Medicaid Block Grants – cup half full or half empty

cuphalffullMissouri Senate Bill 28 has not yet been assigned a formal hearing date on the Senate calendar but it’s already caused a lot of discussion.

Senate Bill 28 would allow Missouri to ask the federal government for a block grant to pay for its Medicaid program, MO HealthNet, each year.  The way things work now, the federal government picks up a portion of the cost of care for all of the services provided to Missouri citizens enrolled in the state’s Medicaid program.  Advocates for Senate Bill 28 say that the block grant, which delivers a set amount of money each year, would help to reduce health care costs to the state and give the state more control over how, and where, the program uses the money.  Proponents argue that a block grant could end up restricting care for those who need it most because once funds are used, or as covered services are eliminated, access to vital care is eliminated.

The bill does not outline how much money Missouri would request in a block grant or how much it would increase over time.  It’s estimated that it would cost the state more than $400,000 annually to apply for the grant.

There are almost 1,000,000 low income Missourians covered through MO HealtNet.  Income eligibility is the primary coverage determination and almost two thirds of those covered are children.

It seems logical that a block grant approach will require the state to reduce Medicaid coverage because funding is capped.  Cuts in funding will lead to reductions in access to care.  As access to care decreases it could drive more Medicaid patients to seek care in the Emergency Department setting which could drive cost to the state and place an undue burden on hospitals.

Funding Medicaid at the state level is a challenge and consumes a significant portion of the state budget.  A block grant will guarantee funding from year to year but at what cost?

When it comes to health care, cost can’t simply be measured in dollars and cents, cost is measured in lives and quality of life.

Block grant to fund Missouri Medicaid, cup half full or half empty?

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Improving access to health care services

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GVMH recently completed a large facility expansion to make access to health care services easier and more efficient for those we serve.  The recent expansion was close to 100,000 square feet and was focused on Outpatient Services as well as a new Emergency Department and new Surgical Suites.

We’ve seen a lot of growth in outpatient activity over the past few years and we were beginning to run out of space to meet patient demand.  The expansion helped us locate all of our outpatient services to one main corridor.  Hospital services have changed over time and more and more things are being done on an outpatient basis.  The addition has had an impact on how patients access our campus.  Prior to the expansion patients coming for outpatient services entered through the admitting entrance which was also shared by the Emergency Department.  Now the Emergency Department and Outpatient entrances are separate but both on the same side of the building and served by the same parking lot.

The Missouri Department of Transportation (MoDOT) recently announced a 50/50 cost share program.  The City of Clinton and GVMH partnered on an application and were awarded a grant to add a Right In / Right Out from 7/13 highway to the hospital campus.

You can see from the picture above the new entrance from the highway will cross Gaines Drive and enter the campus at the service road that runs between the Life Flight Eagle hangar and the new outpatient parking area.

The new highway access will make access to campus easier and more efficient for patients and visitors traveling to GVMH from the South and East and will make exiting campus for vehicles heading to the West and North easier and safer as well.

The 50% cost share opportunity offered by MoDOT made the decision to improve the access easy.  Without the cost share program the only way GVMH could have improved highway access would have been to pay for the project our on own.  The cost share opportunity will provide a very cost effective approach and we will essentially get $1.00 of improvement for every $0.50 invested.  The City of Clinton will oversee and sponsor the project while GVMH and MoDOT will split the cost evenly.

The work will begin soon and is currently out to bid.  Bids to do the work are due to the City by February 28 and work should begin mid-March with the intent of construction being complete by May 25.  We all recognize how much traffic through our community changes over the summer months and project completion by May 25 will allow for work to be complete prior to the Memorial Day Weekend or the official kick off to summer.

GVMH devoted a lot of resources to improve our physical facility to improve access for our patients, their families and visitors.  The new highway access will provide improved and efficient access to our campus for not only patients, their families and visitors but also to emergency vehicles.

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Community Health Needs Assessment

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One of the requirements of the Affordable Care Act is that not for profit hospitals conduct a Community Health Needs Assessment (CHNA) every three years.  GVMH last published a CHNA in 2014 and we are working to finalize our updated plan.

The purpose of the CHNA is to gain a better understanding of perceived health needs in the community and to increase collaboration between community medical providers.  Although GVMH is not required to conduct a CHNA due to our governmental status, we do believe there’s value in getting feedback from the community we serve regarding the health needs they feel need to be addressed.  There’s also value in collaboration and both Compass Health and the Henry County Health Center partnered with GVMH to complete the assessment.

The first step of the process is to pull together demographic and health data for the area GVMH primarily serves.  Henry and Benton County were included in the report.  Here’s a small sample of the data: the population has remained relatively flat for the area over the past three years.  State health rankings for health outcomes, length of life, quality of life and healthy behaviors are all below the Missouri rural norm.  Access to care and quality of care are above the Missouri rural norm.

The second step of the process is to conduct an online community survey.  The survey was conducted in October 2016 and community participation in the survey was very good.  The survey process identified drug abuse, obesity and smoking as the three greatest community health concerns in our service area.

On November 1, 2016, a Town Hall meeting was held to take a closer look at the health data and to gain a better understanding of the survey results.  The Town Hall meeting was open to the public and a good cross section of the public attended the meeting.  The most important aspect of the meeting was to gain better understanding and prioritize health needs that were identified through the survey process.

The following priorities were identified at the Town Hall meeting:

  1. Economic Development
  2. Drug Abuse
  3. Emergency/Urgent Care
  4. Obesity
  5. Healthcare Transportation
  6. Awareness of Mental Health Services
  7. Services for Autistic Children

The final step of the process is to create three year implementation plans to address the needs identified at the Town Hall.  Last Friday, GVMH, Compass Health, Henry County Health Center, City Officials, Clinton School District Administration and local law enforcement met to begin working on the development of implementation plans.  The process allowed us to identify parties who are primarily responsible for each plan priority and to identify partners or collaborators who will provide assistance in addressing the concern.

The final step of the process will be to complete implementation plans, identify cost to implement and then create a timeline.  Once the implementation plans are complete they will be approved by the governing boards of the three main collaborators, GVMH, Compass Health and the Henry County Health Center.  Following approval the entire plan will posted on GVMH’s and Compass Health’s websites for public viewing.

The CHNA process is valuable in helping to identify perceived community health needs and its valuable in initiating discussions between local health care providers.   It was great to see such a diverse group assemble last week to address community health concerns.  Once the CHNA is posted to the website I will put a reminder on the blog to encourage you to take a look.

Its a big process but it provides big value to the communities we serve.

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Now what? ACA repeal or replace

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Campaigns are built on promises and soon to be President Donald Trump promised to come up with “something terrific” to replace the Affordable Care Act.

Campaigning against the ACA is easy.  Doing something about it is difficult.  If the ACA were repealed, nearly 30 million Americans enrolled in health care marketplaces or covered by Medicaid expansion would have some disruption in coverage or lose it all together.  Democrats and Republicans have a hard time agreeing on anything and I’m not going to spend much time sharing what they won’t agree on.  Instead, let me share some things I do believe the two parties can come together on.

Like any new process the ACA has its pluses and minuses, there are opportunities for it to be improved and there are opportunities to recognize some of the benefits it has created.  It’s safe to say the ACA will change over the course of the next couple of years.  I believe both parties could agree on tightening enrollment rules to reduce cost and give insurers more flexibility to sell cheaper plans to young, healthy individuals.  I also believe both parties will be motivated to preserve the pre-existing condition exclusion in the health insurance marketplace and to allow individuals to remain on a parent’s plan up to age 26.  Creating more incentive for people to maintain continuous coverage from year to year is another option that might find middle ground.

The two sides could also come together on giving states greater flexibility in designing their own coverage system.  Slightly more than half of the states have expanded Medicaid and in those states more citizens have access to needed health care services.  States like Missouri, that have not expanded Medicaid, may be more willing to do so if they had the ability to expand Medicaid in a manner they believe will work best in their state.

Allowing insurers to sell insurance products across state lines should be an easy compromise.  For Republicans opening the marketplace falls in line with their desire to create a more business friendly environment by reducing regulation.  For Democrats opening the marketplace could be viewed as a way to increase coverage options and reduce cost.

The stakes are high for Trump when it comes to the ACA.  To some extent he’s an outsider to both parties and he will have to walk a fine line to gain support and trust from his party and he has an opportunity to set a tone of cooperation for the next four years with Democrats.  We all have a stake in hoping that any type of modification to the ACA whether it be repeal and replace or modification happens soon and doesn’t eliminate coverage for anyone.

Anyone who is currently covered has made a conscious decision that the price and benefit of their coverage is fair, otherwise they would not have opted for the coverage they have.  The longer the debate goes over what to do about the ACA the longer other pressing issues are placed on the back burner.  Issues like job creation, tax reform, immigration, trade and national security will likely not receive the attention they deserve until a health care deal is reached.

The ACA, or Obamacare, created President Obama’s legacy.  What happens next with the ACA, or Obamacare, could define President Trump’s legacy as well.

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Making memories

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Christmas is a special time and GVMH’s Oncology Staff made Christmas special for a young couple in their forties who are literally, fighting for their lives.

Battling cancer is tough and it’s a fight taken on by the entire family when one family member is diagnosed.  In the case of the couple that our Oncology staff surprised, both husband and wife are battling their own cancer diagnosis while supporting and nurturing the other.

The husband had been receiving services for more than a year and is fortunately now in remission.  Tragically, his wife was recently diagnosed with cancer and her diagnosis is more severe and the outcome uncertain.

Our caring and compassionate Oncology Staff took it upon themselves to arrange for a limousine to take the young couple, and their family, to the plaza to see the lights and enjoy dinner.

During a December appointment Oncology Staff surprised the wife with a gift certificate for the dinner and limousine ride.  As you can imagine the young woman was moved to tears as were our staff.

We’re blessed, our community is blessed and our patients are blessed that we have such caring and compassionate staff.  Our Oncology Staff took it upon themselves to spread Christmas cheer to a young couple who were having a hard time finding a reason to smile.

GVMH’s Oncology Staff helped to create a memory for a couple who have entrusted them with their care and they created a memory for themselves by extending that care beyond the walls of our facility.

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Wrapping Paper, 2016 Christmas Wishes

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Health care workers represent a lot of different functions and professions whether it be the obvious ones like doctors, nurses, therapists and medical assistants or those that don’t come to mind as readily like food services, engineering, environmental services and even administration.

No matter the role, health care is a difficult business and health care workers have some of the most difficult jobs anywhere. Take a minute to think about the day in the life of a hospital. We’re in the business of saving lives and bringing new life into the world. We are with people at the absolute happiest and saddest moments of their lives.

We deliver healthy babies everyday – what could be happier. We give great news on a daily basis – “your cancer is gone”. We reduce anxiety – “there’s no need to worry, you’re going to be fine”.

We deliver bad news everyday and delivering bad news is especially difficult for health care workers because health care workers go into health care to help people. Sharing bad news is almost as difficult for us as it is for the patient, and family, receiving the news but we never let them know because we have to be strong, or so we tell ourselves. We beat ourselves up when something goes wrong even when nothing could have been done differently. We help people understand how they can help themselves and then do not pass judgment when they choose not to – even though it breaks us up inside. We experience the ultimate highs and the ultimate lows in life – all in the same day and often in the same hour.

Health care is hard work but, no matter how hard, we come back the next day ready for more. The reason we come back is because of the thank you’s we hear and the thank you’s that can’t be said. We come back because there’s a chance to be part of a miracle every day. If you’re not in health care you have no idea how hard it is.

You think we get hardened over time and that we’re jaded. It just appears that way. What you don’t see is that we lie awake at night worrying about things we can’t control and try to fix problems that can’t be fixed. We feel our patient’s pain but our pain can’t be controlled with medication. We’re not able to smile during our patient’s happiest moments because our work requires our concentration even though our heart is about to beat out of our chest.

The job of a health care worker can’t be understood by anyone else, it can only be acknowledged. The job of a health care worker is a lot like the present under the tree. The present is neatly wrapped, looks shiny and perfect.

It’s not the wrapping paper that matters though. What sets the mind to wander is what’s inside but even the gift inside isn’t what matters. In the end what matters is the thought. Someone else thought enough of you to give you a gift. A gift, that while still wrapped, is only limited by your imagination. A gift, that when unwrapped, be it a shiny diamond or wool socks, makes you smile.

Whether the gift is something you’ve always wanted and thought you’d never have or something you’ll never use but someone else thought you might need really doesn’t matter. What matters is that someone thought enough of you to give you a gift.

For the health care worker every day is Christmas. Our patients are our gift. Every day of the year our patients are the shiny, wrapped gift under the tree. Part of our job is to unwrap the gift. We never know what we’re going to find on the inside but it doesn’t matter. What matters is that someone had enough trust and faith in us to share a portion of their life and life is the greatest gift of all.

The real joy in Christmas are the gifts we give not the gifts we receive. You give a piece of yourself to your patients everyday and they give their trust to you. Take a moment over the Christmas holiday to remove your wrapping paper and appreciate what you are on the inside because when all the gifts are gone from under the tree what matters most is who you are and what you give of yourself because that’s what health care workers do, they give a piece of themselves to every patient they encounter.

Merry Christmas.

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Repeal and replace – not so fast

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More than 290,000 Missourians have health coverage through the Affordable Care Act or Obamacare.  In the months leading up to the recent presidential election, the ACA was a sticking point for both sides.  President elect Donald Trump repeatedly called the ACA a disaster and promised to repeal and replace the law.

Repeal and replace makes for a good platform but is easier said than done.

President elect Trump’s stance on the ACA has changed a bit since the election.  His position has softened and he’s said publicly that he’s willing to retain certain aspects of the law and replace or eliminate specific portions.  Specifically, Trump has said that he hopes to keep protections for people with pre-existing conditions and to allow children to stay on their parents plans until their mid-twenties.

Republican members of Congress have been trying to repeal the law for years but they haven’t had the votes to do so, until now.  Republicans hold majorities in Congress and there will be a Republican President in January.  It will be interesting to see if repeal continues to be a priority or if prior discussions of repeal were posturing and rhetoric.

A complete repeal, without a replacement plan, would have severe implications on the health care delivery system and may cause the system to unravel all together.  I don’t foresee that happening.  Instead I would suspect that bits and pieces of the law are changed.  Trump is pro business so opportunities for insurance providers to sell across state lines may come into play.  An increased emphasis on health savings accounts might also be a priority.

I would suspect that Medicaid reform will be a priority at both the state and national level.   One way Medicaid could be reformed would be to switch to a Medicaid block grant system.  Trump hinted at using Medicaid block grants during his campaign.  A block grant system would allow for the federal government to disperse Medicaid funding to states and then states could create eligibility requirements.

Campaigns are full of promises and campaign promises, more than any other, are meant to be broken.  The ACA is the law of the land and the health care system has adjusted and is functioning according to rules.  A total repeal will be difficult and without a suitable replacement it could be disastrous.

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