Advising health care organizations dedicated to better outcomes and more affordable, equitable systems for financing and providing care
More #Medicaid hospital provider taxes and state directed payments to hospitals are coming, confirming my concern that CMS has let this get way out of hand. #Delaware (my home state), one of the few states that doesn't yet have a hospital tax, is enacting legislation (SB 13) to levy a 3.58% tax on acute care hospitals. #NorthCarolina, which raised its hospital provider tax last year to near 6% and now pays hospitals commercial level rates, is considering a bill that would extend the tax to psychiatric hospitals. It seems like a no-brainer--"free" federal matching dollars--but it inflates hospital and health system costs, feeds bloated bureaucracies and increases market power. Worst of all, it overpays hospitals relative to other more important Medicaid services, reinforcing inequities and leaving primary care and community long-term care and behavioral health underfunded and communities underserved. It's a kind of re-institutionalization, with facility-based services favored over community-based ones. In fact, the increase in hospital reimbursements financed by the tax will be paid on a per diem basis--the antithesis of value-based payment. Physicians employed by Christiana Care, Delaware's dominant health system, are seeking to form a union. Christiana Care has acquired or hired many of Delaware's physicians and other clinicians and seems to have bought up all the urgent care. It calls the shots and its working conditions and culture are apparently not good. It ranks quite low in The Leapfrog Group quality ratings. The DE hospital provider tax legislation calls for "72% of the federal funds raised by the tax to be used to increase payments to hospitals." If health care workers want a raise, they have to go where all the money goes. If they want real change, they (along with DE patients and employers) will need to go to Delaware's elected officials. Christiana Care has been expanding outside of Delaware in recent years, and the legislature is writing them checks to finance it. At the same time, DE is not welcoming new providers, care models or physician practices that could offer competitive alternatives to hospital system care. Strict licensure, CON laws, and a natural tendency to favor home grown entities hold DE back and fuel price increases. Delaware leaders have been grappling with high health care costs (well above national averages), driven by hospital costs. I worry they are throwing in the towel. Christiana Care generates 56% of the revenue that would be subject to the provider tax. My rough estimate (thank you NASHP | National Academy for State Health Policy) is the tax could draw down well over $260 million in federal funds and most of it will, of course, go to the dominant health system. #consolidation https://lnkd.in/eab5m4cG Chris Deacon Claire Brockbank Ge Bai Hannah Edelman Leah Binder Amy Abdnor Farzad Mostashari Sean Cavanaugh Joshua Gordon Brian Miller Steven Costantino Chris Koller
Healthcare System Design/Political strategist
1moThe inability of CMS to address the problems of an FFS profit driven system has been going on for decades. Too many blinders on. Meanwhile, rural healthcare is vanishing, the costs have grown, and the outcomes are horrible. It's the systems level that's the problem, and bribing health systems to do what they should be doing only exacerbates the problems. I would like to welcome Medicine to the problems nurses have been dealing with, again, for decades.