Becker's Hospital Review

8 Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 The 10 Biggest Hospital Stories of 2013 (continued from page 1) What other issues impacted hospitals and health systems the most during 2013? Following are 10 of the biggest stories covered in the pages of Becker's Hospital Review throughout the year. 1. Healthcare exchanges launch, with noticeable hiccups Much of the past year's news coverage concerning the PPACA focused on the state-based insurance exchanges, which opened for enrollment Oct. 1 and allow individuals and small businesses to purchase coverage. States had the option of running their own exchanges or marketplaces, allowing the federal government to run their exchanges or operating under a federal-state partnership in 2014. Those running their own marketplaces had to submit an exchange blueprint to HHS by December 2012, while those planning to find a middle ground between a state-run and federally facilitated marketplace had until February 2013 to submit their plans, according to the Kaiser Family Foundation. In total, HHS will support or fully run the exchanges in 36 states next year. Most of the remaining states running their exchanges independently passed legislation to authorize the creation of a health insurance marketplace. The governors of Kentucky, New York and Rhode Island created their marketplaces through executive orders. Meanwhile, the Obama administration launched outreach efforts, aiming to enroll 7 million people in the exchanges in 2014. These initiatives included navigator and in-person assistance programs to provide informational services for Americans who needed help in shopping for and enrolling in plans. HHS distributed $67 million in federal funds to navigator groups. Additionally, CMS signed agreements with web-based insurer broker firms to help enroll people in the exchanges, and HHS announced it would distribute more than $32.5 million to fund efforts to educate and enroll people living in rural areas. The exchanges hit some speed bumps shortly after launching. On the same day enrollment began, the government shut down for about two weeks as Congress struggled to compromise on a spending bill. The federal exchange website also experienced glitches such as crashes due to high traffic and dysfunctional drop down tools, but the Obama administration remained steadfast these problems would not jeopardize the Jan. 1 start of the individual mandate. the federal funds for the expansion didn't come through. For states that expand their programs, the federal government has vowed to pay 100 percent of the additional cost to insure the newly eligible beneficiaries for three years, tapering off to 90 percent by 2020. The issue didn't necessarily split neatly across party lines, with Republican leaders like Michigan Gov. Rick Snyder and Ohio Gov. John Kasich pushing for expansion despite conservative legislators' objections. Ultimately, safety-net providers in states that don't expand Medicaid will face a double-edged sword of pay cuts, since they will not have an expanded Medicaid patient population to lessen the burden of uncompensated care in addition to Medicare cuts under the PPACA. 3. Healthcare price transparency under scrutiny In February, journalist Steven Brill turned the healthcare world on its head in his explosive TIME exposé, "Bitter Bill: Why Medical Bills Are Killing Us." The article delved into the high costs of healthcare, the role of chargemasters and how hospitals profit from the lack of transparency throughout the system. It made ripples throughout the country, and it led to American consumers asking a fundamental question: Why are healthcare bills so expensive, and why don't patients know anything about the prices from the onset? Then, in March, Catalyst for Payment Reform and the Health Care Incentives Improvement Institute released a report that quantified how a majority of states have failed to enact comprehensive healthcare price transparency laws. The two groups graded each state on whether healthcare pricing information is available, how accessible it is and the scope of information available. Overall, 29 states received an "F" grade, and seven states received "D" grades. Since then, price transparency within the healthcare sector has become a major part of reform, catching hospitals in the crosshairs. For example, CMS released troves of data on the 100 most frequently billed inpatient charges and 30 most common outpatient charges, finding that hospitals prices varied wildly from market to market. This led some states, like North Carolina and Arizona, to enact laws requiring hospitals to post chargemaster prices of their most common procedures. And while this does improve transparency, chargemaster data rarely reflects the true costs to a payer or patient, further complicating matters. As employers continue to shift patients to high-deductible health plans, the demand for price transparency is expected to grow since patients will have to shoulder a larger portion of their healthcare costs. 2. States grapple with the decision of whether to expand Medicaid, impacting uninsured projections for hospitals across the country 4. Hospital and health system layoffs abound The healthcare reform law originally required state governments to expand their Medicaid programs to cover adults earning up to 138 percent of the federal poverty level in 2014. After the Supreme Court ruled in 2012 that Congress cannot penalize states for not participating, the expansion became optional. As of September, 26 states had no plans to move forward with Medicaid expansion, although some of those (for example, New Hampshire) were still weighing their options. Hospitals and health systems that resorted to layoffs this year generally cited one or a few of the following as reasons cuts were necessary: lower reimbursements from Medicare and Medicaid, lower inpatient volumes or an overall drive to improve organizational efficiency. In the final months of 2013, states were split over extending Medicaid eligibility under the PPACA, with some embracing the expansion, some rejecting it and others still debating the idea. The expansion became the subject of heated debate in many state legislatures after it became optional, with Republican representatives in states such as Pennsylvania and Ohio protesting expansion for reasons ranging from questionable fiscal sustainability to general objections to the PPACA. Some policymakers also expressed concerns about their states' finances if 2013 appears to have been the year of the layoff in healthcare. Almost every week, major hospitals and health systems nationwide announced they were cutting anywhere from dozens to hundreds of positions from their workforce. According to global outplacement consultancy firm Challenger, Gray & Christmas, healthcare organizations cut a total of 41,085 jobs through September 2013 through layoffs and other means. Several industry-wide forces contribute to those revenue-reducing factors, including states' decisions to not expand Medicaid coverage, leaving hospitals in those states with a larger uninsured population to care for; the federal sequester's 2 percent cut to Medicare reimbursement, which took a bite out of hospitals' bottom lines; quality improvement initiatives, which generally reduce the number of hospital admissions as patients seek care in outpatient settings; and uncertainty surrounding the implementation of the federal healthcare reform law.

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