(From BVHS President & CEO Myron Lewis)
This past week, I visited Capitol Hill in Washington, D.C. to speak with our congressional delegates and attend the American Hospital Association annual meeting. Throughout the week, several congressional representatives spoke from both sides of the aisle on healthcare through deep, rich, and strongly opinionated conversations. In the end, more discussions are needed and, as with any good resolution, both parties need to listen and find balance.
Healthcare is complex. Even understanding the difference between hospitals and insurance companies can be confusing. I hear from employers that their health insurance rates continue to rise in an alarming fashion (6-9% annually). I am not sure where those increased funds are distributed, but only a small portion are passed on to physicians or hospitals. Over 40% of Ohio hospitals are in the red (losing money) due to many variables including inflation, denials, and declining reimbursements. Meanwhile, health insurance companies are posting billions in profits quarterly.
There are several legislative and budget proposals under consideration that would jeopardize the ability of hospitals and health systems, including Blanchard Valley Health System (BVHS), to provide access to care for our patients and communities. Specifically, the Federal Government is looking to cut $880 billion over the next 10 years from the House Committee on Energy and Commerce which oversees Medicare and Medicaid spending. This is significantly more complicated than understanding the difference between a hospital and an insurance company. Medicare and Medicaid represent 38% of United States health spending. Since Medicare (at this point) is declared off limits by administration, that leaves Medicaid funding as the most likely target. Approximately 72 million people in the United States are covered by Medicaid. In Ohio, Medicaid covers over 50% of all births, nearly 12% of seniors, and 40% of children. Additionally, Medicaid is the primary coverage for nursing home residents in long-term care settings.
On average, Medicaid covers around 76 cents for every dollar of care provided, and Medicare covers around 82 cents, according to healthcare associations. To make up this underpayment, other forms of supplemental payment programs have been created at the state and/or federal level. This is where hospital reimbursement moves from complex to complicated. Unfortunately, none of us created this system but, for whatever reason, there has not been a strong interest in a one payer system, which would have the potential to simplify the administrative process.
Many programs that supplement the losses of Medicare and Medicaid are at risk today. The pharmaceutical companies are fighting to reduce their support for 340B drug pricing programs that help reduce the cost of drugs for hospitals. Additionally, the Department of
Health and Human Services (HHS) is looking to cut additional reimbursement that hospitals receive under “site neutral” payments that help cover the increased regulations imposed on hospitals and support access to 24-hour care. Other congressional members are aiming to reduce funding for programs that directly offset losses from Medicare and Medicaid.
BVHS and healthcare providers across Ohio are unable to sustain further cuts from the State, HHS, Centers for Medicare & Medicaid Services (CMS), or the one “Big Beautiful Bill.” Do we need to find solutions to lower the cost of care? Absolutely! Do we need to remove fraud, waste, and abuse across the country? Certainly.
We also need to work together to find solutions.
The tools we use in this pursuit are important. As an illustration, the incision a surgeon makes with a scalpel represents a much more deliberate approach than a hatchet. Likewise, we need to approach the complicated challenges ahead of us with precision. We need to diagnose these challenges and collaborate to address them carefully, keeping our community’s best interest at heart. This is why you will notice us taking actions such as forming the Ohio High Value Network to advance clinical and business initiatives that strengthen healthcare in rural communities.
We are fortunate in Ohio to have State and Federal Representatives and Senators that support access to care and want to hear from you. This is especially true for rural Ohio. I encourage you to reach out and let them know you support access to care in our community by visiting congress.gov/contact-us.
BVHS is committed to providing high-quality compassionate care for you and your loved ones. Supporting your local health system is important and appreciated, and there is no more important time than now to act. You can help by advocating for access to care, choosing to receive your care at BVHS, and referring your friends and family to BVHS.
We’re here for you. Thank you for being here for us.
Myron Lewis, MSW, MBA, FACHE
President and Chief Executive Officer
Blanchard Valley Health System
