JustCare

Tag: Rural

  • Medicare Advantage insurers are killing rural hospitals and communities

    Medicare Advantage insurers are killing rural hospitals and communities

    Write-Off Warrior, a research and advocacy firm that supports rural health systems, just released “Preyed On: How Insurance Corporations are Bleeding Rural Hospitals and Communities to Death.” The report documents the many harmful behaviors of large insurance corporations responsible for endangering the health of rural America. The report also highlights the far-reaching consequences for our country if Congress fails to address insurer behaviors driving rural health disparities.

    Rural Americans represent about 20 percent of the US population. They tend to suffer more from chronic conditions than other Americans. But, they struggle more to get the care they need than other Americans and their plight is worsening.

    The authors surveyed 41 rural hospitals in 15 states across the US and found that the biggest problems they faced were burdensome insurer prior authorization procedures, insurers’ second-guessing of treating physicians, and insurers’ long delays and denials of provider payments. Moreover, insurers take advantage of rural hospitals’ weak bargaining power to negotiate excessively low rates or to keep these hospitals from being in-network. Rural hospitals are foundering.

    Medicare Advantage insurers are the biggest threat to rural hospitals and communities, according to 31 of 41 hospital execs surveyed. These corporate insurers have undermined the hospitals’ financial stability. These insurers have led rural hospitals to end important mental health and rehab services. And, these insurers are leading many rural hospitals to shut down altogether.

    While the top six Medicare Advantage insurers profited to the tune of $41.7 billion in 2023 alone, Medicare Advantage enrollees continue to face rising costs, notwithstanding these insurer practices. They also are often forced to travel long distances for care. Congress must recognize that Medicare Advantage does not work for rural Americans and reform the system.

    Until Congress reforms the Medicare Advantage program to meet the needs of rural Americans, insurers will profit more at the expense of rural communities. Nearly 200 rural hospitals have closed in the last 2o years. And, more than 700 are at serious risk. These hospital closures put rural America on life support.

    Without vibrant rural communities and good rural health, critical food and energy production, vital to the entire country, are at risk of failing.

    Here’s more from Just Care:

  • AMA asks Congress for help saving independent medical practices

    AMA asks Congress for help saving independent medical practices

    In a Statement to Congress, the American Medical Association (AMA) asks for help saving independent medical practices. The AMA wants higher physician pay and government intervention to address systemic inequities and administrative burdens, recognizing the calamitous state of our health care system. “This is not just a call for action; it is a plea to safeguard the heart of American health care before it is too late.”

    What’s concerning is that the AMA does not call out the significant role of corporate health insurers in destroying our health care system. The AMA appears to like the higher rates the physicians receive from corporate insurers and doesn’t want to give those up; rather, it wants higher Medicare rates.

    The AMA highlights many big health care problems, without attribution to the insurers. The practice of medicine is not what it used to be. Small independent practices are vanishing. In their place, big corporations are buying up physician practices and intervening in the practice of medicine. (UnitedHealthcare, for example, now controls 10 percent of physicians in the US.)

    Physicians are increasingly no longer free to make treatment decisions for their patients. Rather, insurance companies second-guess their decisions, coming between them and their patients. The consequences can be dire for the patients, as the data indicates. The AMA also recognizes the need for “expanded support for rural and underserved areas” and “a health care infrastructure secured from emerging threats.”

    Of course, it’s the insurers who are responsible for the bulk of our health care system’s failings. They implement prior authorization protocols that harm providers and patients alike. But, while the AMA doesn’t like these protocols, it’s letter to Congress makes it seem as if the insurers are forced to use prior authorization: “This requirement for insurers to approve treatments before they can be administered not only delays diagnosis and treatment but also involves substantial paperwork and diverts critical resources and time that could be better spent on direct patient care.”

    The AMA only indirectly calls out insurers for their role in underpaying providers, undermining competition and patient choice. After all, it’s the insurers who are failing to pay rural and other hospitals appropriately for the care they provide, threatening their very being, forcing many to close, and making it harder for people to access care.

    The question is whether the AMA will ever join forces with patients to call for guaranteed affordable health care for all. Until then, it will be hard to move Congress to overhaul our health care system.

    Here’s more from Just Care:

  • What’s happening to our hospitals?

    What’s happening to our hospitals?

    Small independent hospitals are being acquired by large hospital systems across the US or, worse still, they are shutting down. What does that mean for the future of hospitals and for their patients? Little, if anything, good. Caitlin Owens reports for Axios on what some experts are saying about the US hospital system.

    Many experts believe that there will be fewer hospitals and that people in remote areas will have to travel further to get hospital care. That seems evident. In the last several years, many small rural hospitals have closed. They have been losing too much money. Or, they have been acquired by larger hospital systems.

    Already, a lot of hospital systems have stopped providing care that they determine is not profitable, such as maternity care. Some hospitals have been forced to close other departments, if not to close altogether. Their physicians and staff do not have enough work. They cannot afford to support a small local population.

    Many hospitals are struggling because insurers offering Medicare Advantage plans are denying critical care and not paying hospital bills after treatments have been provided.

    Many experts are deeply concerned about all the hospital consolidation. They want to see some hospitals providing basic care and other hospitals providing specialty care. If this were the case, many patients would have to travel a lot further to receive hospital care.

    Hospitals serving the most vulnerable patients and that rely on government support for their services are at particular risk of closing down. These at-risk patients could find it even harder to get care than they already do.

    Hospitals should not be focused on profits but on patient care. What will it take to return to hospitals putting patients first?

    Here’s more from Just Care:

  • Half of rural hospitals are losing money, closing units

    Half of rural hospitals are losing money, closing units

    Jazmin Orozco Rodriguez reports for Kaiser Health News on the failing finances of half of rural hospitals. They are losing money. A big part of the reason are the insurers offering Medicare Advantage plans who don’t pay these hospitals the money they are due.

    “The rapid growth of rural enrollment in Medicare Advantage plans, which do not reimburse hospitals at the same rate as traditional Medicare, has had a particularly profound effect.” Insurers don’t profit as much from rural enrollees, so they do not pay rural hospitals adequately, which our government unforgivably allows them to do. (Most people don’t appreciate that government payments to Medicare Advantage plans are based on the payment rates in traditional Medicare.)

    What’s happening? In many cases, rural hospitals are closing their operating rooms and obstetrics units. Hundreds of hospitals have stopped providing chemotherapy. Expenses are greater than revenue. Hospitals cannot find enough workers. And, administrative challenges are large.

    Where are the hospital closures happening? All over the US, particularly in small communities. Chartis describes that, in the last year alone, one in two rural hospitals operated in the red. That’s nearly a ten percent increase from the year before.

    How many hospitals are at risk? Chartis found that 418 rural hospitals were at risk of closing. Of note, those rural hospitals in states with expanded Medicaid coverage were in better shape financially than those in states that did not opt to expand Medicaid.

    Medicaid expansion to low-income adults has helped ensure access to care health care in those states a lot: In Montana, for example, as a result of Medicaid expansion, there are half as many uninsured residents as there had been. Access to care for Montanans has improved. And, rural facilities are still operating. No hospitals have closed in the last nine years.

    The future looks grim for rural hospitals and the people who live in their communities, according to Chartis. Even non-profit hospitals can’t survive financially in rural America. The hospitals have no profit margin. Rural residents tend to live on low incomes, to be older and in poorer health. Overall, they have shorter life expectancies than Americans living in other areas.

    Alan Morgan, CEO of the National Rural Health Association notes that Congress needs to do more: “It’s just bad public policy. And bad policy for the local communities.”

    Here’s more from Just Care:

  • 200,000 UnitedHealth enrollees in North Carolina likely losing coverage

    200,000 UnitedHealth enrollees in North Carolina likely losing coverage

    The University of North Carolina (UNC) Health is planning to end its contract with UnitedHealth because it is  “not negotiating with us in good faith.” Two hundred thousand people enrolled in UnitedHealth’s North Carolina plans are likely to lose their access to UNC Health, reports MedPage Today. As more and more hospital systems throughout the country face health insurer prior authorization delays and denials, denials of payments and other financial and administrative burdens, people are at serious risk of care disruptions.

    If UnitedHealth doesn’t meet UNC’s needs, tens of thousands of people in UnitedHealth’s Medicare Advantage plan in North Carolina will lose access to UNC hospitals and providers effective April 1, 2024. They are not alone. Equally concerning is that many smaller and rural hospitals are closing as a result of UnitedHealth and other health insurers failing to pay them appropriately.

    UNC Health’s chief clinical officer Matthew G. Ewend, MD says that UNC needs to hold UnitedHealth accountable for underpayments and undermining patient care. UnitedHealth is not prioritizing patient health and well-being. He says, “UnitedHealthcare improperly denies claims and causes unnecessary delays in patient care. This can negatively affect your well-being.”

    Since now is open enrollment season, UNC is urging its patients to find a new insurer rather than face disruptions in care in 2024. John Buse, MD, director of the UNC Diabetes Care Center, said “We need a single-payer healthcare system! The incentives are all wrong.” He is so right.

    So long as insurers profit from delays and denials of care and coverage, they will continue to delay and deny care and coverage inappropriately. Unfortunately, it seems that neither the states nor the federal government have the will or the power to hold them accountable for their bad acts. A review of enforcement actions by the Centers for Medicare and Medicaid Services against Medicare Advantage plans in 2023 reveals not a single enforcement action.

    Here’s more from Just Care:

  • Rural hospitals accept Medicare Advantage at their peril

    Rural hospitals accept Medicare Advantage at their peril

    Sarah Jane Tribble reports for Kaiser Health News that small rural hospitals have been hit hard by Medicare Advantage.

    The CEO of Battle Mountain General Hospital, in a Nevada gold mining town, turned away Medicare Advantage plans for the last few years. The Medicare Advantage plans weren’t willing to pay his hospital as much as traditional Medicare pays. And, the Medicare Advantage plans have yet to come forward with a fair offer.

    Consequently, people in the town of Battle Mountain can’t sign up for Medicare Advantage unless they are prepared to drive three hours to Reno or four hours to Salt Lake City to go to the hospital or they are willing to pay out of pocket for their local hospital care.

    Hospitals across the country, small and large, say that at times the insurers don’t pay them or don’t pay them promptly, putting them at financial risk. More than 150 rural hospitals have closed. The largest number of hospital closures have been in Texas, Tennessee and Georgia. Even though Medicare calls these rural hospitals “critical access,” the government has not ensured their ability to continue or protected them against the threat of Medicare Advantage payment denials.

    Dozens of hospital systems are cancelling their Medicare Advantage contracts because of patient safety concerns as well as inappropriate delays and denials of payment, forcing their patients to find new health care providers. Still, in rural America, enrollment in Medicare Advantage continues to grow at a rapid pace since 2010.

    What’s noteworthy is that the government pays these hospitals more in traditional Medicare because they are designated as “critical access.” Since government payments to Medicare Advantage plans are based on payments to providers in traditional Medicare, it appears that Medicare Advantage plans are the ones benefiting from these additional payments. They are pocketing the extra money, not willing to pay the hospitals the same rates as traditional Medicare pays.

    But, some rural hospitals have no choice but to accept the terms the Medicare Advantage plans offer them. Too high a percentage of their patients are enrolled in Medicare Advantage. Mesa View in Nevada, for example, has 21 Medicare Advantage contracts. But, the hospital can’t get the MA plans to pay for the care they provide enrollees. Mesa View is now owed more than $800,000 for care it has provided.

    Not only are the insurers that offer Medicare Advantage plans hurting the rural hospitals with which they are contracting, they are hurting the patients who most need care. These patients have to travel long distances to get their nursing care and rehab care covered. The local providers won’t take Medicare Advantage because they are not paid appropriately to treat them. They only take Traditional Medicare patients.

    Some Medicare Advantage plans appear to pride themselves on saving money and maximizing profits by hurting provider finances and keeping people from getting easy access to care. Meanwhile, according to Kaiser Health News, ‘Centers for Medicare & Medicaid Services press secretary Sara Lonardo said CMS has acted to ensure ‘that private insurance companies are held accountable for providing quality coverage and care.’” I have been trying to determine what CMS is doing to ensure accountability from the corporate health insurers offering Medicare Advantage for years now; if CMS is doing anything meaningful, it is far from evident.

    In response to a bi-partisan Senate letter to CMS about ensuring MA pays health systems appropriately, the CMS administrator claimed a final rule issued in April addresses concerns about MA coverage rules. She makes no mention about inappropriate MA payment delays and denials.

    Here’s more from Just Care:

  • Medicare Advantage endangers rural hospitals

    Medicare Advantage endangers rural hospitals

    Rural hospitals are a critical source of health care for millions of Americans. But, Medicare Advantage plans are refusing to pay them Medicare rates and denying coverage for a large portion of services they provide. Corporate health insurers offering Medicare Advantage plans are putting the survival of rural hospitals at risk, reports Axios.

    At more people enroll in Medicare Advantage, more rural hospitals are closing or feeling the threat of closure. These hospitals don’t have the negotiating power of larger hospitals to ensure Medicare Advantage plans pay them adequately and appropriately. (And, even some larger hospital systems are cancelling their Medicare Advantage contracts because of inadequate payments and patient care concerns.) Traditional Medicare is a far better payer that they have relied on.

    Still, rural Americans are enrolling in Medicare Advantage, likely unaware of the risks to their health and well-being, particularly if they develop a complex and costly condition. Medicare Advantage marketing and sales agents highlight the “free” benefits in Medicare Advantage, without describing the dangers–inadequate networks, inappropriate delays and denials of care and coverage, and more.

    The biggest dangers in Medicare Advantage come when you most need health care. You can face long waits for approval of care. And, too often, Medicare Advantage plans wrongfully refuse to pay for care that traditional Medicare covers. Hundreds, if not thousands, of Medicare Advantage plans deny care and coverage inappropriately.

    People don’t appreciate that it can be hard to come by a good oncologist in Medicare Advantage if you’re diagnosed with cancer. Mental health benefits can also be hard to get. And, Medicare Advantage plans have been found to deny people rehab therapy post hip and knee replacements or to cover far less therapy than people need.

    Some Medicare Advantage plans might actually be doing right by their members. But, if they are, no one is disclosing which are the good ones and which are the bad ones. Imagine buying a car without knowing whether the engine is likely to fail or buying a house without being able to inspect for termites. Tens of thousands of older adults and people with disabilities end up with serious health complications or worse because their Medicare Advantage plans refused to cover the care they needed.

    Now, hundreds of rural hospitals are at risk of closure, in part because Medicare Advantage plans are not paying them as they should. Corporate insurers such as UnitedHealth and Cigna, which both cover care for people in Medicare Advantage and in the employer market, profit from denying care and coverage. Because the Centers for Medicare and Medicaid Services lacks the resources to oversee them properly, they can get away with these denials with impunity.

    Let your representatives in Congress know that you will hold them accountable if they don’t protect Medicare Advantage members and their hospitals from the bad actors in Medicare Advantage. At the very least, the government should be identifying the Medicare Advantage plans with high rates of delays and denials rather than giving some of them four and five star ratings.

    Here’s more from Just Care:

  • Rural hospitals need government help to survive

    Rural hospitals need government help to survive

    No American should have to travel long distances to get to a hospital, especially in an emergency. But, as more hospitals are being swallowed up into hospital systems and profitability becomes a prime focus, rural hospitals are a dying breed. Now, David Muioio reports for FierceHealthcare that 14 Senators from rural states are asking the Centers for Medicare and Medicaid Services, CMS, the agency that oversees Medicare, to increase payments to rural hospitals.

    The money is there. All CMS really needs to do is move some of the billions in excess payments from Medicare Advantage plans into these rural hospitals. As it is, CMS is paying the Medicare Advantage plans to cover care in rural hospitals, and the Medicare Advantage plans too often are delaying and denying payments to these hospitals to maximize their own profits.

    There has been a policy in place since 2019 to help hospitals with low wages, which are generally rural hospitals. The policy has helped hundreds of hospitals in 23 states. The policy was intended to address disparities between hospitals providing care in low-wage areas and those providing care in high-wage areas. And, the policy helps ensure that rural residents have access to the care they need.

    The Senators say in their letter to CMS that this policy has been a “valuable lifeline” for low-wage hospitals. But, it is set to sunset this year at the end of September. The Senators are requesting a four-year extension.

    As it is, pandemic funds to rural hospitals are drying up. And, the data suggests that rural hospitals are at great risk of closing this year. If CMS continues the policy, low-wage hospitals will be able to bring on needed staff, ensuring that residents in their communities can continue to use their services.

    Which senators are asking for the money? Mark Warner, D-Virginia; Marsha Blackburn, R-Tennessee; Tim Kaine, D-Virginia; Tommy Tuberville, R-Alabama; Joe Manchin, D-West Virginia; John Boozman, R-Arkansas; Shelly Moore Capito, R-West Virginia; Bill Hagerty, R-Tennessee; James Lankford, R-Oklahoma; Roger Wicker, R-Mississippi; Cindy Hyde-Smith, R-Mississippi; Tim Scott, R-South Carolina; Tom Cotton, R-Arkansas; and Katie Boyd Britt, R-Alabama.

    Congress has already helped rural hospitals a bit through some higher Medicare payments last year. Rural hospitals can also get a five percent increase in reimbursement for outpatient services if, among other things, they continue their emergency rooms, through a Rural Emergency Hospital designation. But, it is not clear whether the bump is worth the conditions.

    Here’s more from Just Care:

  • People living in rural communities disenroll from Medicare Advantage at a high rate

    People living in rural communities disenroll from Medicare Advantage at a high rate

    Sungchul Park, David Meyers et al. report in Health Affairs that people living in rural communities have far higher rates of disenrollment from Medicare Advantage into traditional Medicare than people living in urban and suburban communities. The disenrollment rate from Medicare Advantage to traditional Medicare is high in rural communities, and particularly high for people with complex and costly conditions.

    People don’t tend to switch from traditional Medicare into Medicare Advantage, be they people living in rural or metropolitan communities. But, for people living in rural communities, the converse is not true. They had high rates of switching out of Medicare Advantage and into traditional Medicare, and higher rates than people in Medicare Advantage living in cities. People living in rural communities who needed expensive treatments were especially likely to switch to traditional Medicare from Medicare Advantage.

    The authors hypothesize that people in rural communities leave Medicare Advantage because these health plans restrict their access to care and keep them from getting the care they need. But, they cannot say so with certainty. What we know is that rural Americans have higher levels of dissatisfaction with the quality and cost of care available to them through Medicare Advantage than other people with Medicare.

    Differences in health status did not explain why people in rural communities were more likely than other Medicare Advantage enrollees to switch to traditional Medicare. The authors did not find that people living in rural communities in Medicare Advantage plans were in worse health than people living in urban communities. Out-of-pocket costs also did not seem to be a larger driver of disenrollment in rural communities than in urban communities.

    Policymakers should take note that rural Medicare Advantage enrollees are not happy with the access to doctors and hospitals Medicare Advantage plans offer them. Congress might want to consider imposing more robust standards for network adequacy in rural communities so that rural Americans have access to more physicians and other providers. Congress also should consider ways to lure more providers to practice in rural communities and improve quality of care in Medicare Advantage in rural communities. Right now, Medicare Advantage plans do not appear to offer as good quality care in rural communities as they do elsewhere.

    The authors do not indicate whether some Medicare Advantage plans are better than others at meeting the needs of rural residents or whether all Medicare Advantage plans do an equally poor job. It is important that people understand that there can be substantial differences among Medicare Advantage plans, differences that can lead to poor or excellent health outcomes. But, as of now, some thirty years into the government’s experiment with private Medicare plans, people cannot know key differences.

    Here’s more from Just Care:

  • Rural hospital closures mean poor health outcomes for rural Americans

    Rural hospital closures mean poor health outcomes for rural Americans

    In the last ten years, 124 rural hospitals have closed, and hundreds more are at risk of closing. According to a new report from Chartis Center for Rural Health, rural hospital closings are leading to poor health outcomes for many rural Americans. If Congress continues to let market forces determine which hospitals thrive and which go under, it will leave rural Americans at serious health risk.

    Nearly 50 million people live in rural America, one in six Americans. Of the rural hospitals, Chartis reports that almost one in four (453) are at risk of closing. Nearly four in ten are unprofitable. Because many rural residents are uninsured and underinsured, rural hospitals deliver a significant amount of uncompensated care.

    Over the last ten years, Texas saw 20 rural hospitals close and Tennessee saw 12 close.  Oklahoma and Georgia each saw seven hospitals close. And, these four states have the most rural hospitals at risk of closing in the next few years.

    Medicare and Medicaid have helped rural hospitals over the last several decades. Rural hospitals are stronger in states that have expanded Medicaid than in states that have not expanded Medicaid. In states that have expanded Medicaid to people with incomes up to 137 percent of the Federal Poverty Level, the uninsured rate has dropped from 35 percent to 16 percent. Rural hospitals in these states are more often compensated for the care they provide than rural hospitals in states that have not expanded Medicaid

    Rural hospitals in states that have not expanded Medicaid are serving more uninsured patients and delivering more uncompensated care. The uninsured rate in those states for people with incomes under 138 percent FPL is 32 percent. These rural hospitals struggle to remain profitable.

    Not surprisingly, adequate health care is hard to come by for many rural Americans. People with chronic conditions in rural America are at greatest risk, particularly people with chronic obstructive pulmonary disease and diabetes.

    Americans living in rural areas have worse health outcomes, are more likely to be hospitalized, and are significantly more likely to die than people living in cities and suburbs. 

    Congress needs to step in to ensure that rural Americans are not forced to go without needed care. Medicare for All would ensure rural hospitals are paid for the care they deliver and guarantee rural Americans access to the health care they need.

    Here’s more from Just Care: