Kansas editorial writers rarely consider that market forces and even government itself may have a bigger hand in painting a dire outlook for Kansas hospitals. St. Francis Hospital in Topeka faces intense competition from a hospital less than 1 mile away and changes to the way healthcare is provided, as the Sentinel noted last week. Owners of St. Francis warned on April 18 that operations will cease this summer “with or without another operator,” according to a press release issued by SCL Health, the non-profit parent of St. Francis.
“There has never been a more difficult environment for hospitals today, with health reform and its related challenges,” the release reads.
The release lists Medicaid expansion among its challenges as well as other public programs. St. Francis has long been cutting back on services due to decline in patients that made services too expensive to offer. This article in the Jeff County News discusses clinics being shut down, and this Topeka Capital-Journal story outlines the elimination of two surgery lines at the hospital.
St. Francis owners pointed a finger at state legislators for not expanding Medicaid. And when Mercy Hospital in Fort Scott, Kansas, announced it was paring down services, its president cited Medicaid as one of many causes like low volumes, rising costs, outmigration, and decreased reimbursement from all payer sources.
It’s odd the press ignores Medicare.
The National Rural Hospital Association points the finger at Medicare as a reason many rural hospitals are closing. Medicare is the federal health insurance program for people over the age of 65, while KanCare, Kansas’ version of Medicaid, uses state and federal money to provide health insurance to those with low incomes. Media cheerleaders conveniently forget that Congress took $716 billion from Medicare to pay for part of Obamacare and Medicaid expansion.
Fort Scott’s Mercy Hospital is a 69-bed, inpatient hospital in southeast Kansas.
According to data released in 2016 by iVantage Analytics, rural hospital closures are on the rise in large part due to continuing Medicare cuts. The study concluded that nearly one-third of all rural hospitals in America are in danger of closing.
“Our 2016 analysis suggests that the situation is worsening for many rural communities,” said Michael Topchik, iVantage senior vice president. “Each year, our study’s methodology is rigorously reviewed to ensure this benchmark report reflects the impact of many pressure points converging on rural health care.”
Kansas has a graying population. In Bourbon County, where Mercy Hospital is located, nearly 20 percent of the population is 65 or older. It borders Anderson, Linn, and Allen counties, each with more than 20 percent of their populations 65 or older.
Rural hospitals face increased financial challenges related more to Medicare reimbursement rates than Medicaid expansion.
Since 2010, more than 71 hospitals have closed. Many of the closures occurred in states that expanded Medicaid, but many close in states that didn’t expand Medicaid. According to the NRHA, cuts to federal Medicare reimbursements coupled with the Affordable Care Act, which favors high volume hospitals, are slicing into rural hospitals’ bottom line.
According to the NRHA, 683 hospitals across the country are at risk.
“Bad-debt reductions, sequestration cuts and other cumulative Medicare cuts hurt rural hospitals disproportionately hard, because per capita rural America is older, poorer and sicker than their urban counterparts,” Alan Morgan, CEO of the National Rural Health Association, said.
Congress cut Medicare payments by 2 percent in 2011, and reduced hospital reimbursement by 30-40 percent for Medicare patients who couldn’t cover out-of-pocket expenses in 2012. Medicare took a 2 percent hit again with the sequestration in 2013.
Media worked overtime to suggest that the closing of an Independence hospital, a different Mercy Hospital, was the result of Kansas’ failure to expand Medicaid. The media effort occurred in spite of Independence hospital officials listing a variety of problems including declining populations, utilization patterns, staff recruiting challenges, and shrinking reimbursement as reasons for their decision. There’s nary a mention of Medicaid in the press release announcing its closure.
“This was not the outcome we had sought or expected at the beginning of the discernment process, and our hearts are heavy,” Lynn Britton, Mercy president and CEO, said in a press release last fall. “However, like many other rural health care providers today, we have struggled to remain viable in the face of a changing environment and economy.”
Buckets of ink have been spilled covering the challenges Medicare and Obamacare present to rural hospitals, but Kansas media continues the disingenuous narrative that failure to expand Medicaid is killing Kansas hospitals.