Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Monday, July 28, 2014

Annual Kids Count report offers a wide range of information on child well-being in your community

The annual Kids Count report, with loads of county-level information on child well-being, was released last week by the Annie E. Casey Foundation. The report focuses on four main areas: economic well-being, education, health, and family, and also looks at national trends, comparing current data with trends since the first report was released in 1990. This year's report ranks Massachusetts, Iowa and Vermont as the top states for child well-being, with Nevada, New Mexico and Mississippi the three lowest ranked states. (Annie E. Casey Foundation map)

The report has a wealth of information about child well-being, with the four main areas broken up into four sub-sets, which look at the rate of children in poverty; children whose parents lack secure employment; children living in households with a high housing cost burden; teens not in school and not working; children not attending pre-school; fourth-graders not proficient in reading; eighth-graders not proficient in math; high school students not graduating on time; low-birthweight babies, children without health insurance; children and teen deaths per 100,000; teens who abuse alcohol or drugs; children in single-parent families; children in families where the household head lacks a high school diploma; children living in high-poverty areas; and teen births per 1,000.

The report has excellent information for local stories and we recommend checking it out. To read the report click here.

Deal reached on VA bill; includes relief for rural veterans who are far from a facility

House and Senate negotiators have reached a tentative agreement to deal with the long-term needs of the struggling Department of Veterans Affairs and are expected to unveil their proposal this afternoon, Ed O'Keefe reports for The Washington Post. Aides said negotiators "have 'made significant progress' on legislation to overhaul the VA and provide funding to hire more doctors, nurses and other health-care professionals."

There has been concern among veterans, especially those in rural areas, that they have had to travel long distances to receive care, or often wait months for an appointment, if they get one at all.

"According to a draft summary of the measure provided by House aides, Congress would give eligible military veterans a 'Veterans Choice Card' and allow them to seek health care outside the VA medical system from Medicare-eligible providers, other federally qualified health centers or facilities operated by the Defense Department or federal Indian Health Service centers," O'Keefe writes. "Veterans eligible to seek care outside the system would need to be enrolled by Aug. 1, or enroll for VA care within five years of ending their military service in Afghanistan and Iraq, according to the draft agreement. A veteran could leave the VA system if they’re unable to receive an appointment within 14 days — the current VA wait-time goal, or if they live more than 40 miles from a VA facility."

In response to complaints of long wait times to get an appointment, "new legislation would not allow scheduling and wait-time metrics to be used as factors in determining a worker’s performance," O'Keefe writes. "Instead, most performance reviews would focus on the quality of care received by veterans, according to the draft summary."

The compromise would authorize $5 billion for more employees, "require VA to enter into 27 leases for new major medical facilities; expand a scholarship program for the surviving spouses of service members who died during conflicts since the Sept. 11, 2001, terrorist attacks; and allow VA to provide counseling care and other services to veterans who suffered sexual trauma while in the ranks. Additionally, VA would be required to conduct regular audits on the accuracy of care and staffing levels at each major medical facility," O'Keefe writes.

Thursday, July 24, 2014

Older rural residents are more likely than younger ones to seek treatment at rural hospitals

Rural hospitals are more likely to serve older patients seeking hospitalization, while younger rural residents seek medical care in urban areas, says a study by the National Center for Health Statistics at the federal Centers for Disease Control.

"Rural hospitals primarily serve an aging, poorer population admitted for low-acuity care of chronic diseases, and so they likely want to remain close to their homes and their personal physicians," John Commins reports for HealthLeaders Media. "The younger rural hospital patients, who are more likely to have greater mobility and access to commercial health insurance, likely seek care in urban settings because rural hospitals often don't have the funding or patient populations to support specialists or a particular area of specialty care, such as cardiac or oncology."

The study found that 60 percent of the 6.1 million rural residents who were hospitalized in 2010 sought care in rural hospitals, while 40 percent went to urban ones. For patients over 65 years old, 51 percent were hospitalized in rural areas, with 53 percent using Medicaid as their principal source of payment, compared to 37 percent of patients over 65 going to urban hospitals, with 44 percent relying on Medicaid. Rural residents ages 45-64 made up 24 percent of those hospitalized in rural areas and 32 percent in urban areas. The study found no significant difference among patients under 45. (The disparity of where difference age groups seek hospitalization)
Rural residents hospitalized in an urban hospital were three times more likely to have three or more procedures than patients in rural hospitals, the study found. Only 38 percent of patients in rural hospitals received a non-surgical procedure, compared to 74 percent of rural patients at urban hospitals.

Rural residents at rural hospitals were less likely to be discharged home, with 63 percent of rural patients sent home from rural hospitals, compared to 81 percent at urban ones, the study found. Rural hospitals were more likely to discharge patients to another facility, with 14 percent of rural residents at rural hospitals discharged to a long-term care institution, compared to 8 percent at urban ones, and 7 percent of rural hospitals discharged patients to a short-stay hospital, compared to 3 percent of urban ones. (Read more)

Missouri working to increase number of rural doctors; North Carolina gets grant to train rural nurses

Attempting to combat a shortage of health personnel in rural areas, Missouri and North Carolina are trying to fill the void through a program in one state to encourage more young doctors to choose to practice in rural areas and a program in the other state to advance the education of the state's nurses.

In Missouri, 37 percent of the state's residents live in rural areas, but only 18 percent of doctors practice in those areas, Grant Sloan reports for OzarksFirst. The University of Missouri is trying to help solve the problem through its Rural Summer Community Program that places medical students in rural areas. About 300 students have participated, or are currently enrolled, in the program, and about 50 percent of the students who participate in the program end up practicing in rural areas, "nearly 40 percent above the national average." (Read more)

Missouri lawmakers recently passed a bill allowing medical school graduates to bypass their residency to practice as an assistant physician—allowing them to treat patients and prescribe some medications—in underserved rural areas after spending 30 days working under the supervision of a a doctor. Gov. Jay Nixon's signed the bill into law earlier this month.

While Missouri is trying to increase its number of doctors, Western Carolina University received a grant for more than $1 million to train rural nurses to work in Western North Carolina. As part of the program, the state Department of Health and Human Services "will provide $350,000 annually over three years to create a program designed to increase the number of nurses with four-year degrees working in the mountains," Clarke Morrison reports for the Times-Citizen in Asheville.

"The project will support the development of nurses qualified as 'advanced rural generalists,'” Morrison writes. "It will focus on registered nurses with two-year degrees who are ethnic minorities or from economically and educationally disadvantaged backgrounds who work at Mission Hospital or one of the system’s rural affiliate hospitals in the region. The programs provides scholarships, stipends and mentorship opportunities to help students obtain bachelor’s degrees."

Judy Neubrander, director of the WCU School of Nursing, said "research has found that medical services are more successful when providers reflect the communities they serve," Morrison writes. "Although the majority of nurses who work in rural health care facilities grew up in rural communities, many lack the advanced levels of education and training needed today, Neubrander said." (Read more)

Tuesday, July 22, 2014

Rural Iowa hospital pitches to Des Moines residents

In an attempt to reverse the trend of rural residents traveling long distances to seek medical care in cities, a critical-access hospital in northern Iowa is trying to draw patients 90 miles from Des Moines to use its new operating rooms for weight-loss surgery, Tony Leys reports for The Des Moines Register. "The Iowa Specialty Hospital in Belmond (Wikipedia map) is partnering with a Des Moines surgeon to provide the operations, which reduce the size of patients’ stomachs so they can’t eat as much."

"The new arrangement represents a rare effort by a rural hospital to compete directly for business with big-city counterparts," Leys writes. "Most Des Moines-area residents wanting bariatric surgery go to Iowa Methodist Medical Center or to Mercy Medical Center." Dr. Todd Eibes, a former employee of Iowa Methodist, now runs a clinic in West Des Moines, Leys writes. While he and his staff see patients at that facility, surgeries will be performed in Belmond, where patients will on average spend two days in the hospital. Eibes said he was impressed with the hospital's high patient satisfaction surveys and its inviting and modern setting. He told Leys, “That’s the kind of thing our patients are looking for. They don’t want to get lost in a huge system.” (Read more)

Monday, July 21, 2014

Woman at free medical clinic calls Medicaid expansion in Virginia a handout she doesn't want

Federal health reform is a complex topic that was made more complex by the Supreme Court ruling that made it easy for states to reject the law's main device for helping the poor, expansion of the federal-state Medicaid program. That added political complexity to a subject that has philosophical complexity, which showed up at the end of an recent article in The Washington Post about Virginia Gov. Terry McAuliffe's campaign to expand Medicaid against the wishes of the Republican-led legislature.

To illustrate the need, McAuliffe attended a free medical and dental clinic in Wise, in Virginia's southwestern coalfield. The Post's Laura Vozzella ended the story with her interview of Gilda Mountcastle, who had been waiting in line since 5:30 a.m. Mountcastle said she would not have access to a dentist or eye doctor without the free clinic, but said "she did not support Medicaid expansion, which she saw as a government handout." She told told reporters, “We’re hardworking, hillbilly mountain people. We’re too proud to beg and bum.” From the government, at least. (Read more)

Monday, July 14, 2014

Rural hospitals at risk; they blame Obamacare and some states' lack of Medicaid expansion

Fewer patients are being admitted to rural hospitals, instead choosing to go to larger hospitals, and more rural hospitals continue to shut their doors, because of Republican-controlled states' refusal to expand Medicaid under federal health reform. From "1996 to 2012, the average number of acutely ill inpatients at critical access hospitals fell by half, from an average of 8.7 to 4.35 per hospital per day," retired rural pediatrician Wayne Myers reports for the Daily Yonder. Meanwhile, the National Rural Health Association says 14 rural hospitals closed in 2013, Abdulai Bah reports for Aljazeera America.

If the number of rural patients admitted to critical-access hospitals continues to fall, most of the inpatient business at those hospitals will be gone in the next decade, Myers writes: "Inpatient care accounts for a third or less of the revenue of critical-access hospitals, but it’s a vital stream of money for institutions that operate in the black by only 1 percent of their budgets, on average."

Fewer patients means hospitals are closing, and closures affect more than just inpatients, Myers writes. "When a hospital closes, other problems with health services arise. Communities frequently lose medical clinics associated with the hospital, specialist practices and other treatment services like physical and occupational therapy." (Read more)

Shuttering hospitals can also have dire consequences on the rest of the community, Bah writes. When North Carolina's Pungo Hospital closed earlier this month, it left 25,000 people in two of North Carolina’s poorest counties, Beaufort and Hyde, with only a 24/7 urgent care clinic for treatment. The closest hospital is 30 miles away. (Story of America photo by Eric Byler: Sign outside Pungo Hospital)

"The 50-bed Pungo Hospital was the largest employer in the predominantly African-American community of Belhaven," Bah writes. "It represented roughly 10 percent of the funds the town received each year by providing utilities such as electricity to its residents and businesses, said Town Manager Guinn Leverett. Belhaven is now considering raising property taxes by 10 percent to make up the loss of that revenue."

"The closure of Pungo Hospital is in part due to North Carolina’s refusal to expand Medicaid, Vidant Health said in a statement," Bah writes. "Other considerations, including the failing state of the 60-year-old facility also contributed to the decision to close it. The hospital ran close to a $1.8 million deficit last year—although it’s unclear what caused the shortfall."

Failing to expand Medicaid has hurt hospitals in other Republican-controlled states, such as Georgia, Alabama and Tennessee, Bah writes. Georgia has shut down four hospitals in the past two years and as many as 15 more are on the chopping block. Alabama has closed six rural hospitals in the past 18 months and 22 more are in financial trouble. Haywood Park Community Hospital in Brownsville, Tennessee announced in April that it would end inpatient and emergency room services on July 31, leaving most of the county's 10,000 residents without no access to an emergency room. (Read more)

Friday, July 04, 2014

National Newspaper Association announces individual winners in annual Better Newspaper Contest

The National Newspaper Association, which is the main organization for weekly newspapers but also includes many small dailies, has announced the individual winners in its annual Better Newspaper Contest. It reserved announcement of the general-excellence awards for its Oct. 2-4 convention in San Antonio, but you might make some reasonable guesses from the list of news awards by paper and perhaps the following list of winners by in issue-oriented categories, by circulation and/or frequency classifications:

Best local news coverage (daily and non-daily)
Circulation of 6,000 or more: First place, The Washington Missourian; second, The Standard-Banner, Jefferson City, Tenn.; third, the Cape Gazette, Lewes, Del; honorable mention, The Livingston Parish News, Denham Springs, La.
Circulation 3,000 to 5,999: The Alamance News, Graham, N.C; second, the Mount Desert Islander, Bar Harbor, Me.; third, The North Scott Press, Eldridge, Iowa; honorable mention, the Wise County Messenger, Decatur, Tex.
Click on image for larger version
Under 3,000: Sangre de Cristo Chronicle, Angel Fire, N.M.; second, the Ozona Stockman of Texas; third, Nebraska's West Point News; honorable mention, North Dakota's Tioga Tribune.

Best investigative story or series
Dailies: James Beaty, Kandra Wells, Kevin Harvison, Brandy Jeffreys of the McAlester News-Capital, for a package of stories on the 40th anniversary of an Oklahoma prison riot; second and third place, Nick Hytrek of the Sioux City Journal, for stories on a cold case and early release of Iowa prison inmates.
Non-dailies, circulation 10,000 or more: First place, Tom Dunlop, Sara Brown and photographer Ray Ewing, The Vineyard Gazette, Edgartown, Mass., for a series on coastal erosion; second, Jennifer Johnson, The Beaumont Examiner, on waste in a Texas school district.
Non-dailies, circulation 3,000-9,999: First place, Mike Koshmrl of the Jackson Hole News & Guide, for a story on the local airport board making regular "official" trips to Hawaii (here's a follow-up); second, Jared Strong of the Times Herald in Carroll, Iowa, on a killer who fell through cracks in the system; third, Publisher Tom Boney Jr., Tomas Murawski, Janice Crisp and Kristy Bailey of The Alamance News, Graham, N.C., for an examination of a state agency's cases against the local sheriff.
Non-dailies, under 3,000: First place, Phil Johnson of The Western News, Libby, Mont., for stories (here's one) on overtaxation; second, Melissa Meinzer of Missouri Lawyers Weekly, St. Louis, for stories on lawyer discipline hearings; third, Amy R. Sisk and Resa Haukedahl of the Tioga Tribune, for stories showing the need for more law enforcement in the North Dakota oil-boom town; honorable mention, Bill Moss of the Hendersonville Lightning in North Carolina, for "Legal fights imperil restitution promises."

Best editorial (daily and non-daily)
10,000 or more: The Taos News, for an editorial by Joan Livingston criticizing the city council and mayor for circumventing of New Mexico's open-meetings law.
6,000-9,999: The Cody Enterprise of Wyoming, for an editorial by Bruce McCormack criticizing a state representative's rudeness.
3,000-5,999: The Hutchinson Leader of Minnesota for "County has gone gun crazy," an editorial by Doug Hanneman.
Under 3,000: The Sangre de Cristo Chronicle of Angel Fire, N.M., for "Red River is not above the law, an editorial by Jesse Chaney.

Best editorial pages (daily and non-daily)
6,000 or more: First place, the Wyoming Tribune Eagle of Cheyenne; second, the Leelanau Enterprise of Michigan; third, The Washington Missourian; honorable mention, the Antelope Valley Press of California and the Ellsworth American of Maine.
Under 6,000: First place, the Mount Desert Islander of Bar Harbor, Maine (same ownership as the Ellsworth American); second, the West Point News of Nebraska; third, The Clarendon Enterprise of Texas; honorable mention, the Iowa Falls Times-Citizen.

Best environmental story (daily and non-daily)
9,000 or more: Matthew Renda and photographer John Hart of The Union, Grass Valley, Calif., for a series on the Yuba River.
Under 9,000: David Bunker of Moonshine Ink, Truckee, Calif., for a story on quagga mussels in Lake Tahoe.

Best health story (daily and non-daily)
6,000 or more: First place, Megan Moser of The Manhattan Mercury of Kansas; second, Ginny Privitar of The Chronicle, Chester, N.Y., third, Starla Pointer of teh News-Register, McMinnvile, Ore.
Under 6,000: First place, Luige del Puerto and Jeremy Duda, the Arizona Capitol Times, Phoenix; second, Maek Good of the Mount Desert Islander; third, Ellary Prenice of The Paynesville Press in Minnesota.

Best education story
Dailies: Aerin Curtis of the Wyoming Tribune Eagle, for a story on new teacher-evaluation standards.
Large non-dailies: Steve Marion and Ronnie Housley of The Standard-Banner of Jefferson City, Tenn., for a story about reading that was easy reading: "It isn't long, but full of good writing," the judges wrote.
Small non-dailies: Claire K. Racine of the Westmore News, Port Chester, N.Y., for "Bullied student slits her wrists." (She survived.)

Freedom of information (daily and non-daily): Wyoming Tribune-Eagle, for editorials on openness at the University of Wyoming; second, Arizona Capital Times, Phoenix, for reports on lobbying.

Best website (daily and non-daily: Hendersonville (N.C.) Lightning; second, Santa Clarita Valley Signal of California; third (tie), the News-Register, McMinnville, Ore., and Lakota Country Times, Martin, S.D.

Other categories include feature story, localized story, performing arts story, review, obituary, cartoon, column, typography, special section, photo essay, and use of photographs. A list of all winners by category is here. The contest also includes an advertising division. For more information about the contest and the convention, see www.nnaweb.org.

Wednesday, June 25, 2014

Mobile health coming to rural Michigan; college faculty, staff and students hit the road

Rural Michigan residents who can't make it to a health care clinic need not worry. The health clinic is coming to them. Funded by a $500,000 grant, the Herbert H. & Grace A. Dow College of Health Professions at Central Michigan University is rolling out its "39-foot motor home that will serve rural Michigan residents by providing access to high-quality health care and preventative health education through community outreach efforts," reports the Midland Daily News.

Called Mobile Health Central, the motor home will act as an extension of the college's Carls Center for Clinical Care and Education, "which serves more than 8,000 patients each year in the Health Professions building on CMU’s Mount Pleasant campus," the News writes. "The goal is to improve health and quality of life by reaching into communities through local partnerships and collaborations to address gaps in access to health care services."

"The cost of the services provided will be similar to what a patient would pay if visiting the Carls Center on CMU’s campus; however, it is hoped that free services could be provided through sponsors or investors. Many insurances are accepted," the News writes. "While not uncommon in the field of medicine, the Mobile Health Central vehicle is unique to a college campus, CMU stated. Equipped with medical necessities such as exam tables, sinks and a soundproof booth for hearing testing, it will provide additional training opportunities for CMU health professions students and interdisciplinary partnership opportunities in health care research across campus." (Read more)

Thursday, June 19, 2014

W.Va. Medicaid deal could lead to closure of rural clinics; fraud issues could cost state funding

A West Virginia lawsuit settlement that "will alter how rural health clinics and larger health centers are reimbursed for treating low-income patients on Medicaid" could lead to big financial windfalls for larger health care centers, while smaller clinics could face back fees in the millions that could lead to the closure of dozens of rural facilities, Eric Eyre reports for The Charleston Gazette.
 
The settlement will lower Medicaid reimbursements for rural clinics, and "also requires some rural health clinics to reimburse the state and federal government for charges dating back to October 2012," Eyre writes. Dr. Mark Tomsho, who said Summersville Regional Medical Center (right) would lose $750,000 per year because of lower Medicaid reimbursements, estimated that under new rules he owes $1 million. He said the clinic runs on an operating budget of $3 million a year.
 
State health officials said they wouldn’t know how many of the state's 40 rural clinics "must pay back money and face lower Medicaid reimbursement rates—an estimated 30 percent to 50 percent cut—until after the clinics file cost reports," Eyre writes. "The clinics must submit reports by June 30."

Medicaid reimbursement changes were prompted by a 2011 lawsuit filed in federal court by eight larger health-care facilities that "alleged that the state Bureau of Medical Services miscalculated Medicaid reimbursement rates for years," Eyre writes. "Under the settlement, seven of the eight large health-care centers, as well as some of the other 19 federally qualified facilities, will be reimbursed at higher rates. Some health centers also will get a windfall for being shortchanged in previous years. (Read more)

Meanwhile, "Legislative auditors said West Virginia is at risk of losing millions of dollars in federal Medicaid funding because state hasn't complied with a 2011 directive [that] requires states to suspend Medicaid payments to health care providers if fraud allegations are determined to be credible," WCHS-TV in Charleston reports. "A legislative audit says Medicaid has paid at least $17.9 million to providers whose cases were referred to the state's Medicaid Fraud Unit. The payments could be as a high as $211 million.

Program to expire that allows veterans living in remote areas to receive local medical care

The Veterans Health Administration is ending a pilot program that allows veterans who live at least one hour from a VA health facility to get health care services from a community provider, Bryan Thompson reports for Kansas Public Radio. The program, called Access Received Closer to Home, is used in Northern Maine; Farmville, Va.; Pratt, Kan.; Flagstaff, Ariz.; and Billings, Mont.

In a letter to acting VA Secretary Sloan Gibson senators from the states wrote: “For reasons we do not understand, the Veterans Health Administration is choosing—at VHA’s own initiative—to end this successful program despite the more than 90 percent satisfaction rate communicated by veterans. All along, the VHA gave us the impression that they were waiting on analysis about the success of ARCH to inform their decision about extending the program—this is a misleading storyline at best. We are deeply disappointed by this breach of trust because those who suffer from this recklessness are veterans.” (Read more)

Tuesday, June 17, 2014

Physicians at national meeting discuss future of rural primary care, how to solve doctor shortages

The shortage of primary-care physicians is a big problem in rural areas, and people need to do more to meet the need, according to a panel of physicians at "Rural Health Journalism 2014," Kris Hickman writes for the Association of Health Care Journalists, sponsor of the conference last weekend in Portland, Ore.

Almost half of rural counties, 44 percent, struggle with primary-care physician shortages, said Andrew Bazemore, M.D., M.P.H., director of the Robert Graham Center for Policy Studies in Family Medicine and Primary Care of the American Academy of Family Physicians. He said the U.S. ranks lowest in primary care and health outcomes among 10 other highly developed nations.
Primary care docs per 100,000 in 2012 (Centers for Disease Control and Prevention)
The number of primary-care doctors is expected to drop soon because almost 27 percent of those providers are older than 60, said Mark A. Richardson, M.D., dean of Oregon Health and Science's School of Medicine.

Bazemore said the medical community needs to draw more attention to the need for more primary care physicians in rural areas. He also said that for every dollar spent on health care, only six or seven cents are spent on primary care. "States facing a shortage should remember that primary care is the logical basis of any health care system," Bazemore said.

Richardson recommended that medical schools try to recruit students who have rural backgrounds because they're more likely to return to practice in rural areas. He and Bazemore agree that students who practice in rural areas should be given loan forgiveness or scholarships. "Debt prevents many people from choosing primary care," Bazemore said.

Richardson said the most important factor for where medical students end up practicing is where they completed their training. "Rural training is one of the highest predictors of a rural practice and should be required," he said. To do this, the government-imposed cap on graduate medical education (GME) spending would have to be abolished.

Bazemore said primary care in rural America "should be affordable and accessible to all. It should be more patient-centered and community-oriented . . . rather than the current fee-for-service dynamic that is 'provider and hospital centric,'" Hickman writes.

"Medical care is not a free market dynamic," Richardson said. "We pay for health care transactions, rather than health." (Read more)

Monday, June 16, 2014

Thursday webinar to reveal survey results of people who bought their own health insurance under reform

The Kaiser Family Foundation is holding a reporters-only webinar at 11 a.m. ET Thursday to release results from a survey on people who bought their own health insurance under federal health reform. The webinar will feature the foundation's president and CEO, Drew Altman; its director of survey research Liz Hamel; and Senior Vice President Larry Levitt. "After a brief presentation providing an overview of the survey, the foundation's experts will take participants' questions online and over the telephone," says a news release. For more information, contact acawebinars@kff.org. To register click here.

Friday, June 13, 2014

Maine's rural nursing homes face an uncertain future

Maine, the state with the largest percentage of rural population, is also one of the country's neediest when it comes to funds for nursing homes. Of the state's 7,000 nursing-home residents, 56 percent have been diagnosed with dementia, and the state ranks fourth in the U.S. "in the number of nursing home residents who need help with tasks of daily living, such as bathing, grooming and eating," Jackie Farwell reports for the Bangor Daily News.

"Maine nursing homes also must meet some of the most stringent staffing ratios of any state, Farwell writes. "Despite the challenges, Maine’s facilities boast one of the lowest rates in the nation of deficiencies, such as mistreating patients or high infection rates, which is a reflection of nursing home quality. Without adequate funding, however, Maine seniors and their families will suffer, experts say."

MaineCare, the state’s Medicaid program, foots the bill for nearly 70 percent of the state's nursing home residents—above the national average of 63 percent, Farwell writes. "At some homes, particularly in poor rural areas, the program covers nearly every resident, stretching bottom lines even further." (Daily News graphic)

Medicare, which only pays a fraction of nursing home costs, has underfunded the state's nursing homes "for the last several years, reimbursing them based on their costs from 2005," Farwell reports. "The payment structure hasn’t changed since 2008, except for a 1.5 percent raise in 2012." A 52-bed nursing home in Calais closed two years, leaving 100 people without jobs, and two more nursing homes are on the brink of closure, according to independent Gov. Paul LePage.

Rick Erb, president and CEO of the Maine Health Care Association, said "The MaineCare funding crunch is affecting some families in ways they may not realize." As a result, Farwell writes, nursing homes underfunded by the state often shift the cost burden to patients with private insurance, which averages about $80 more per day than MaineCare.

Officials hope help is on the way. "The new legislation promises to give Maine nursing homes $4 million in additional state Medicaid funds in the fiscal year beginning July 1," Farwell notes. "Another $5 million is due to follow in the subsequent two years. The federal government would kick in its matching share to the tune of more than $24 million over the next three years." (Read more)

Tuesday, June 10, 2014

VA audit finds 120,000 veterans wait months for care; long waits especially bad for rural vets

More than 120,000 veterans who tried to schedule an appointment with the Department of Veterans Affairs were told they had to wait a minimum of 90 days to get medical care, while some who requested an appointment never got one, according to an audit by the agency. Statistics for each of the 731 VA facilities are available by clicking here.

The audit found that 57,436 newly enrolled veterans were told they had to wait at least 90 days, while 63,869 veterans who enrolled within the past decade were unsuccessful in scheduling an appointment, Tom Cohen reports for CNN. The VA has acknowledged that long waits resulted in the deaths of 23 veterans.

The longest average wait for specialist care was 145 days at Texas Valley Coastal Bend Health Care System, while the longest average wait for mental-health care was 104 days in Durham, N.C., the audit found.

Long waits are especially bad for rural veterans, whose average age continues to rise. Now about half of all rural veterans are 65 or older. Rural veterans, who on average are 18 years older than urban ones, also suffer from a homeless problem that prevents some veterans from having the means to get to a facility. (Economic Research Service graphic)
"Despite efforts to address some issues in recent years, including reductions in backlogs for benefits and the number of homeless veterans, the long waits have continued for newly enrolled veterans to get initial appointments for care," Cohen writes. "Reasons for the chronic problems include the increasing number of veterans returning from wars in Iraq and Afghanistan and a bonus system that rewarded managers for meeting goals regarding access to treatment."

A lack of open appointment slots with approved providers was another reason given for the long wait time, Jamie Fuller reports for The Washington Post. "Senate Veterans Affairs Committee Chairman Bernie Sanders (I-Vt.) and Sen. John McCain (R-Ariz.) are working on a bill that would let veterans facing long wait times go to out of network for health care providers. It would also provide about $500 million for the agency to hire additional medical personnel."

Monday, June 09, 2014

Doctors in ERs say they're busier since Obamacare began; hospitals struggle to handle extra patients

Nearly half of emergency-room doctors say their ERs have seen an increase in patients since health reform went into effect, and 86 percent say they expect the increase to continue, according to a poll by the American College of Emergency Physicians. Of the 1,845 completed surveys, 9 percent said ER visits had increased greatly and 37 percent said they had increased slightly. When asked what they think will happen over the next three years, 41 percent said visits will increase greatly and 45 percent said they will increase slightly. (ACEP graphic)

"Dr. Jay Kaplan, a member of ACEP's board of directors, said he wasn't surprised by the findings given the large influx or Medicaid enrollees and the difficulty in locating primary-care doctors who will see those patients," Paul Demko reports for Modern Healthcare. Kaplan told him, “When people get insurance, they feel like they deserve healthcare. When they deserve health care, and there's nobody else they can see, they come to us.”

77 percent of respondents
said their ER is not prepared
for an increase in patients
But some hospitals say many patients are going to the ER for ailments that are not emergencies, Laura Ungar reports for The Courier-Journal. Lewis Perkins, vice president of patient care and chief nursing officer at Louisville's Norton Hospital, said the emergency room is seeing 100 more patients per month, an increase of 12 percent. "We're seeing patients who probably should be seen at our (immediate-care centers)," he told Ungar. "And we're seeing this across the system."

ER visits at the University of Louisville Hospital are up 18 percent, while Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physicians' group, said ER services are up 7.5 percent in that city. He told Ungar, "It's a perfect storm here. We've given people an ATM card in a town with no ATMs." (Read more)

Phil Galewitz of Kaiser Health News reports that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years. Hospital officials around the country told him that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care.

Monday, May 12, 2014

Wall Street Journal looks at rural hospitals' problems related to Obamacare, lack of Medicaid expansion

"Rural hospitals have long been under financial pressure from the rising cost of providing health care, the dwindling number of patients staying overnight and the shift of more profitable services like cardiac care to bigger medical centers," Valerie Bauerlein reports for The Wall Street Journal. "Now, the Obama administration, saying that some rural hospitals have been receiving subsidies they weren't meant to get, has proposed eliminating a further $2.1 billion in Medicare payments next fiscal year for hospitals designated as providing 'crucial access." (WSJ graphic)

Some rural hospitals in states that chose not to expand Medicaid under federal health reform have struggled to stay open. A rural Tennessee hospital recently announced it's shutting its doors, while four rural Georgia hospitals have closed in the past year. Because those states chose not to expand Medicaid, hospitals are losing government subsidies for providing care to the uninsured.

"Health advocates say a disproportionate number of working poor people who might qualify for Medicaid after an expansion live in rural areas and may have trouble getting treatment," Bauerlein writes. "Rural hospitals are particularly sensitive to changes in Medicare and Medicaid payments because about 60 percent of their revenue comes from the government, according to the American Hospital Association."

That's bad news for rural residents in places like Belhaven, N.C., where city leaders are trying to find $3 million to take over the local hospital from its owner, who has said the hospital will close this summer, Bauerlein writes. The hospital serves fewer than 20 people per day, but it is the town's largest employer, and the closest emergency room is 75 miles away. North Carolina didn't expand Medicaid. (Read more)

Monday, May 05, 2014

Rural hospitals join with larger ones to stay afloat

Small, rural hospitals are struggling to stay open because of rising costs and fewer patients, and many are partnering with larger health systems for project funding or financial support. At Brooks Memorial Hospital, in Dunkirk, N.Y., about two-thirds of the 65 beds are empty because doctors can perform some procedures elsewhere, and many complicated procedures are referred to an urban facility that has access to expensive technology. As a result, "Brooks has reached out to UPMC Hamot, 50 miles away in Erid, Pa., an affiliate of the University of Pittsburgh Medical Center," Henry Davis writes for The Buffalo News.

"Every one of the small, rural hospitals is talking to somebody because they have to," said Kenneth L. Oakley, chief executive officer of the Western New York Rural Area Health Education Center. For example, Mount St. Mary's Hospital in Lewiston will unite with Catholic Health so it can gain the use of administrative and corporate services as well as speciality medical services. United Memorial Medical Center in Batavia is merging with Rochester General Health System, to not only ensure the hospital's financial stability but also to provide all the necessary medical services in Genesee County. Here's a Feb. 27 report from The Batavian.

"The increasing cost and complexity of speciality care, as well as rapid changes in medicine, accelerate the trend," Davis writes. "Hospitals face more pressure from the government and insurers to coordinate care, adopt electronic medical records an accept payment based on quality and cost-control measures." Moves toward consolidation of the hospital industry began soon after Congress passed the health-reform law in 2010.

While keeping rural hospitals open is important for providing service to the community and preserving a large source of jobs in rural areas, partnering with big institutions does present some risks. In some cases, the small hospital may have to give up independence or stop being full-service. In many cases, though, the arrangement is very beneficial. For example, United Memorial Medical Center's affiliation with Rochester General—which began with a collaboration in cardiology, pathology and urology—resulted in the establishment of a cancer and infusion center in Batavia. Now citizens of Batavia have somewhere close by to go for treatment.

The larger hospitals also benefit from the partnerships, receiving patient referrals and expanding their brand names. "The path forward in health care requires collaboration," said Roger Duryea, vice president of planning and business development at Catholic Health. (Read more)

Thursday, May 01, 2014

Hospital in rural Tennessee to close; company says state's lack of Medicaid expansion is a factor

Jackson Sun photo by David Thomas
Another rural hospital is closing in a Republican-led state that chose not to expand Medicaid under federal health reform. Haywood Park Community Hospital in Brownsville, Tenn., will end inpatient and emergency services on July 31, Tom Wilemon reports for The Tennessean. The 62-bed hospital will be turned into an urgent-care clinic that will treat minor illnesses and non-life-threatening injuries.

Larry Cash, chief financial officer of Tennessee-based Community Health Systems, which operates or leases 208 hospitals in 29 states, "said Tennessee’s failure to expand its Medicaid program was a contributing factor for the decision," Wilemon writes. Cash told him, “It is a situation where we will continue certain services there but inpatient services can be done at our hospital there in Jackson better.” Jackson is about 31 miles from Brownsville.

The hospital has seen a continual decline in patients, from 1,300 in 2009 to less than 250 in 2013, David Thomas reports for the Jackson Sun. Joel Southern, Haywood Park Community Hospital’s chief executive officer, said in a statement: "These are challenging times for all hospitals and we must evolve and adjust to new realities. Maintaining a full-service hospital for the current inpatient demand from acute and emergency patients is not sustainable.” (Read more)

It's no surprise that the hospital is closing, Wilemon writes. "The Tennessee Hospital Association warned that rural hospitals would close if Tennessee did not expand its Medicaid program." Craig Becker, president of the association, told The Tennessean in December, “The vast majority of our hospitals that are financially distressed right now are in our rural areas.” Four rural hospitals have already closed in Georgia, which also did not expand Medicaid. (Read more)

Wednesday, April 30, 2014

Murray Energy cuts 1,200 Consol retirees' benefits

Placing blame on the Obama administration for destroying the coal industry, Murray Energy, one of the largest coal employers, announced Tuesday that it will terminate health benefits for 1,200 non-union retirees "who worked in mines Murray purchased one year ago" from Consol Energy, reports WTRF in Wheeling, W. Va. Benefits for salaried retirees, including medical, prescription drug and life insurance will end on Dec. 31.

"Murray Energy’s inability to provide these benefits is, in part, due to the destruction of the coal industry, including our markets, by the Obama administration and its appointees and supporters, who have eliminated the livelihoods of thousands of coal miners, and their families, by the forced closing of 392 coal-fired electric power plants in America, now and in the immediate future," the company said in a statement. "Due to these action and devastated coal markets, Murray Energy is unable to support these benefits."

"Murray Energy is making this announcement at this time to allow affected salaried retirees of Consolidation Coal [Consol's former name] the opportunity to make other arrangements," the statement reads. "Over 80 percent of the lost benefits can be made up with Medicare. Also, these former Consolidation Coal retirees have good pension benefits. The company has provided these salaried retirees with information on and access to alternate coverage." (Read more)