NRMC board adopts resolution on ObamaCare

Friday, March 3, 2017

jbrann.ndm@gmail.com

While the biggest news has already been reported from Tuesday's meeting of the Nevada Regional Medical Center's Board of Directors, several other important items need to be mentioned.

The board adopted a resolution related to the repeal of the Affordable Care Act, commonly known as ObamaCare.

Title III of the Affordable Care Act contains a provision, which essentially is a trade.

In exchange for hospitals accepting lower payments yet coming out in support of the original legislation, the government offered the prospect of significantly higher volumes due to more people having insurance.

Measured over 10 years, the payment reductions would exceed $9 billion.

Now that repeal of the Affordable Care Act seems assured, hospitals are naturally concerned about their reimbursement rates under any new legislation.

With the removal of mandates and penalties, Missouri hospitals project the number of uninsured to increase by more than 250,000. In turn, hospitals project lower overall patient volumes and, as a result, an increase in unpaid bills.

Missouri hospitals annually incur more than $1 billion of uncompensated costs.

The NRMC board voted unanimously to adopt a resolution, which states, "that if the Affordable Care Act's expanded coverage disappears and is not replicated, hospital payment cuts must be repealed and a plan implemented to provide coverage to the uninsured."

Earlier in the meeting, NRMC Chief Executive Officer Kevin Leeper, talked about the urgent need for action, "one way or another," on a prescription drug monitoring program.

A PDMP can flag those shopping for prescriptions from one provider to another and allow doctors to intervene, giving medical professionals a chance to identify those with opioid addiction as well as those seeking the drugs for sale.

Missouri has become infamous as the only state without a PDMP, a status it has held since 2014. While Missouri has not suffered the worst consequences nationally in the nation's opioid epidemic, the state has seen a steady increase in deaths, according to the Department of Health and Senior Services. The department's statistics show in 2015, 93 people out of 1 million in Missouri had died from opioid-related deaths in 2014, far above the national average of 59 per million.

Medical experts ascribe much of the epidemic to the over-prescribing of opiate-based painkillers like oxycodone, morphine and even codeine, which for many can produce an addiction in a single use. If an addicted patient can no longer get enough of those drugs, they may move to heroin or other illegal opiates, or they may try to doctor shop to feed that addiction.

In remarks separate from the meeting, Steve Russ, who is both NRMC board president and founding director of the local Celebrate Recovery program, said he has had people from the Fort Scott area who came to him early on in their addiction.

"I've had a number tell me how thankful they were caught," said Russ.

The PDMP did its job and a physician, dentist or pharmacist picked up on their hopping from one doctor to the next in order to get a prescription to support their habit.

"Those of us who deal day to day on the front lines of addiction, understand a PDMP is not single handedly going to solve the problem but this is an important piece which could help this situation," said Russ.

"This situation" refers to the nationwide opioid epidemic, which has seen overdose deaths surpass the number of deaths from traffic accidents and shootings.

Leeper told the board that the Missouri House has passed legislation creating a PDMP but a small group in the state Senate has filibustered the bill for five consecutive years in order to prevent a vote being taken. Procedural votes on each year's bill reveal it would easily be adopted if a straight up or down vote was taken.

At a study session held by Nevada's city council on Wednesday, Leeper spoke in support of the city of Nevada joining an effort to create a PDMP for Missouri, which goes around the legislature.

Hosted by St. Louis County and joined by the counties of St. Charles, Ste. Genevieve, Jackson, Cole and Lincoln as well as the cities of St. Louis, Kansas City, Independence, and others represent about 40 percent of the population of Missouri.

Vernon County's presiding commissioner, Joe Hardin, also attended the city study session and has previously indicated his support and willingness to have the county commission join the city of Nevada in participating in the St. Louis County PDMP.

The Long Term Care Unit -- which includes Barone Alzheimer and Moore-Few Care Centers -- reported a net gain of $14,475 for January. LTC has 246.8 cash days on hand.

Because the purchase of the Lovinger property, which involved a large amount of cash from LTC, was booked in February, the board was warned that the amount of cash held by LTC would see a dramatic drop in next month's report.

Federal and state regulations require hospitals to generate a lot of reports. Holly Bush, NRMC's compliance officer, provided an executive summary on seven areas of compliance and six quality outcomes.

Bush reported, "No hotline reports have been received this quarter" nor any medical record privacy violations.

While hospitals are where patients come to be treated for infection they can also be a place where infections are passed on. The American Hospital Association has a serious interest in seeing these significantly reduced and is "coaching" NRMC in its use of grant funds to address this problem. Hospital personnel are working to be more judicious in prescribing antibiotics while using more antimicrobials to reduce over all rates of infection.

The hospital carefully monitors sepsis. When a body has an infection, it releases a series of chemicals into the bloodstream to fight the infection. Sepsis develops when those chemicals cause inflammation throughout the entire body. Severe cases of sepsis can lead to septic shock and death.

Said Bush, "I take these things personally because family and friends of mine have been treated here and I want all our patients to be treated with the best evidence based medicine possible."

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