Are pediatric and adult hospitalist, critical care, ER etc (all hospital based jobs) all going to face dramatically increased work burden combined with slashed, lower compensation?
Like, none of the new tax bill changes are good for hospitals. It’s going to be horrific.
“Hospitals say they are big losers under the new legislation. More uninsured people will mean more uncompensated healthcare costs, they say. And many hospitals now face reductions in some supplemental payments that most states have come to rely on to augment low Medicaid payment rates.
Over the next decade, Medicaid payments to hospitals will be reduced by nearly $665 billion, an 18.2% reduction, according to analysis by Manatt. Meanwhile, hospitals’ uncompensated care costs are projected to increase by upward of $84 billion in 2034, according to an analysis of the bill by America’s Essential Hospitals, which represents some 350 hospitals nationwide. That number takes into account lower Medicaid payments and Medicaid payment shortfalls, as well as costs from caring for the uninsured.
“It is a double-whammy. We’re going to have many millions more uninsured individuals showing up needing care,” said Beth Feldpush, the group’s senior vice president of advocacy and policy. “But at the same time, hospitals won’t be able to backfill financial holes.”
Medicaid payment rates are notoriously low compared with other types of insurance. States have increasingly boosted these rates in recent years through so-called state-directed payments, which can raise Medicaid payment rates to levels comparable with Medicare or even average commercial insurance rates.
The bill clamps down on these payments. States that have expanded their Medicaid programs under Obamacare to include more low-income adults would have state-directed payment rates capped at 100% of Medicare rates; states that haven’t adopted expansion would be capped at 110% of Medicare rates. The change will reduce federal spending by $149.4 billion over a decade, according to a CBO analysis.
Hospitals in about 30 states will likely see reductions in the state-directed payments they receive once cuts go into effect, according to an analysis by KFF, a health-policy nonprofit.
State hospital associations said these payments are lifelines for hospitals, many of which operate at or near a loss. Even before the bill’s passage, several hospitals across the country laid off employees, froze hiring and tightened spending, citing the impending cuts to Medicaid as a factor. Providence, one of the country’s largest health systems, said last month that it had implemented a restructuring plan that would lead to 600 employees losing their jobs.
Other hospitals say they are bracing for the changes to come. Our Lady of the Angels Hospital, a safety-net hospital in Bogalusa, La., said it would have to consider closing its doors, and the University of Kentucky said it might have to pause construction on a new building dedicated to caring for cancer patients if state-directed payment cuts go into effect.
The cuts may also eat into the earnings of for-profit hospitals like HCA Healthcare and Tenet Healthcare that have enjoyed lucrative boosts to their bottom lines from state-directed payments.
The National Rural Health Association said it was worried that the bill’s provisions would significantly hamper healthcare access in rural areas. Senate Republicans added a $50 billion relief fund to the bill at the last minute for rural hospitals, but Sen. Susan Collins (R., Maine), who voted against the bill, said it wouldn’t be enough to offset the other changes.”
