(Henry D. Lipman is chair of the New Hampshire Hospital Association and senior vice president for Financial Strategy and External Relations at LRGHealthcare in Laconia; Andy Patterson is senior vice president of Provider Relations and Contracting and executive director of the Laconia Clinic.)
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