Hospitals and lawmakers are asking why the $6.2 billion the Obama administration requested for battling Ebola doesn't include any money to reimburse hospitals for the high cost of treating patients with the virus or preparing for the possibility of more cases.
U.S. hospitals have seen nine cases of Ebola in the past four months. Most of the patients were healthcare workers who had traveled to Africa to help treat victims at the source of the outbreak. They also include Liberian man Thomas Eric Duncan and two nurses who were infected while treating Duncan at Texas Health Presbyterian Hospital Dallas. Emory University Hospital in Atlanta took on four of the cases, including one of the Texas nurses. UMass Memorial Medical Center, Nebraska Medical Center, and Bellevue Hospital in New York City have also treated Ebola patients.
In several of these cases, the government specifically requested that the hospitals take them. State officials, meanwhile, have been working to designate a select set of hospitals across the U.S. as receiving hospitals for Ebola patients, and all hospitals are under intense pressure to acquire more personal protective equipment and provide more rigorous training for their employees.
The lack of support for hospitals' contribution to the Ebola response was seized upon during a hearing Wednesday of the Senate Appropriations Committee.
Sen. Mike Johanns (R-Neb.) has requested (PDF) that the federal government compensate the hospitals that have already handled cases and make a commitment to reimburse hospitals for any new cases, especially in the instances where the government asks a hospital to step in and help.
“Private insurers look at the cost of care of Ebola and it's through the roof,” Johanns said. “They will cover a minuscule amount, and it will come nowhere near to covering the cost of care.”
None of the hospitals that treated Ebola patients has requested reimbursement, HHS Secretary Sylvia Mathews Burwell said during the hearing. It was her understanding that the issue was being addressed between the hospitals and private payers, she said. She added, however, that HHS would use a portion of the requested emergency funds to pay hospitals if directed by Congress.
The unique costs associated with treating Ebola are not fully covered under current standard diagnostic codes used in Medicare, Medicaid or private insurers, Dr. Bryce Gartland, vice president of operations at Emory University Hospital, said in a written testimony.
“Guaranteeing financial sustainability for the regional centers designated to care for confirmed Ebola virus disease cases is critical to ensuring ongoing access to the best care possible,” Gartland said. “Caring for patients with Ebola virus disease effectively and safely is enormously resource consuming, far above and beyond usual care. To date, our experience in direct variable cost alone can approach $1 million for a single high-intensity case.”
Hospitals also have no recourse financially when they are asked to treat a foreign national with Ebola, according testimony submitted by America's Essential Hospitals, a trade group that represents safety net hospitals.
Committee Chairwoman Barbara Mikulski (D-Md.) agreed that the reimbursement issue was important and said she would meet with Johanns to discuss the possibility of adding language to the appropriations bill for the emergency funds.
“It's costly, and in this era of stringent reimbursement from both the private and public sectors, hospitals are already stretched,” Mikulski said.
The American Hospital Association, meanwhile, pointed out in a statement submitted to the committee that its members are assuming great expense to buy protective equipment and train their employees to handle the unusual threat presented by Ebola. Appropriations for the Hospital Preparedness Program have dropped to $255 million in 2014 from $515 million in 2002.
Hospitals that are agreeing to become designated Ebola treatment centers, the association said, require additional support. “We believe a dedicated funding stream needs to be provided to designated hospitals,” the AHA said. “In addition, we are working with a number of our designated hospital members to ascertain what level of funding they will need.”
The Obama administration wants lawmakers to provide $4.5 billion in funds for immediate response to the disease and $1.5 billion in contingency money. Of that, HHS is specifically requesting $2.43 billion in emergency funding not only to battle Ebola abroad, but to ensure states and other domestic stakeholders have the resources needed to prevent, detect and treat the virus.
Follow Virgil Dickson on Twitter: @MHvdickson
