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Friday, September 22, 2023

Rural hospitals rejecting Medicare Benefit? – Healthcare Economist

That could be the case. Fashionable Healthcare studies:

Final month, St. Charles Well being System threatened to chop ties with all Medicare Benefit plans subsequent yr, a transfer that would depart an estimated 26,000 native beneficiaries with out entry to a hospital lower than 100 miles away.
“The truth of Medicare Benefit in central Oregon is that it simply hasn’t lived as much as the promise,” St. Charles Well being System CEO Dr. Steve Gordon wrote in a information launch on the time. “A program supposed to advertise seamless and better high quality care has as an alternative turn into a fragmented patchwork of administrative delays, denials and frustrations,” he stated. The Bend-based nonprofit firm declined to make an government obtainable for an interview.

St. Charles Well being System isn’t the one one. The article goes on to say that rural hospitals are “disproportionately affected by components similar to reimbursement cuts or denied and delayed funds from Medicare Benefit plans as a result of Medicare enrollees make up most of their affected person populations.”

Rural hospitals are notably delicate as a result of enrollment in Medicare Benefit amongst rural beneficiaries has grown from 11% to 40% of all rural Medicare beneficiaries between 2010 and 2023.


On the constructive facet, plan alternative for rural Medicare Benefit beneficiaries has elevated, however this competitors has lead MA plans to purpose to decrease premiums and move via these decrease prices to hospitals with decrease reimbursement and reimbursement delays.


My FTI Consulting colleague Adam Broder was additionally cited within the article, stating:

“It’s like, ‘What’s the purpose of preventing about charges if we are able to’t even receives a commission?’” Broder stated. “They earn a living on the industrial contracts. The margins are simply a lot smaller from Medicaid or Medicare, and if they will’t receives a commission on time or correctly or within the full quantity, then that’s going to result in a dispute.”

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