전사 🔗
Welcome to Aging Health Matters, a podcast from Acentra Health, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today's show may help you or someone you know in their healthcare journey. Thanks for joining us. Now let's get started.
Hello everyone, I am Nancy Jobe, an Outreach Specialist for Acentra Health. Acentra Health is the Beneficiary and Family Centered Care Quality Improvement Organization providing services for Medicare beneficiaries in 29 states. And we have three key services for people who have Medicare: beneficiaries have a right to appeal discharges from the hospital and skilled service terminations. Acentra Health helps beneficiaries with Immediate Advocacy through helping to resolve any medical care issues that they may encounter. And beneficiaries can file a quality of care complaint with Acentra Health. You can find more information about this on our website at acentraqiocom.
We also work with many outstanding partners to help spread information about the Medicare program and its benefits. While we greatly appreciate their partnerships, we also want to be clear that the opinions and guidance expressed by them in this podcast are solely theirs or their agencies and are not necessarily those of the QIO, CMS, or the Medicare program. Please keep in mind that state-by-state guidance may differ as well.
We appreciate you all coming to our podcast to listen today, and today, we're going to talk about hospital associations and how they benefit Medicare beneficiaries or help Medicare beneficiaries. And today we have as our guest, Rich Rasmussen, the President and CEO of the Oklahoma Hospital Association. Rich, thank you so much for being our guest today. And could you tell us a little bit about yourself?
Yes, Nancy, and thanks for inviting us to participate. I've been the Hospital Association CEO here in Oklahoma for the last two years. Prior to that, I was five years in Montana and 28 years in Florida. So yes, I have gone from where it's very, very warm to it's very, very cold. And I'll tell you, you can still shake and bake here in Oklahoma too. So, it's nice to be where it's warmer.
It's a real delight to be able to have the opportunity to advocate on behalf of hospitals. This is what I've done for most of my entire career, spent a little bit of time on Capitol Hill. Spent a little bit of time working for Orlando Health before going to work for the hospital association. And so Nancy, what we do is we serve as the advocates on behalf of our member hospitals, our communities, our patients, and our clinical team members, and our real focus is ensuring that we deliver on the best that we can in terms of healthcare quality. And essentially, our motto here is that we're working together to improve health and health care in the state of Oklahoma.
That's a big order to fill, I'm sure with any of the state associations. Now every state does have a hospital association. Is that correct?
We do. Every state as well as our brothers and sisters in Puerto Rico as a territory. They also have a hospital association, and you'll find out that most of them are headquartered in their state capitals because a big part of what we do is advocacy, both on the state level and on the federal level, and so within each hospital association, if you've seen one hospital association, you've seen one hospital association. We all approach our policy development a little bit different from one another. Because we try to build it based on the politics and the headwinds and the environment that were operating in each state.
As our listeners hear your information about the hospital associations, they should check with their state hospital association because they could be doing different programs than maybe you're doing. But the main focus is, I'm sure, advocating for patients and providers.
Absolutely. You can look at our advocacy being political advocacy, but we also advocate in terms of what we're doing on behalf of our vulnerable patients. What we're doing on behalf of our Medicare patients. Let's just pause there on Medicare, for example. If you look at most states that have rural hospitals, they're participating in a Medicare beneficiary quality improvement program, MBQIP. And so, a lot of states, their hospital associations are working to assist their hospitals in improving their quality numbers as measured by MBQIP. Hospital associations have also, for over a decade, been focusing in on quality improvement as it relates to CMS’ focus on the work of hospital improvement networks, which became hospital engagement networks, which became hospital quality improvement collaboratives.
The bottom line is that hospital associations have helped our member hospitals focus in on the very quality measures and the strategy that CMS has had who is the overseer of the Medicare program. We have all worked together to do the work of improving quality, improving outcomes. And improving the best environment for our seniors to be able to continue to receive their care. And in so doing it impacts what we do in Medicaid, what we do in terms of serving folks that are privately insured as well as those who have no health insurance at all.
I can see where that is definitely a benefit to our Medicare beneficiaries listening today. As far as knowing that there's someone out there that's advocating for them and helping them to make sure that their stay in hospitals have the best outcome with good quality care so that is definitely a great role that the hospital association does. When we talk about hospitals, mainly people are just thinking, oh, when I get sick, I go to the hospital. That kind of thing. Are there other types of hospitals that are part of your association as well?
Well, we represent all of the hospitals in the state. So if you look at hospitals, you can kind of organize them in a couple different ways. If you
Load full transcript
think about traditional metropolitan hospitals, we tend to call them PPS hospitals, right? That's how we're paid. We're paid based on a prospective payment system. That's what CMS sets up, which is essentially, we're reimbursed based on your diagnosis as a patient. And if a hospital spends less money to get you well and to send you home than the government thinks we should, then we are able to keep that difference. If your health condition deteriorates and we spend more money to get you well and to send you home, we might lose money on you as a patient. That's the prospective payment system. It's based on a diagnosis.
We have hospitals that we call critical access hospitals. Those are very small hospitals that tend to be in our most rural communities, and they're reimbursed differently. They're reimbursed on what it actually costs to deliver the care to you. And then we have specialty hospitals that can fall into that PPS category. So that's how we tend to look at hospitals based on how we pay. Now from a licensure perspective and we again have all of those hospitals in our state and as do our peer states, from a licensure perspective, we would have what we would call acute care hospitals.
Those are hospitals that provide essentially all of the services that you would need, emergency care. They would provide surgery, things like that. We would have specialty hospitals, those that would may be focused in, for example, on orthopedics or on behavioral health. We might have a children's hospital. There are different ways in which you could define or different ways in which you could look at how the services are delivered or how they're reimbursed. But the bottom line here in Oklahoma, we represent all the hospitals.
Well, thank you. I learned a lot there myself, listening to all the different types of hospitals that are available because I know everybody kind of just thinks, oh, I go to the hospital and don't really give it much thought on that. But I have seen like long-term care hospitals, drive by them, and I'm like, what are those?
Yes. That would be an example of a specialty hospital, right? So their specialty is long-term care acute. If somebody is a ventilator patient, they may be in that long-term care acute hospital. There may not be the ability for them to be discharged to their home or to a nursing home because their level of intensity that they need for care is much higher, and we tend to see that in ventilator patients. We might see that in neurologically impaired patients. You know they've been in a traumatic accident, and they need neuro care. It might be someone who is potentially burned could be fit in that category. So long-term acute care is just what it is. They need acute care services for a longer period of time.
Thank you for that explanation. I know that you've been really busy advocating for different programs there in Oklahoma. And I'm just curious, can you share an initiative or a project that you are doing in Oklahoma that you're pretty proud of there?
Thank you. I appreciate that question. We have been working really hard. In OHA, we've stepped back when I got here, and we reimagined what we could do through our foundation. You know all foundations are charitable organizations. And so for us, we wanted to say, what could we do with what we have today, and how can we grow it, and how can we have even greater impact on outcomes and on quality in our state? And so we reimagine our foundation. We renamed it, rebranded it. It’s the Foundation for a Healthy Oklahoma, and the real focus is on that term healthy. And so again, stepping back, we looked at what we could be doing. And so one of the areas we immediately flexed into is working with our Oklahoma perinatal quality improvement collaborative, which is the collaborative that focuses in on making sure we have the best environment for moms and babies, and we were able to bring OPQIC up underneath our foundation, so we look at the quality work we're doing in our foundation. Now we have a real clear focus area for moms and babies. We have historically been very involved in quality improvement for the Medicare population.
Now we don't know what that's going to look like under a new federal administration, how that program is going to work, and if even if it will be continued. So we don't know the answer to that, but we continue to focus in on how we can improve the quality and the outcomes for our Medicare population. And so in that Medicare population, and I give you an example of one area we focused in on. Obviously, it's a very vulnerable population. Seniors are vulnerable. Look at my mom as an example. At 95 years old, trying to keep her in her home becomes more and more difficult. But coverage for her where she has historically been in a Medicare Advantage plan, we've now had to work to move her back into traditional Medicare, not knowing if her health condition will decline. And she might need skilled nursing or some other services that a Medicare Advantage plan may not offer or may not approve.
And so at OHA, we oftentimes find ourselves trying to communicate and educate seniors about the differences between Medicare Advantage and traditional Medicare. And so at OHA, we launched a website called MedicareDisadvantaged.com. It's just as it is disadvantaged dot com. Because what we wanted to do is we wanted to create a communication stream for seniors to better understand before you make a decision on whether you leave traditional or original Medicare, however, you define it, and move to a Medicare Advantage plan that you understand that you are waiving your rights away. Because now you're no longer with Medicare, you're with the private health plan. And so what happens when you do that? And questions you should be asking yourselves. Like the services that are being promised to me, are they really available in my community? And I will tell you if you're a Medicare Advantage patient in Buffalo, Oklahoma, guess
what? There's no health club there for you to participate in. There are no dental services there for you to participate in. There are no optometry services available for you there, so you think you're getting all of these additional benefits. You're not getting them in that community.
So for seniors to understand that it's really important. And if they do decide on a Medicare Advantage plan, what are the questions they should be asking themselves? Or if their spouse, partner, or dependent is doing the work for them to evaluate, what should they be asking themselves? And so, we launched this last fall during the Open Enrollment, and last fall, we had over two and a half million impressions to our website, all coming from Oklahoma. And we continued it. We adjusted our content beginning in January, as folks had the opportunity to switch out of an MA plan back to traditional Medicare during the second Open Enrollment, and we continue to see growth in the use of our website. So, I will use that as just one example of a project that we've worked on that really has impact on Medicare beneficiaries because we don't want to see our most vulnerable seniors exploited, and we know that there are some really bad behaviors through the sales or marketing of some of these health plans.
And that's evidenced by what we've seen Congress talk about, and certainly my understanding is the National Association of Insurance Commissioners are also asking Congress to give us some ability to monitor, manage, even, potentially sanction bad operators. And that's what we wanted to be able to do is to protect our most vulnerable seniors.
I understand that, and it's great that the hospital association saw that as a need and jumped in and are trying to protect the Medicare beneficiaries from making bad decisions when it comes to when they get hospitalized. They need to have the coverage and not all of the sudden find out, oh, I don't have that coverage. So that's a great piece that really complements the hospital association for sure.
One of the other things that we talked about was also I know that you have a quality of care program as well that's within your group. Can you just give me just a little quick input as to what their quality-of-care side of the hospital association does?
Sure. We have a quality council within OHA, and within that council, it's led by Emily Coppock, who is our Vice President of Clinical Excellence. Emily is a Masters-prepared nurse, and she was the director of quality for one of our largest health systems in the state. And so we were able to convince her to come to OHA, and she quickly saw the value of what we could do moving forward. Certainly, we've had a lot of good work that we've done historically, but where do we go moving forward?
And so our quality council was assembled, and in that, we have quality leaders from hospitals all across the state. Anyone who wants to participate in quality, we're going to welcome them in, and we're going
to find resources to support them in that effort. It's chaired by one of our board members, Trent Bourland, who is a hospital CEO from one of our critical access hospitals, who has a real passion for improving quality in our rural communities. And so they come together, and they focus in on what are the scope of measurements that CMS is looking at, and how can we learn from one another as we lean into improvement in areas where we as individually or as a field can do a better job? And we focus in on those, and we celebrate also where we have seen accomplishment.
As I mentioned earlier, what we're doing for improving the best environment for moms and babies. That's a focus area for our quality. What we were doing in terms of Medicare beneficiaries through what was, and we're waiting to see what the feds are going to do next, what was the hospital quality improvement collaborative. We focus in on that and where we are focusing in on some other areas in terms of rural health improvement, comprehensive lung screening across the state, which we have an involvement in, looking at social determinants of care, and where the association can have influence and improving that as well. And then our biggest goal is to utilize what we're doing in quality along with the strategic leadership that our board members and our hospital members CEOs have, and that is to move Oklahoma from a position of 47th nationally in health performance to a much better place, perhaps 35th by 2035. So that's our aspirational goal, and we have our foot to the pedal on that to move us into a better place. We're confident that we can continue to improve, and certainly that's a whole other conversation about how we're attempting to get there with the work that we're doing.
Well, I can see why you're always busy, Rich. That's for sure. Is there any last-minute thoughts or anything that you'd like to end our podcast with as far as to reach out to Medicare beneficiaries, and how they can maybe get a hold of the hospital associations in their states?
A couple things Nancy. I think they're real important for your listeners. One, yes, there is really no better organization that advocates on behalf of the Medicare population than hospital associations, than perhaps, you know, AARP or any other national organizations or other QIO, but hospital associations are working to ensure that our patients, Medicare, Medicaid, private, and our uninsured patients are getting the best care that they can receive in their communities, but there is a risk factor out there, and that's where I want to leave with your members. There's a real cloud that is hanging over the entire healthcare system in this nation, and that is what will happen with these Medicaid cuts that are being contemplated by Congress.
Now as a Medicare beneficiary, why would I care about Medicaid cuts? Well for a couple reasons; most states provide Medicaid coverage for Medicare enrollees if they can't pay for their out-of-pocket costs for Medicare. Medicaid is one of the biggest payers for nursing home care. And so, Medicaid is huge. But Medicaid also ensures that hospitals will have a payer source for our uninsured who are now are insured through Medicaid.
And so if we lose Medicaid eligibility, for example, in the expansion population, or if hospitals and physicians and others take a Medicaid cut, it will have a disastrous impact on health care because if you undermine what hospitals and others are doing to support our most vulnerable, it's going to have an impact on all of the rest of the patients as well because hospitals will be starved of resources. Hospitals will be forced to come back and look at our core businesses and say, OK, what is it that we have to let go because Congress has cut the Medicaid program?
We can no longer continue to make these appropriate investments. In our state, where we are at risk, if we lost Medicaid expansion in our state, everything that's wrapped up into that, it's about 2 1/2 billion dollar annual impact on our hospitals. Where are we going to make the cuts to right size that loss in revenue? We will make it by cutting services. We'll go there, but we'll also have to make it by reducing staff, and so just doing napkin math if you did it based solely on staff, we're talking about 38,000 jobs could be upended in Oklahoma if Congress went through on cuts like that.
And so for your listeners to understand, you may be sitting here thinking well, I'm a Medicare beneficiary, how's this going to impact me? What it's going to do is it's going to impact the people who deliver care to you if we receive cuts like this. If they want to be involved in helping to amplify their concern, there are places they can go, and certainly one of them is to contact their hospital association, and I would encourage you to check that out. And there are also resources that the American Hospital Association has made available too, and the American Hospital Association has a coalition, a national coalition that is focused on bringing folks together to share their concerns about these cuts and I think it's the Coalition to Protect America's Health Care. And so, I would encourage folks to check that out. But reach out to your state hospital association and say I'm concerned about this. I would welcome the opportunity to amplify my concern with our members of Congress.
Well, thank you for that closing statement. I'm sure that many of our listeners can at this point in time go check out their own states’ hospital association. See what kind of programs they are doing. Rich, I really appreciate you being a part of our podcast and wish you luck there in Oklahoma for all the initiatives that you are working on.
And please check the Show Notes.
And Nancy, I was going to say thank you for the work that QIOs do. Hospitals and certainly our hospital associations always look for opportunities to collaborate, and we appreciate the willingness to collaborate. It's when we come together and we unify our strategic goals of our organizations to improve health and health care for our patients, that's how we get better, and I just want to say thank you for the work that you guys are doing, and certainly your peer QIOs are doing around the country.
Thank you so much, Rich. I know we like to collaborate with our partners, and the hospital association is a great partner to work with. Thank you for listening to Aging Health Matters. Please go to our website at acentraqio.com and check out our other podcast topics or sign up for our newsletter for the most up-to-date information.