Opinion: Legislation could shutter Barton’s skilled nursing
By Mary Bittner
In recent months, Barton Memorial Hospital’s Skilled Nursing Facility has been challenged with keeping patients, staff and the facility in its entirety safe from the effects of California Assembly Bill 97. If passed, this bill would create devastating cuts to reimbursement for Medi-Cal services provided by distinct part skilled nursing facilities (DP/SNFs) throughout the state, including South Lake Tahoe’s only long- term care facility located at Barton Memorial.
This bill requires a two-thirds vote in the Assembly and Senate before it goes to Gov. Jerry Brown for action. It will first be heard in the Assembly Health Committee on April 30.
Mary Bittner
Since Assembly Bill 900 is considered an “urgency” bill, it would take effect immediately if Brown signs it into law by July 1. Barton Health is hopeful the state Assembly and Senate seriously consider this bill. In reality, to sustain continued operations of our high-quality long-term-care services AB900 must pass on Tuesday.
AB900 would stop the proposed budget cuts to Medi-Cal reimbursement (that are called for in AB97) for medical services provided by hospital-based skilled-nursing facilities. Barton Memorial’s Skilled Nursing Facility is of-that-type and predominately has a population of Medi-Cal patients. At present, our licensed 48-bed skilled-nursing and short-stay rehabilitation facility often runs at full capacity. It provides care for aging adults, offering private and semi-private rooms, 24-hour care, activities, and programs that maintain and/or improve independence. In 2012, our Skilled Nursing Facility was awarded five-stars from Medicare, which is only given to the top 10 percent of nursing homes in the nation.
Cuts in reimbursement would force Barton Memorial to reduce capacity or close services completely as the acute-care reimbursement simultaneously declines with health care reform. 2011’s AB97 reduced Medi-Cal reimbursement rates for DP/SNF to rates applicable in the 2008-09 rate year, less 10 percent, effective June 1, 2011, resulting in an effective rate decrease for most facilities of 25 percent. Cuts of this magnitude will have a devastating impact on the access of Medi-Cal beneficiaries to medically necessary skilled-nursing services.
If AB900 does not pass, our skilled nursing facility may not only face cut-backs or closure, but will have to pay to the state of California (retroactive to June 2011) the amount of reduced reimbursement. Barton has been setting aside money for this very issue, however, losing those funds will impact our overall operations, drive up cost for the provision of acute-care and possibly jeopardize the future viability of Barton as the sole community health care provider for our community.
Part of the most vulnerable population Barton serves is the elderly and those with severe chronic disease. According to Barton’s 2012 Community Health Needs Assessment Report, 13.7 percent of the community in Barton Health’s primary service area are 65 years and older. Of this population, 76.9 percent are Medicare supplement insurance dependent (compared to the U.S. benchmark of 75.5 percent), which does not provide coverage for long-term care needs.
Surrounding facilities on the West Slope have in recent years decreased their long-term care bed capacity and California residents do not qualify for Nevada Medicaid.
Barriers to long term-care access would impact family members of elderly patients, forcing elderly residents to be removed from their loved ones and housed in facilities miles away from home. The distance disparity is complicated by geography (surrounded by four mountain passes), weather/road condition variability, and transportation challenges within the local community. Per the 2012 Barton Community Health Needs Assessment, 9.8 percent of primary service area adults lack transportation compared to 7.7 percent nationally.
If long term-care services were forced to close, unemployment rates would rise, (current local unemployment is at 16.7 percent) adding to the ongoing threat of departure of local residents on the South Shore. This would negatively impact the fiscal landscape of our local economy, which already suffers from a $5.2 million deficit. Reduction of services could impose further erosion of our rural community resources, imposing a trickle-down effect to local businesses relying on tourism.
Barton Health is dedicated to educating our community on the effects of health care reform and its impact on Lake Tahoe residents and our surrounding areas. As the safety-net provider of health care for the South Lake Tahoe community, we rely on our local residents to make their voice heard on these concerns and issues. It is imperative that our state legislative representatives become educated about the importance of AB900 and understand how vital the Barton Skilled Nursing Facility is to our community. We plan to keep you informed of the progress of AB900 and other changes related to health care reform.
We encourage you to contact our local legislators and urge them to vote for AB900: Sen. Ted Gaines, email senator.gaines@senate.ca.gov and Assemblyman Frank Bigelow, email.
Mary Bittner is vice president of Nursing and Ancillary Services for Barton Health.
so what this editorial is saying is despite being a non-profit community hospital, if Medicare does not pay Barton what it wants to collect in fees for Medicare services, it will refuse to treat medicare patients….so much for health care reform and a good arguement for a single payer system.
The editorial also provides no details on what Barton’s markup for services is or what it really costs them to provide a service so that a reader could decide if this is just an attempt to maintain a desired revenue stream or really reflects insufficient Medicare reimbursement? But while they were at it, the editorial could have explained why a cat-scan and other diagnostic tests at Barton are 1.5 times as expensive at Barton as in Reno??
ljames is right on target. Perhaps Barton wouldn’t have to cut services if they didn’t pay paper pushers so much
Barton’s prices are too high for most folks without gold-plated health insurance. It’s no surprise, and actually refreshing, that Medi-Cal is resisting such high rates.
Barton is not now, nor has it ever been a not-for-profit hospital (no matter what they tell you). Their prices border on the ridiculous.
My husband all but refuses to have anything to do with them.
I do not know if most people are aware of the multi-tiered pricing of health care. Lets say you, John Smith goes to the hospital and gets a procedure done. They charge you $1000. If you do not have insurance, you are responsible for $1000. If you have insurance or Medicare a different contractual price structure comes into play. What ever your company and the hospital have agreed upon is what they charge. Etna Health may contract $775, Healthnet may pay $600, while Blue Shield agreed upon a contract of $836. And Medicare? If the provider accepts it, is is whatever the government says it will pay. In the end, the person who can afford it least ends up being charged the most. Healthcare costs should be realistic and equal across the board regardless of who pays the bill. Yes, Barton and other providers will tell you that you can come in and plead your case and they will set up special pricing and payment options.
I have to agree with ljames statement as well as the the pricing of diagnostics. Very easy to document. Call the hospital in Carson City and ask for the price of an MRI of the knee. Around $2,700 not counting the radiologist read. Then call Great Basin Imaging which is owned by the same hospital. $900 and that includes the radiologist fees. Why is there such a huge discrepancy?
There is confusion in her article. The problem she is addressing is MediCal which is a State program for the poor.
She brings into this discussion a comment about Medicare which is Federal Insurance which every worker pays for during their earning period as well as after they retire and become age eligible. On top of the payment to Medicare, many retirees purchase secondary insurance to pay what Medicare does not (about 20%).
MediCal cuts are the near term threat she should be highlighting.
Ummm…hello Barton haters! When are you going to stop hating and think outside of your negative view? I agree there are pricing discrepancies…but that’s not what this article is about.
This bill would hurt ALL rural independent long term care facilities in California! Many won’t be able to survive the effects of this bill and will be forced to close. Which will hurt ALL rural residents, no matter which insurance you have (Medi-Cal, private, or somewhere in between.)
Each day you and your loved ones are getting older and many enjoy high-risk activities, when the time comes to need a Skilled Nursing facility – do you want to stay in this beautiful area or be shipped to the big city? Sacramento? Reno? Stockton? How would that affect you and your family? Not really appealing, huh? Get off your hater soapbox, look at the bigger picture and help solve the problem.
I agree that the letter is confusing. I think it has been Barton’s plan to keep things confusing so people will keep coming, instead of seeking other options.
The West Coast edition of the Wall Street Journal, a few years ago, had an article on the expense of medical care in California, and Barton was right up there at the top with the likes of Sutter etc in Sacramento. There were hundreds of percent differences reported in common services like the typical routine blood testing we all go through. It is still the same if not worse.
For many years, after a couple of Barton disasters (cost and incompetency) on a family and personal basis, my family is one of those who would go to Barton only to stop the bleeding until we could get somewhere else.
On a routine blood testing basis, I can go to Carson city or Minden/Garnerville, get in immediately without an appointment, do a little shopping at off-the-hill prices, fill up my gas tank, and come home with 50 bucks still in my pocket as opposed to Barton’s pocket compared to the same testing in Tahoe. And yes this includes the money I spend on shopping and gas.
Imaging is another very expensive thing in Tahoe, as someone just pointed out.
Time and time again, I have been treated to the explanation, “Well, we are required by law to provide emergency treatment to anyone who comes in, and all the
(you fill in the name of your choice for Hispanic,alien etc) we treat for free makis it so we have to charge everybody else for those costs in order to break even.”
UhHuh….RIIIGHT!
Tahoe doctors will often inform you how to save a few hundred dollars on non emergency evaluation, x-rays etc if you ask. The last time one of my family needed xrays, Great Basin saved us about $300. I can drive 60 miles round trip for that kind of money most every day.
I have also wondered what the deal is with “Barton University” and what the cost of that is ( staff, rental real estate etc) compared to the benefits to the community or anybody else.
I think a good examination of Barton’s Budget would be illuminating.
Just how does the rest of the industrialized world possibly exist without our “for profit” system? No wonder we’re #1 in all health care categories for positive outcomes and patient satisfaction…. Yea right.
Let’s face up to the failure we have now and move on to some sort of single-payer system, eliminate all these incremental improvements with Obamacare and just get on with it. The heck with the corporate lobbyists for these thieves, do what’s right for our citizens for a change.
Bijou Bill
I don’t think anyone could have said it better. My biggest disappointment with Obama is his failure to support single payer. We even have the system up and running…it needs only to be made bigger.
But the lobbyists of insurance companies, hospitals and and many more have so much sway he was afraid to go for it, or he might not have been elected again.
There is simply too much money to be made in overpriced health care, and where would all those thousands of insurance company drones work then?
May we live long enough to see it change.