Speaking to the largest hospital association recently, CMS Administrator Seema Verma expressed the frustration being felt by millions of patients on a routine basis: “Americans are fed up, not only are they paying more, but they aren’t being treated fairly. Like when they go to a hospital they think is in-network, and then receive bills from out-of-network providers.”
Verma further chastised hospitals for sometimes crippling families financially with aggressive collections efforts.
“This is unacceptable,” she told an American Hospital Association regional policy board. “Hospitals must be paid for their work, but it’s actions like these that have led to calls for a complete Washington takeover of the entire healthcare system.”
The hyperbole about a government takeover aside, Verma had a point. On both sides of the political aisle, lawmakers are stumping for government action in the face of industry inaction.
Is the industry listening? Sometimes it’s hard to tell … even when their motto is, “It’s your story, we’re listening.”
That’s the motto for Ballad Health, a 21-hospital system serving a mostly rural, 29-county region in Kentucky, North Carolina, Tennessee and Virginia. Ballad was formed in 2018 after two struggling health systems sidestepped antitrust concerns by federal regulators thanks to the go-ahead from state lawmakers.
Executives almost immediately embarked on a series of moves to consolidate operations, mainly in Tennessee and Virginia. Those actions, as Modern Healthcare’s Tara Bannow described in a detailed four-part series, created friction within the community.
While shuttering duplicative services may make fiscal sense, Ballad officials discount any opposition. System executives fall back on one of the industry’s most overplayed lines—healthcare is complicated. “I think it’s a smaller group that has a difficult time understanding the change and where we’re headed,” Lindy White, CEO of Ballad’s Kingsport, Tenn., market, told Bannow.
Contrast that with Maria Ryan, CEO of Cottage Hospital, a critical-access facility in Woodsville, N.H. Ryan closed the hospital’s birthing unit a few years ago. But before doing so, she spent “four or five years, sharing the financials with anybody and everybody,” she explained in a Q&A earlier this month. The birthing center was losing $500,000 a year. That community outreach, including a large town hall-style meeting, softened the blow when the unit closed.
Even when industry leaders agree that there’s a problem, their actions undermine potential solutions. On surprise billing, hospital and physician lobbies, mixed with dark money, have blanketed congressional districts with ads and op-eds warning against interference from Washington. Their messaging is drowning out a nuanced and legitimate policy debate.
Similarly, the industry has attacked a Trump administration proposal that would require hospitals to disclose rates they negotiate with insurers.
What patients really want, the AHA says, is information on out-of-pocket costs. True. Posting rates isn’t the perfect solution, but at least it’s an idea aimed at easing consumer angst.
Thankfully, inertia hasn’t set in everywhere. Some hospitals are being proactive. Memorial Healthcare System in Hollywood, Fla., has a web tool providing prices on more than 330 services. It matches that up against the patient’s insurance to determine their portion of the contracted price.
It wasn’t easy getting there, as Matthew Muhart, chief administrative officer, described in a recent commentary. There were a lot of excuses, he wrote. “No doubt many of you have heard some variation of, ‘it’s too complex’ … ‘there are too many variables.’ ”
At a time when Amazon, Walmart and others are offering consumer-friendly alternatives, the industry could use more examples like Cottage Hospital and Memorial Healthcare and fewer excuses that prolong the status quo.