Showing posts with label medicaid. Show all posts
Showing posts with label medicaid. Show all posts

Wednesday, July 12, 2017

Crippling Medicaid Cuts Could Upend Rural Health Services in Georgia


When her pregnancy hit a crisis, Ginger Peebles rushed to her hospital in Swainsboro, Ga., where daughter Brenlee Pepin was born healthy. But that hospital closed a year later, a casualty of the financial problems plaguing rural areas. (Family photo courtesy of Kimberly Howell)
ATLANTA — Each day as Ginger Peebles watches daughter Brenlee grow, she sees the importance of having a hospital close by that delivers babies.
Brenlee’s birth was touch-and-go after Peebles realized something was wrong. “I couldn’t feel the baby move, and my blood pressure was sky-high,” said Peebles, a nurse.
Dr. Roslyn Banks-Jackson, then an OB-GYN specialist at Emanuel Medical Center in Swainsboro, Ga., diagnosed preeclampsia, a potentially lethal complication of pregnancy, and induced labor to save Peebles and the baby. Brenlee was born on Oct. 28, 2014, completely healthy.
Had Peebles given birth the following year, she might not have been so fortunate, she said. Emanuel shuttered its labor-and-delivery unit the next spring, becoming one of a handful of such units in the state to close from 2010 to 2015, most because of budget problems. Another is expected to close this month, said Daniel Thompson, executive director of the Georgia OBGyn Society.Republican bills to replace the federal health law would worsen rural areas’ financial straits through reductions in Medicaid funding. Patient advocates predict that would lead to fewer enrollees, more shutdowns of rural facilities, reduced payments to doctors and fewer programs for people with health needs or disabilities. In the aggregate, such changes threaten the health of thousands of state residents, especially those in rural areas.
“I’ve seen changes, and I’ve seen cuts, but I’ve never seen changes like what’s being proposed in this bill,” said Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities. “This is the first time it’s been this scary.”
Possible Strains On A Lean Budget
One of the key aims of the House and Senate bills is reversing the Affordable Care Act’s expansion of Medicaid. But the legislation also would institute changes to the federal-state health program for low-income residents that could devastate states such as Georgia that didn’t expand Medicaid. Georgia already ranks 45th in the nation in per capita Medicaid spending, according to the Georgia Budget and Policy Institute.
The bills would switch Medicaid from an entitlement — in which the federal government agrees to pay its share of costs for anyone who qualifies for the program — to a system in which the federal government by 2020 would limit its payments and reimburse states based on a per capita formula.
The nonpartisan Congressional Budget Office concluded in a report released June 29 that the Senate plan would slash 35 percent of expected federal Medicaid funding by 2036.
“Cuts now would cripple rural Georgia,” said Dr. Ben Spitalnick, president of the Georgia chapter of the American Academy of Pediatrics.
He said that is because most primary care visits, which include OB-GYN, pediatric and adult care, in the state’s sparsely populated areas rely heavily on Medicaid reimbursements.
The federal cutbacks would have to be offset by the state. But that means taking money from other programs or raising taxes. As a result, state officials facing those shortfalls would likely scale back an already lean Medicaid coverage.
“If you cut back, [people] still go to the hospital, they’ll still need care. No matter what you do, the buck stops somewhere,” said Renee Unterman, a Republican state senator who chairs the health and human services committee. In the end, she added, the cost for that uncompensated care gets passed to taxpayers and consumers through higher health costs and insurance premiums.
Georgia’s rural hospitals have proved vulnerable. Five closed in the past five years and another two merged. Plus, several have closed their emergency rooms.
That translates to a loss of doctors in affected counties. Of Georgia’s 159 counties, 79 do not have an OB-GYN specialist, and 65 do not have a pediatrician, according to 2015 figures from the Georgia AAP and the Georgia OBGyn Society.
Close to 1.7 million Georgians, or nearly 1 in 5 state residents, live in these areas, according to figures from the Rural Health Information Hub.
Improving Pay For Doctors
For 15 years, Georgia Medicaid reimbursed primary care doctors at only 60 percent of the amount that the federal Medicare program reimbursed similar services, said Ward.
But in 2015, the Legislature implemented three rounds of pay increases to primary care doctors, including pediatricians and OB-GYNs, to bring them in line with the Medicare reimbursement.
Many of these doctors are now concerned those rates would be the first to be lowered. “That’s our big fear,” said Rick Ward, executive director of the Georgia chapter of the AAP. “We just clawed our way back and to deal with it again would just be unbelievable.”
Key among those concerns are prenatal care in rural areas. With a maternal mortality rate that is among the worst in the country, OB-GYNs are worried that the cuts would eliminate fragile solutions to doctor shortages that the state has implemented.
For example, pregnant, low-income women in 17 counties around Augusta can arrange for a ride in a van, paid for by Medicaid, for their prenatal visits at the medical school at Augusta University. The service has been vital in keeping these women healthy and insuring successful births. Advocates fear it is the type of program that could face problems if Medicaid funding becomes tight.
People With Disabilities Fearful
Advocates for residents with disabilities worry that home health care would be likely to suffer from the cuts.
That’s because while states are required under Medicaid to pay for nursing home stays, care for people living at home has been optional.
About 38,000 people in the state get the services, also called community-based benefits. Qualifying takes years, and benefits are not guaranteed, even for people who are eligible. Almost 10,000 Georgians are on the waiting list, according to Jacobson, because there is not enough money in the Medicaid budget to cover everyone.
One of those who is getting coverage is Joshua Williams, 22, who has severe cerebral palsy and needs constant care at home and school.
“I’m terrified” that funding cuts could end the program, said his mother, Mitzi Proffitt, 53. “I’d have to quit my job” to take care of him. Williams’ stepfather, Jack Proffitt, 65, has advanced cancer and cannot provide much assistance.Nursing home or institutional care for a year, on average, is $172,280, said Jacobson, while the average home health care is $28,901.
Williams, who is on the dean’s list at East Georgia State College in Swainsboro and loves NASCAR, also admits to being “very scared.” He said if his coverage is discontinued, he would have to drop out of college, ruining his hopes of becoming a sports broadcaster. He is eager to get a part-time job until he graduates.
“I want to work. I don’t want handouts,” he said.
A supporter of President Donald Trump’s, Williams said he is counting on the president to keep disability benefits in place and to ensure that health care is affordable for all.
“He thinks that if Trump knew his story, he’d get on this and fix things,” said Mitzi Proffitt.
“I like him because he’s a businessman, but he said he has heart,” Williams added.
Joshua Williams, who receives home health care services through Medicaid, is worried about funding changes being considered by Congress. But he is counting on President Donald Trump to keep disability benefits in place because “he said he has heart.” (Photo by Virginia Anderson/KHN)

This story was originally published by Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Tuesday, September 13, 2016

Georgia's uninsured rate drops but remains among the highest in the nation

While the number of Georgia residents without health insurance declined last year, Georgia remains one of only five states with uninsured rates above 12.0 percent.

States with Highest Uninsured Rates: 2015
In 2015, 13.9 percent of the state’s population was uninsured, which translated to more than 1.3 million residents.

“All Georgians and Georgia businesses are affected by this uninsured burden through higher health insurance premiums and the corresponding cost shift on employer-sponsored health insurance,’’ in a statement attributed to Earl Rogers, who serves as president of the Georgia Hospital Association.

Nationally, the uninsured rate is 9.4 percent with Massachusetts recording the lowest uninsured rate at 2.8 percent, as measured by the American Community Survey (ACS), according to a new report from the Census Bureau.

If there was any good news in the report, the percentage of uninsured Georgians has decreased over the past years. In 2013, 18.8 percent of Georgians were uninsured, and in 2014, that number dropped to 15.8 percent.

The drop can be attributed to more individuals receiving insurance through under the Affordable Care Act, and an aging population of people 65 and older who fall under the provisions of Medicare, the government’s other major health insurance program.

State continues to resist Medicaid expansion

Georgia remains one of 19 states that have chosen not to expand Medicaid to low-income families, although the federal government has promised to pick up all of the costs of Medicaid expansion.

The failure to insure the population is putting strains on hospitals in Georgia, especially in rural areas, where emergency rooms are required to treat patients regardless of their ability to pay.

Without any form of health insurance, increasing numbers of residents are also finding their way to emergency rooms for non-emergencies, such as the flu, and then are unable to pay their bills.

The lack of an insured population also hurts employers. Employers not providing health insurance must put up with sick employees at their establishments who cannot afford to miss work or seek medical assistance.

Employers who do provide health insurance pay higher premiums to subsidize the losses suffered by hospitals that are required to treat uninsured patients.

When hospitals are unable to collect payments from patients, they then have to increase charges to other paying patients to make up for the losses suffered from uninsured patients. That results in higher health care costs to insurers and higher premiums to those with health insurance.

Georgia Chamber of Commerce prepares options to cover the uninsured

 Some Georgia state legislators, as well as the Georgia Chamber of Commerce, are re-thinking their opposition to Medicaid expansion as more hospitals in the state struggle to stay open. Since 2013, five hospitals in Georgia have closed and many more are having financial difficulties, especially in rural parts of the state.

The health care task force, created by the Georgia Chamber of Commerce, has developed options that they will bring next year to the Georgia General Assembly.

All three options include a requirement that individuals receiving health insurance must pay at least part of the premium costs, and all three options would require a waiver from the federal government because they differ from the standard Medicaid expansion.

Chris Clark, president and CEO of the Georgia Chamber of Commerce, said in a statement that “any of these plans would serve as a game-ready playbook for lawmakers seeking a fiscally responsible and sustainable path to cover Georgia’s uninsured, revitalize a rural health care network in crisis and undergird our safety net hospitals. That’s important not just to the health of our families but also to the health of our economy, because no good jobs are going to come to a region that lacks access to quality health care.”

More information about the Chamber's work regarding health care in Georgia is available here.

Monday, September 7, 2015

Whistleblower allegations leads to Columbus Regional paying $35 million settlement

A whistleblower's allegations of fraud by Columbus Regional Health has led the healthcare corporation agreeing to pay $35 million to settle fraud claims brought by the federal and Georgia government. 

Columbus Regional Healthcare System, John B. Amos Cancer Center, Columbus Radiation Oncology Center, Regional Oncology LLC, and Dr. Andrew W. Pippas are all defendants in the court case. Richard Barker was the whistleblower who brought the fraud allegations to the governments' attention.

In the agreement filed in U.S. District Court for the Middle District of Georgia, the defendants will pay $25 million and up to a maximum of $35 million to settle claims under the False Claims Act.

Richard Barker, as the whistleblower in the case, will receive 15% of the initial $10 million settlement with additional payments still to be negotiated between the governments and Mr. Barker.

The government alleged that the health care institutions falsely billed fees higher than were supported by documentation in the patients’ medical records between May 2006 and May 2013. Submission of claims to Medicare, Medicaid, Federal Employees Health Benefits Program (FEHB), and TRICARE for Intensity-Modulated Radiation Therapy (IMRT) treatments did not qualify to be billed as IMRT during the period from July 15, 2010 through 2012. In addition, the government claims that CRHS made improper salary and medical directorship payments to Dr. Pippas resulting in improper claims to Medicaid and Medicare for reimbursement between 2003 and 2013.

The initial $10 million will be paid immediately with an additional $15 million plus interest to be paid over five years. In addition, the defendants have agreed to pay 1.5% of all annual net patient revenues that exceed $445 million between fiscal years 2016 through 2020.  The defendants will also pay all annual earnings that exceed $3.3 million from the joint venture of TMC with HealthSouth Corporation known as the Rehabilitation Hospital of Phenix City LLC. Total recovery shall not exceed $35 million.

In making these payments, the defendants did not admit any liability.

Columbus Regional Health describes itself as established in 1986 as a not-for-profit health services organization with roots going back to 1836. It refers to itself as "the region's health care leader offering compassionate care and an unwavering commitment to the residents of the region."

Case 4:12-cv-00108-CDL Document 112 Filed 09/04/15