Regarding the Aug. 12 article Study shows safety net hospitals at crossroads by Jennifer Lubell:
Safety net facilities have no choice but to expand the outpatient business to continue to receive payments allowed by third-party carriers. The problem for the safety net plan or critical-access facilities is the old, outdated process of cost reimbursement. The more the regulators try to improve, the higher the expense. If the government and other regulatory bodies want to protect healthcare and access, maybe they should look at what has worked in the past and what is available today. A periodic payment system based on cost of operations mixed with the market service area of the facility would give capitated income, sure, but it would allow a constant operational cash flow to improve the management of the facility. Indigent care and emergency services could be funded through the operational mix. A socialized medicine concept with fixed capitated market bases could actually save the government money and stabilize healthcare services for the safety net facility.
Centralized safety net facilities should be eligible for the government-priced supply networks to allow them to hold down costs. Nursing and allied health personnel should be considered on the same principles of public health physicians. This would allow the employee rates to be held down for a period of time when working out contracts for education allowances. These comments are given only as potential improvements for controlling costs, as opposed to the most recent guidelines suggested by the Joint Commission and the CMS quality reporting that increase costs and do nothing for the safety net facilities trying to serve the local communities. I agree with quality standards and patient-safety protections, but why increase expenses just to have a reporting format in order to get higher payments. Put it back under licensure requirements instead of payment incentives. If a facility complies with facility standards, they will operate; if they dont, close them.
John NealMendenhall, Miss.
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