Joe Biden: My Plan to Extend Medicare for Another Generation
By Joseph R. Biden - NYT - March 7, 2023
Millions of Americans work their whole lives, paying into Medicare with every working day — starting with their first jobs, even as teenagers. Medicare is more than a government program. It’s the rock-solid guarantee that Americans have counted on to be there for them when they retire.
For decades, I’ve listened to my Republican friends claim that the only way to be serious about preserving Medicare is to cut benefits, including by making it a voucher program worth less and less every year. Some have threatened our economy unless I agree to benefit cuts.
Only in Washington can people claim that they are saving something by destroying it.
The budget I am releasing this week will make the Medicare trust fund solvent beyond 2050 without cutting a penny in benefits. In fact, we can get better value, making sure Americans receive better care for the money they pay into Medicare.
The two biggest health reform bills since the creation of Medicare, both of which will save Medicare hundreds of billions over the decades to come, were signed by President Barack Obama and me.
The Affordable Care Act embraced smart reforms to make our health care system more efficient while improving Medicare coverage for seniors. The Inflation Reduction Act ended the absurd ban on Medicare negotiating lower drug prices, required drug companies to pay rebates to Medicare if they increase prices faster than inflation and capped seniors’ total prescription drug costs — saving seniors up to thousands of dollars a year. These negotiations, combined with the law’s rebates for excessive price hikes, will reduce the deficit by $159 billion.
We have seen a significant slowdown in the growth of health care spending since the Affordable Care Act was passed. In the decade after the A.C.A., Medicare actually spent about $1 trillion less than the nonpartisan Congressional Budget Office projected before the A.C.A. reforms were in place. In 2009, before the A.C.A., the Medicare trustees projected that Medicare’s trust fund would be exhausted in 2017; their latest projection is 2028. But we should do better than that and extend Medicare’s solvency beyond 2050.
So first, let’s expand on that progress. My budget will build on drug price reforms by strengthening Medicare’s newly established negotiation power, allowing Medicare to negotiate prices for more drugs and bringing drugs into negotiation sooner after they launch. That’s another $200 billion in deficit reduction. We will then take those savings and put them directly into the Medicare trust fund. Lowering drug prices while extending Medicare’s solvency sure makes a lot more sense than cutting benefits.
Second, let’s ask the wealthiest to pay just a little bit more of their fair share, to strengthen Medicare for everyone over the long term. My budget proposes to increase the Medicare tax rate on earned and unearned income above $400,000 to 5 percent from 3.8 percent. As I proposed in the past, my budget will also ensure that the tax that supports Medicare can’t be avoided altogether. This modest increase in Medicare contributions from those with the highest incomes will help keep the Medicare program strong for decades to come. My budget will make sure the money goes directly into the Medicare trust fund, protecting taxpayers’ investment and the future of the program.
When Medicare was passed, the wealthiest 1 percent of Americans didn’t have more than five times the wealth of the bottom 50 percent combined, and it only makes sense that some adjustments be made to reflect that reality today.
Let’s ask them to pay their fair share so that the millions of workers who helped them build that wealth can retire with dignity and the Medicare they paid into. Republican plans that protect billionaires from a penny more in taxes — but won’t protect a retired firefighter’s hard-earned Medicare benefits — are just detached from the reality that hardworking families live with every day.
Add all that up, and my budget will extend the Medicare trust fund for more than another generation, an additional 25 years or more of solvency — beyond 2050. These are common-sense changes that I’m confident an overwhelming majority of Americans support.
MAGA Republicans have a different view. They want to repeal the Inflation Reduction Act. That means they want to take away the power we just gave to Medicare to negotiate for lower prescription drug prices. Get rid of the $35 per month cap for insulin we just got for people on Medicare. And remove the current $2,000 total annual cap for seniors.
If the MAGA Republicans get their way, seniors will pay higher out-of-pocket costs on prescription drugs and insulin, the deficit will be bigger, and Medicare will be weaker. The only winner under their plan will be Big Pharma. That’s not how we extend Medicare’s life for another generation or grow the economy.
This week, I’ll show Americans my full budget vision to invest in America, lower costs, grow the economy and not raise taxes on anyone making under $400,000. I urge my Republican friends in Congress to do the same — and show the American people what they value.
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American Health Care Is Dying. This Hospital Could Cure It.
by Ricardo Nuila - NYT - March 9, 2023
A few months ago, I had to give a patient the worst news.
“It looks like your cancer has returned,” I said.
The man had religiously attended his chemotherapy and radiotherapy sessions in the city’s public health care system up until nine months before. Looking for a little more scheduling flexibility with his appointments, he took a step that seemed logical.
“I got health insurance,” he said, the eyeglasses on his forehead still for a moment. “Everything changed from there.”
Health insurance was supposed to improve his medical experience, but my patient couldn’t find an oncologist or hospital — even in the public system — that accepted his particular type. After months of searching, he grew discouraged; eventually he gave up. “A lot of this is on me,” he told me, ruefully.
This is the level of confusion and complexity we’ve come to accept as normal in our health care system.
I work as an internal medicine doctor at Houston’s Ben Taub Hospital, which is part of a public health system that treats Harris County’s most vulnerable patients, many of whom don’t have insurance. I often see the back end of our insurance fiasco: I’ve cared for dozens of patients who were sent to our E.R. hours after receiving inadequate treatment elsewhere. I’ve felt the injustice of a patient dying after he was dropped by his insurance. I’ve also seen patients hit with unexpected medical bills showing arbitrary prices after visiting the emergency room of a private hospital.
Visiting a hospital or clinic today feels like facing a firing squad, with rounds and rounds of bills coming from every direction. Fewer than half of Americans rate the quality of U.S. health care as excellent or good. We all have our stories. Whether through Twitter rants or opinion pieces or surveys quantifying how many of us grade the system as a failure — 56 percent at last count — we are fed up.
Patients are burned out. Nurses are leaving the profession. Doctors are demoralized. In the meantime, the people not sick or tending to sickness — the corporate middlemen in charge of insurance companies, private hospitals, doctor practices and pharmaceutical companies — are feasting. As Donald Berwick, a former administrator for the Centers for Medicare and Medicaid Services, noted, the “glorification of profit, salve lucrum, is harming both care and health.”
After listening to partisan rants on both sides that aim only to tweak rather than remake our system, I suggest we hold a national referendum on health care. Americans should vote yea or nay on a system that provides basic health care for all.
A federal ballot measure like this has never been held in our country. A referendum would ask Americans to focus on the proposal rather than on a candidate or political party. There’s reason to believe that a direct vote could help us solve our health care quagmire. In a recent survey, about two out of three Americans said it was the government’s responsibility to provide universal health coverage. Another study conducted in my home state showed the same, with seven out of 10 Texans declaring universal health coverage important.
It won’t be easy. Scholars have indicated that it may take multiple election cycles, along with volunteers collecting millions of signatures across the country, to achieve such a monumental feat. Americans are already split about how private insurance would figure into the equation. If history is any indication, those who benefit from our bloated system — the large corporations that keep American consumers in a stranglehold — would brew confusion about the plans in an effort to resist any change.
If the referendum resulted in a majority of “yes” votes, it would send a clear message to Congress and the president: Build us a universal health care system. The hard work of constructing that system and a way of paying for it would start there. Medicare for All, as proposed by Senator Bernie Sanders, would eliminate private insurance that duplicated what was offered in the single-payer system. This standard insurance would eliminate patients’ out-of-pocket expenses and make it harder for hospitals and doctors to cherry-pick those with more lucrative insurance. Multiple iterations of single-payer plans have sprung from Medicare for All, including some that would preserve private insurance. An altogether different plan, a public option, would preserve Americans’ choice to buy private insurance. The drawback would be that without a mandate, health care gaps would most likely still exist.
Controlling health care costs is a problem that has long confounded Americans. For this reason, I favor something different, a public health care system modeled after the one I’ve worked in for the past 12 years. The system provides health care directly — without the middleman of insurance — to nearly half its patients. When it bills a patient’s insurance, the system does so at a reasonable rate, on par with what Medicare pays.
As a resident, I rotated through private hospitals and saw how easy it is to default toward more expensive treatment. In a public system, doctors like me work on salary without financial incentives to overutilize tests or procedures, which further keeps costs in check and patient outcomes top of mind. The lack of a profit motive allows the system I work in to focus on providing quality care while cutting costs. In fact, in 2022, Ben Taub Hospital and the public system saved more than $1.8 billion in health care costs. This amounts to $2.30 in health care cost savings to Harris County taxpayers for every $1 in county taxes collected.
The public health care system in Harris County came into existence thanks to a local referendum in November 1965. The charity hospital that preceded it, Jefferson Davis Hospital, was notoriously underresourced and underfunded. When news spread of its deplorable conditions, citizens decided that the city’s standards had to be addressed. Health care had become a moral issue.
I’m not a specialist; I’m the hospital’s jack-of-all-trades, the doctor tasked with keeping care effective and efficient. As a hospitalist, I don’t have to spend time figuring out if an insurance company will authorize a patient’s treatment. Not worrying about reimbursements means I can focus on medicine. Ours are not easy jobs — our patients often arrive with undiagnosed diseases resulting in one or more organs failing — but at least we can provide good care to everyone. More than 50 years later, it remains as such. I take solace in knowing that I work for a system that tries to help all patients.
After the news sank in of his cancer’s return, my patient asked that I sit down with him. He had things on his mind, questions. He confided to me that his family didn’t know about his illness, and I told him how much I wished he had stayed at Ben Taub and that things had been different. I began to tell him what kind of treatments he might still expect. He stopped me. “I appreciate this hospital so much,” he said. “Y’all are here when no one else is.”
https://www.nytimes.com/2023/03/09/opinion/american-health-care-hospitals.html
Maine launches campaign to ensure MaineCare recipients don’t lose health insurance
by Joe Lawlor - Portland Press Herald - March 8, 2023
Beginning April 1, Maine and the rest of the nation will start shifting people who are no longer eligible for Medicaid to other forms of health insurance coverage.
During the pandemic, Medicaid recipients were allowed to keep their coverage even if they became ineligible. Some are no longer eligible because they now qualify for employer-based coverage, their wages have grown and they now are eligible for Affordable Care Act coverage, or they have reached 65 years of age and they are eligible for Medicare.
About 420,000 Mainers are expected to be receiving Medicaid in April.
Medicaid recipients who lost eligibility were allowed to remain enrolled during the COVID-19 pandemic to make sure there were no gaps in health coverage. But with the pandemic easing, Congress approved an omnibus spending bill last year that requires states to update their Medicaid rolls. States must now ensure that people who no longer qualify are not still receiving the coverage.
Maine estimates that 65,000 to 90,000 people who are ineligible now, or will be within a year, are still receiving Medicaid. Medicaid – called MaineCare in Maine – is insurance for low-income residents funded with a combination of federal and state dollars.
Jeanne Lambrew, Maine’s health and human services commissioner, said in a news conference Tuesday that many people may not realize they are no longer eligible. The state is setting up the “Stay Connected to Stay Covered” campaign to help people switch to other health insurance. A website called MyMaineConnection.gov provides information, and people can also call 855-797-4357 for assistance.
In addition, the Maine Department of Health and Human Services will be mailing reminders to people on a rolling basis, based on the month they originally signed up for MaineCare. Enrollees who receive a mailer from MaineCare with a blue block image will know it is the form to either renew or to determine if they need to find other insurance.
“Our goal is to make this as easy as possible,” Lambrew said.
Ann Woloson, executive director of Consumers for Affordable Health Care, which is partnering with DHHS to ensure Mainers maintain health coverage, said the agency “is taking steps and making a good effort to inform people that they will need to update their contact information and also will need to update their MaineCare eligibility information.”
Mainers are eligible for MaineCare if they earn up to 133% of the federal poverty level. Those who earn more will qualify for Affordable Care Act plans – those just over the MaineCare eligibility threshold can often get ACA plans with premiums of less than $25 per month.
Lambrew said it’s unclear what percentage of the 65,000 to 90,000 will migrate to ACA plans or employer-based plans. But once everyone shifts to plans they quablify for, there should be relatively few uninsured Maine residents.
Maine’s uninsured rate declined from 8% before the state expanded Medicaid in 2019 to 5.7% in 2022, according to the U.S. Census. Some people remain uninsured because they choose to do so, or simply because they neglect to sign up for Medicaid or an ACA plan even though they qualify.
How Mass. and RI are pushing back against the rising cost of healthcare
by Luis Hernandez - NPR - February 22, 2023
A handful of states are trying to address the problem by holding insurance companies and providers accountable.
The cost of healthcare in the U.S. has skyrocketed over the past fifty years, a problem that’s become unsustainable for many Americans. Massachusetts has been trying to tackle the issue by holding hospitals, doctors and insurance companies responsible for spending – and other states, including Rhode Island, are following their lead. Alex Olgin is a reporter-producer for the health policy podcast, Tradeoffs, which recently released an episode examining these efforts to curb costs. She spoke with our morning host Luis Hernandez about what Massachusetts and Rhode Island are doing, and what impact these programs have had.
This interview has been edited for length and clarity.
TRANSCRIPT:
Luis Hernandez: So Alex, in your podcast, you pointed out that healthcare costs for individuals and communities have grown it seems almost exponentially over the last few decades. But can we point to something and say why?
Alex Olgin: Yeah, it's crazy. And there are actually several reasons why this is happening. I would say retail pharmacy drugs spending has shot up, hospital inpatient spending shot up. Paying for physicians is much more expensive, like doctor's office visits, is much more expensive. And as to why this is happening, I would say that there – ever since the Affordable Care Act went into law in 2013-2014, there has been a rise in high deductible health plans, which really just put consumers much more on the hook for these high prices. And so they're feeling it a lot more than they may have in the past. But health spending nationally has gone up also, for more people getting medical services, but really, it just, a lot of comes a lot of it comes down to prices. … You know, we're not that much sicker than European countries, we just pay a lot more for health care.
Hernandez: So the state of Massachusetts started to tackle this even before that, going back to 2012. What, what has that state been doing? And what kind of impact has it had?
Olgin: So what the state has been doing is, they tied health care cost growth year to year to the state's overall economic growth. And the plan was to say to insurance companies and hospitals and physicians, like, we got to get this in check. We're not saying we should get rid of your profits or that you shouldn't grow, but you shouldn't be growing at these crazy high rates, because it's just making it unaffordable for consumers. And so they would analyze whether or not the health insurance companies, hospitals, and physicians met these targets. And in the beginning, they were doing a pretty good job meeting the targets. … One of the reasons that was the case is because they wanted to avoid public embarrassment. And so when they were going into negotiations with insurance companies, they were keeping their rates to the target, or, you know, below the target. But it started to fade a little bit when they realized, you know what, there aren’t that many consequences. Now, to be fair, there have been a lot of changes. Inflation's a lot higher. The pandemic has sort of set things all off. And so that is why, in the past couple years, they haven't met the targets as much. But one of the insurance executives that testified before the commission in the past couple years has said, look, when hospitals go into rate negotiations with us, they no longer see this target as what we need to meet. They say it's unrealistic, and it's unaffordable.
Hernandez: So numerous other states look to Massachusetts to really, to copy the idea. And Rhode Island, of course, is one of them. And I wonder, you know, what do these efforts look like in Rhode Island right now?
Olgin: So Rhode Island is doing a couple things. It is implementing this cost growth target. It's kind of new, there's only been one year of data, which is 2020, which is really off because of the pandemic. But Rhode Island has been doing something also in addition to the cost growth target for years, that has actually made a sizable difference. The health insurance commissioner for the state has this extra authority to approve insurance company rates. And they have these standards to make them affordable. And so they actually limit how much hospitals can charge through the insurance companies. And all kinds of analyses have shown that that's actually had a really significant impact on lowering spending, something like lowering it 8% over several years. And that's compared to if they hadn't done that.
Hernandez: You touched on this a little while ago, and I’m wondering, you know, the program has a limit on how much any hospital or insurer can be penalized. So I'm wondering, you know, does it really have any bite? You know, because if that's, if there's a limit, is it really a deterrent?
Olgin: That's a good question. I think that some policy experts and organizations would argue that it's not enough of a deterrent. Some other states, like Oregon and California, which have implemented similar programs have upped those penalties. So they can charge organizations that go past the target, the, like the amount they've gone past the target, or they can penalize them in relative comparison to their size. … So that's one thing. And then … providers, hospitals have not really faced this kind of scrutiny by state governments, and – on their rates. And so there is some argument that hospitals are just, they don't want the bad press, they're more aware of this. So even if there isn't a huge financial deterrent, some people I spoke with in my reporting have said they are going to be – they're going to want to avoid the public embarrassment, the bad press, and they're going to want to keep their prices more in check.
Hernandez: We talked about the drug industry, we talked about hospital costs, but you mentioned insurance, and I wondered, what is the role insurance companies play in this, you know, in the price hikes? What part do they play? And how is, again, how is this issue in Massachusetts dealing with them?
Olgin: They play a huge role because, like I said, especially for commercial, for private insurance, people that get their insurance through their employer. They, those rates are negotiated by insurance companies – and how much they increase premiums, a lot depends on how much prices are increased and how those negotiations go. And like, especially in Rhode Island, insurers have a huge role, because that is how the local government in Rhode Island is regulating prices, is through insurance companies. So they have a big role to play in Rhode Island. And actually the cost, the annual hearings that happen in Rhode Island where they analyze whether or not organizations meet this spending target, they analyze it through insurance companies. And they break it down and say, which insurance company met the target, which exceeded it?
Hernandez: You know, since all of this started, have costs really gone down since Massachusetts, launched this, this commission and started working on this? I mean, have we seen a reduction in costs?
Olgin: So here's the thing that's not that sexy about this is that it's not supposed to bring costs down, it's supposed to slow how fast they grow. So I think realistic expectations are not that costs are going to go down. And it, as a consumer you're like, well then how am I going to see this in my bills if they're just going up less fast? These cost growth target programs are a starting point. The policy experts I spoke with say these alone are not going to be enough to lower prices. You have to do things in addition to it, implement policies on top of that to actually lower prices.
Hernandez: Fantastic, Alex, I really appreciate it. Thank you so much.
Olgin: Thank you.
With no place to go, some patients in Maine spend months in hospitals
A lack of beds and staffing at assisted living facilities and nursing homes creates an unwelcome situation that benefits neither the languishing patients nor the hospitals shouldering their care.
by Joe Lawlor - Portland Press Herald - March 5, 2023
Susan Cameron spent 164 days this winter in the same small hospital room at Southern Maine Health Care in Biddeford – a gray room with a view of the parking lot.
Cameron was ready to be discharged weeks after being admitted for a series of breathing problems. But, like hundreds of other patients around the state, the 76-year-old remained hospitalized longer than necessary – in Cameron’s case months longer – because she could not find a bed in a nearby assisted living facility and was not well enough to go home.
Hospital officials say there’s a glut of patients stuck in the same limbo, although there is no statewide data to measure the scope of the problem. The backup is creating a domino effect, hampering patient care and jeopardizing the finances of health services, both at hospitals and long-term care facilities.
It’s a bottleneck that is straining hospitals and frustrating patients nationwide. Staffing shortages at long-term care facilities, such as nursing homes, rehabilitation centers and assisted living centers, are the primary driving force behind the problem.
“I got here Sept. 4 and I’m still here,” said Cameron on Feb. 16 from her hospital bed, hours before she was finally discharged. But Cameron said she understands her predicament was not the fault of the hospital, but rather a lack of supply at nursing homes and assisted living facilities.
“What were they going to do?” she said. “They couldn’t put me out in the street. So here I am.”
Cameron was discharged on Feb. 16 to St. Andre Health Care rehabilitation center in Biddeford. Cameron suffers from COPD and other breathing issues, and she needs a BiPaP – bilevel positive airway pressure – machine to breathe.
While hospital officials say Cameron’s situation is far too common in Maine, it’s difficult to quantify as statewide data on how many patients are languishing in hospitals is lacking.
But there are signs the problem is acute.
As of Friday, Maine Medical Center in Portland alone had 50 patients who were ready to be discharged but remained stuck at the hospital while waiting for a bed in a long-term care facility.
At Eastern Maine Medical Center in Bangor, the hospital created a “discharge unit” for patients who are ready to be released but don’t have a place to go, said Christopher Laird, associate vice president for nursing operations at Northern Light Health. Laird said the 27-bed discharge unit is filled up, and there’s a waiting list.
“The system is stretched right now, in every aspect,” Laird said.
‘UNSUSTAINABLE’ PATH
Hospital officials and those representing the long-term care industry paint a grim picture.
A severe workforce shortage at nursing homes, skilled care and assisted living facilities means the supply of beds for patients to be discharged to is low, while the demand for beds is high.
Despite being licensed for more than 6,300 beds, Maine nursing homes were only able to house and care for about 5,100 residents, according to a November 2022 report. Overall nursing home utilization has declined by about 10% since 2018, according to state statistics.
“Hospitals are not designed for people to live in,” said Katie Fullam Harris, chief government affairs officer for MaineHealth, the parent company of Maine Medical Center and seven other Maine hospitals, including Southern Maine Health Care. “They are meant for acute care for people who need that level of care.”
Angela Westhoff, executive director of the Maine Health Care Association, which represents long-term care facilities, including nursing homes, said 84% of the facilities reported in a December survey that they had staffing shortages. About 10% of the workforce has left the industry, and so far people are not coming back, she said.
“We’ve had more people exiting the profession than ever before,” Westhoff said. “It’s difficult work emotionally, and hard on the body. If you can make $20 an hour flipping burgers, or working at a convenience store, well, that’s a tough choice.”
Laird said the pandemic exacerbated health industry workforce shortages, and that many people across all professions have stopped working in health care. He said health system recruitment and retention should be a top priority.
But recruiting and retaining employees in a tight labor market takes money.
Westhoff said with low reimbursement rates by MaineCare for services, it’s difficult to pay competitive wages. And long-term care facilities have been forced to pay traveling employees, sinking millions into temporary workers. Fifteen long-term care facilities have closed since the pandemic, Westhoff said. Wages vary, and nursing homes have been forced to pay more despite not having the funding to do so, but are often paying less than $20 per hour for unskilled labor.
“It’s creating this perfect storm,” Westhoff said. “The path we are on is unsustainable.”
Westhoff said there’s at a minimum $60 million that needs to be infused into the system with state or federal dollars, which would allow long-term care facilities to pay competitive wages. The Mills administration agreed to spend $25 million in one-time federal money to help nursing homes. Westhoff said while that’s helpful, it’s only putting a Band-Aid on the problem.
“It’s very helpful, but it doesn’t close the gap,” Westhoff said. The Maine Department of Health and Human Services is conducting a comprehensive rate review to reform how nursing homes and other recipients of MaineCare funding are reimbursed. But the rate review is expected to take years, and Westhoff said the problem is immediate.
“How many more facilities are we going to lose in the next two years before we get to the next reimbursement rate?” Westhoff said.
Jackie Farwell, spokeswoman for Maine DHHS, said in response to severe workforce problems at nursing homes that the agency “continues to explore opportunities to address nursing facilities’ concerns in the near term.”
Maine already has a short supply of licensed nursing home beds despite being one of the oldest states in the nation. According to the Kaiser Family Foundation, Maine’s licensed-bed supply was the sixth-lowest in the nation.
Farwell said that in addition to examining what to do in the short term, the state has recently increased funding for long-term care facilities, and is working on longer-range solutions.
“As of December 2022, occupancy at nursing facilities across the state is higher than it’s been over the last two years,” Farwell said. “Enrollment is up in several home care programs, and wait lists have declined. Although the improvement is slight in some cases, the positive year-over-year data across a number of services suggest that providers have been able to reduce staff vacancies in the past year and the direct-support workforce is stabilizing.”
Farwell said the budget includes $47 million in cost-of-living adjustments for long-term care facilities, and the federal government sent $50 million directly to nursing homes as part of COVID-19 relief efforts.
“Maine is making progress in restoring access to a range of long-term support services in the wake of the pandemic,” Farwell said.
Westhoff said aside from increasing reimbursement rates, another idea to alleviate the workforce shortage is to offer free community college to workers such as CNAs – certified nurse assistants – and nutrition and housekeeping jobs at assisted living facilities. That would give workers an incentive to take these jobs, she said. A bill before the Legislature would make community college free for such workers.
Harris, the MaineHealth chief government affairs officer, said a similar dynamic is playing out with patients hospitalized for psychiatric reasons who need to be discharged to residential treatment, but can’t get into programs because of a lack of supply.
DELAYED DISCHARGES, DELAYED CARE
Harris said hospitals are not set up for comprehensive therapy that helps patients recover, such as physical therapy or mental health counseling. As a result, plans for after-care healing are upended, delaying patient recoveries.
Another ripple effect, Harris said, is that people needing preventive screenings and elective surgeries, such as knee and hip replacements, are having their procedures delayed.
“A delayed cancer screening can result in failing to detect cancer before it has spread. Or a delayed cardiac test can result in a heart attack that could have been prevented,” Harris said. “Health care is like an ecosystem, and when one part fails, there are serious consequences on the other elements of the system.”
Patients languishing in hospitals also cause myriad financial problems for hospital systems, Harris said. One example is that Medicare will only reimburse what is supposed to be the average length of stay for a procedure. So if a patient ends up at the hospital for two months when they were supposed to be discharged in seven days, Medicare is reimbursing hospitals for the seven-day stay, and the rest of the time the hospital has to pay for patient care.
“It’s an untenable situation,” Harris said. “These are patients who don’t belong in a hospital at all.”
MaineHealth operated with a $45 million deficit in fiscal 2021-22, and while Harris said it’s not possible to break out how much of the deficit was caused by patients languishing in hospital rooms, it was part of the reason for the deficit. Labor costs, especially the cost of traveling nurses and doctors, are also straining budgets. The deficit would have been much higher if not for a $102 million infusion in one-time COVID-19 relief funds from the federal government, Harris said.
But Harris said despite the financial woes, the most important reason to fix the problem is that patient care is suffering.
Tom and Sandy Verge of Buxton both had to cope with delayed discharges from hospitals.
Tom Verge, 77, suffered a brain injury after falling from a ladder in November 2021. He should have been discharged within two months but stayed at Maine Medical Center until April 2022. Verge, who cannot speak because of the brain injury, is now at St. Joseph’s Rehabilitation and Residence in Portland.
Daughter Terry Davenport said her father had to wait on crucial therapy services while being stuck at Maine Med.
“He needed all kinds of therapy. There was all kinds of stuff that he needed that they couldn’t do at the hospital,” Davenport said. “They kept saying there was no place for him.”
In March 2022, Sandy Verge, Tom’s wife, fell in the bathroom and punctured a lung and fractured her ribs. She was taken to Mid Coast Hospital before being transferred to Maine Medical Center.
She spent about three weeks longer at Maine Med than was necessary, which she said was frustrating. She was discharged to rehab in the same room as Tom at St. Joseph’s, recovered and was back living at home in Buxton. Davenport said on Friday that her mother recently suffered another fall and is back at St. Joseph’s rehab.
“I wanted to go home,” Sandy Verge said of her extra, unnecessary weeks at Maine Med. “I didn’t want to be stuck in the hospital.”
Children are ‘languishing’ in hospitals while waiting for mental health services, providers say
Children with mental and behavioral health needs end up 'languishing' in hospitals for months on end thanks to long waiting lists and administrative barriers to treatment.
by Emily Bader - Lewiston Sun Journal - March 5, 2023
AUGUSTA — Children with mental and behavioral health needs end up “languishing” in hospitals for months on end thanks to long waiting lists and administrative barriers to treatment, proponents of a bill that would repeal the MaineCare “fail first” rule said.
Under the MaineCare rule, to be approved for treatment at a children’s residential care facility a provider must give clinical documentation that a child or adolescent’s situation has not improved with home or community-based services over the prior two to six months.
This often leaves children — defined as anyone under the age of 21 under state and federal laws — stuck waiting at the most restrictive level of care while their families and providers “jump through administrative hoops” to get them the proper level of care, the bill’s sponsor, Rep. Ed Crockett, D-Portland, said.
This bill, LD 387, comes on a personal note, he told lawmakers on the Joint Standing Committee on Health and Human Services on Thursday. He said his nephew, who has severe autism, has “cycled in and out of hospital emergency departments and Spring Harbor Hospital when he didn’t get the supports he needed in the community.”
With not enough providers, children end up on long waiting lists. As of this past December, there were 679 children on the list waiting for home and community-based treatment services. Those children had been on a list for 215 days — about seven months — on average, according to the Maine Office of Child and Family Services.
The number of children and time spent on a waiting list varied greatly across the state. In Washington County, there were 11 children who had been on a list for an average of 435 days. In Penobscot County, 143 children had waited an average of 208 days.
Children in state custody do not have a “home” where they can access these services, Crockett said, nor do children who are already hospitalized “have the opportunity to ‘fail’ a lower level of care,” Crockett said.
The dearth of providers and services is particularly apparent in rural areas. Franklin Memorial Hospital in Farmington has one psychiatrist who serves an area “at least as big as Rhode Island, if not Delaware,” Franklin Community Health Network Chief Medical Officer Dr. Ross Isacke said in an interview Friday.
“It’s actually greater than 50 miles for some people, you know, in our community,” he said. “If you were to, you know, travel from Eustis to the next closest psychiatrist at St. Mary’s (Regional Medical Center in Lewiston), that’s probably almost 90 miles,” he said.
As one example of the strain this is putting on hospitals and particularly on emergency departments, Isacke said the Farmington hospital opened an annex next to its emergency department earlier in the pandemic that “at one point this past year was filled with adolescents. It’s actually probably, honestly, more than (at) one point filled with adolescent behavioral health cases.”
Though that has eased a bit, “we still see so many, all the time, of kids who don’t have anywhere to go,” Isacke said.
“And really, it comes down to, you know, this failure of this, this law that’s currently in place not allowing us to have, you know, to meet this less restrictive community care before residential care. Because, you know, people in our community — they don’t have access to that in the first place.”
Gina DiDonato, Spring Harbor Hospital’s associate chief nursing officer, said the MaineCare rule can have “disastrous impacts.”
She told lawmakers at the Thursday hearing about a teenager who was admitted to the Westbrook psychiatric hospital in December 2021 after “languishing in a hospital emergency department for approximately seven weeks.”
His doctors quickly determined he needed residential care and submitted the application to the Department of Health and Human Services. It was denied for insufficient evidence that the patient’s needs could not be met at a lower level. After five months and multiple appeals, DHHS finally approved the application.
It then took another seven months to find a residential care facility that could take the teenager. A year after he was first admitted, he was finally transferred to a facility — in Florida.
“This patient experienced an entire year of holidays, a birthday, and a full year of his formative teen years in a hospital, further institutionalizing his experience at the highest level of care,” DiDonato said.
Repealing the MaineCare rule would allow children whose needs would be better met at a residential care facility to access those services more easily and efficiently, proponents said.
But not everyone sees it that way.
“We oppose this change because Maine is already institutionalizing children with disabilities unnecessarily due to the failure to provide timely access to home and community-based services,” said Atlee Reilly, legal director for Disability Rights Maine.
The American Civil Liberties Union of Maine, GLBTQ Legal Advocates & Defenders, the Center for Public Representation and the Maine Developmental Disabilities Council had also signed the advocacy agency’s testimony.
Reilly cited the report from the U.S. Department of Justice published last summer that said Maine was in violation of the Americans with Disabilities Act for its failure to provide adequate and appropriate behavioral health services to children.
“Instead, the state unnecessarily relies on segregated settings such as psychiatric hospitals and residential treatment facilities to provide these services. As a result of these violations, children are separated from their families and communities,” the report said.
Reilly said Maine should be addressing the “bottom of the pyramid” instead of making it easier to institutionalize children. He said many children who are stuck in hospitals and emergency departments have already been approved for residential services and are on a waiting list.
But those children will continue to be stuck there so long as residential providers are allowed to “pick and choose which youth to accept.”
This is a particularly impressive set of articles. It is also a particularly depressing set of insights into the disaster that accurately describes the disastrous state of health care in America.
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