The unsettled health care debate leaves hospitals lacking the one factor needed for a healthy bottom line.
“Predictability in our business is stability. Not being able to forecast where you’re going, what your revenue sources are, puts you in a state of uncertainty that is problematic,” said Carilion Clinic CEO Nancy Agee.
As president-elect of the American Hospital Association, Agee was involved in lobbying Congress as Republicans attempted to tally enough votes to advance the American Health Care Act.
“What a roller coaster,” Agee said. “I was stunned by the news last week when the bill got pulled, even though we expected they didn’t have the votes, you would assume they would manage to do something after all this time.”
Agee on Wednesday talked about her involvement in advancing the hospital association’s message in Washington, and about what reform means to Carilion.
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“Our message was twofold. One, all the people who got coverage need to continue to have coverage,” she said. “But the Affordable Care Act isn’t perfect. There are a lot of opportunities to repair that bill. To do this thoughtfully, that was our message. A lot of people in Congress did hear that and agree with that.”
Still, Agee said she became increasingly concerned about last-minute deals that would have cut Medicaid funds.
“Things worsened in my mind as they got closer to the vote,” she said.
Since the passage of the Affordable Care Act, Republicans have repeatedly voted to repeal it. The aim of the act was to provide health insurance to all Americans by creating marketplace exchanges for people without workplace coverage and subsidies to help pay the premiums, and by expanding Medicaid coverage to low-income Americans.
The insurance industry found that the exchanges weren’t working, as people would move in and out of them when they needed health care and fail to pay their premiums. Also, healthy people who would help spread the insurance risk were not purchasing plans.
Several Republican-controlled states, including Virginia, refused to expand Medicaid.
Agee said all of this had the effect of pushing the costs onto those with coverage, which led to higher premiums and high-deductible plans.
“The consumer is clearly concerned about health care costs because it’s crowding out their ability to pay for other things,” Agee said. “That’s at the heart of what we’ve got to solve, and honestly, I don’t think it’s going to be solved in a very long time.”
The debate is far from over. Congress and President Donald Trump could cobble together a plan that gains enough votes for passage. And the administration can make regulatory changes without congressional action.
“In the Affordable Care Act, there are some 700 times it says ‘the secretary shall.’ So it gives unprecedented authority to the secretary” of health and human services, Agee said. “There are opportunities for Dr. [Tom] Price to make changes.”
Agee said hospitals favor changes that would allow them to collaborate with private physicians, home health care services and nursing homes without running afoul of an anti-kickback law. They also would like to move toward bundled payments for services, which are antitrust violations under the ACA.
Several changes to Medicare under the ACA also should be repaired, she said.
Medicare terms some hospital stays as observation days and pays a reduced rate, even though patients get the same services, she said. Also, hospitals are penalized when patients are readmitted, which is problematic when treating chronic illnesses.
Agee said Carilion Clinic in the six years of the Affordable Care Act has experienced $100 million in reduced revenues and did not benefit from Medicaid expansion as the law intended.
She expects that she will continue to be busy on the national front.
“As providers we don’t know what’s going on. So my direction for our organization is we do what we do best. We take care of patients. We continue our strategies, but we’re very in touch with what’s going on nationally and regionally, and we’ll respond appropriately,” Agee said.