Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital

The Knox County Fiscal Court and the Knox County Board of Health reached a deal Monday to aid its debt-laden county hospital's recovery from bankruptcy by diverting, at least temporarily, 37.5 percent of local health tax revenue to the hospital, asking the local library to do likewise and converting an ambulance tax into a hospital tax.

The proposed agreement is "revenue neutral" and would not create any additional tax for Knox County residents while allowing the Knox County Hospital in Barbourville to stay open, writes Jeff Noble of The Times-Tribune in Corbin.

To save the hospital, the hospital board needs a tax of about 8 cents per $100 worth of property, County Judge-Executive J.M. Hall said. The deal would convert a 5-cent ambulance tax to a hospital tax, and the county health board has agreed to shift 1.5 cents of its 4-cent tax to the hospital. The library board is considering similar action, which would make up the total 8 cents, Hall told Noble.

Health Department Director Susan Liford said the two-year deal with the health board will begin in January 2014 and will be re-evaluated at the end of that period. The health department will be diverting $300,000 to $400,000 a year to the hospital, Noble reports.

"The board felt like we needed to help the hospital, and they were very adamant they did not want to put the health department in jeopardy and have no one here lose their jobs," Liford told Noble. "I think it’s the moral thing to do. And we need our hospital."

The hospital has a debt estimated at $23 million, though the Knox County Fiscal Court purchased it out of bankruptcy by in 2004 for just $7.2 million, according to documents analyzed by the Barbourville Mountain Advocate, Knox County's weekly newspaper. Last July, the fiscal court took over hospital operations of the hospital, borrowing $6 million to fund them, after the former owners filed Chapter 11 bankruptcy. (Mountain Advocate graphic; click on it for larger version)

The Knox County Fiscal Court and the Knox County Board of Health reached a deal Monday to aid its debt-laden county hospital's recovery from bankruptcy by diverting, at least temporarily, 37.5 percent of local health tax revenue to the hospital, asking the local library to do likewise and converting an ambulance tax into a hospital tax.

The proposed agreement is "revenue neutral" and would not create any additional tax for Knox County residents while allowing the Knox County Hospital in Barbourville to stay open, writes Jeff Noble of The Times-Tribune in Corbin.

To save the hospital, the hospital board needs a tax of about 8 cents per $100 worth of property, County Judge-Executive J.M. Hall said. The deal would convert a 5-cent ambulance tax to a hospital tax, and the county health board has agreed to shift 1.5 cents of its 4-cent tax to the hospital. The library board is considering similar action, which would make up the total 8 cents, Hall told Noble.

Health Department Director Susan Liford said the two-year deal with the health board will begin in January 2014 and will be re-evaluated at the end of that period. The health department will be diverting $300,000 to $400,000 a year to the hospital, Noble reports.

"The board felt like we needed to help the hospital, and they were very adamant they did not want to put the health department in jeopardy and have no one here lose their jobs," Liford told Noble. "I think it’s the moral thing to do. And we need our hospital."

The hospital has a debt estimated at $23 million, though the Knox County Fiscal Court purchased it out of bankruptcy by in 2004 for just $7.2 million, according to documents analyzed by the Barbourville Mountain Advocate, Knox County's weekly newspaper. Last July, the fiscal court took over hospital operations of the hospital, borrowing $6 million to fund them, after the former owners filed Chapter 11 bankruptcy. (Mountain Advocate graphic; click on it for larger version)

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Medicaid expansion would have 'a big health impact,' and critical-access hospitals need to change, rural-health expert says

Expansion of the Medicaid program under federal health-care reform would have a major beneficial impact on the health of Kentucky, a doctor who ran the state and national rural-health agencies told a rural-health meeting in Louisville Tuesday.

"Medicaid expansion has a big health impact," Dr. Wayne Myers, left, told those at "Doing Care Differently in Rural Kentucky," a seminar sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association in Louisville, just before the opening of the National Rural Health Association's three-day conference in the city.

Myers said that in the three states that expanded Medicaid eligibility since 2000, one life was saved for every 176  people added to the program, according to a study by the Harvard University School of Public Health, published in the New England Journal of Medicine. If that figure were extrapolated to the entire nation, the number of lives saved would be greater than if breast, prostate and stomach cancer were eliminated, Myers said.

Skeptics argue that Kentucky can't afford the estimated 6.3 percent annual cost increase for expanding Medicaid eligibility up to 138 percent of the federal poverty level, but Myers said, "It would be nice to shift that argument from dollars to health impact." He said that if the three cancers were curable with a certain amount of money, and you argued that the nation should not spend it because of the cost, "You'd have an uphill argument."


Myers also said Eastern Kentucky would be an ideal place for Medicaid and Medicare to start rewarding small, rural hospitals for increasing their role in health promotion and disease prevention.

The federal designation of "critical access hospital" has kept open many rural hospitals, which get greater Medicare and Medicaid reimbursements in return for limiting beds, procedures and patient stays, but President Obama's proposed budget calls for revoking the CAH status of some hospitals, and rural political clout has declined with the rural share of the nation's population, Myers noted.

"The old models aren't working too well," Myers argued, saying "What people don't realize is that [critical-access] hospitals get three-fourths of their money from the outpatient department" and have relatively few traditional admissions. He said half of them have fewer than four acute-care patients per day, and fewer than two patients who are recuperating or getting skilled-nursing care.

Then he displayed maps showing that life expectancies of rural Americans are not keeping pace with the rest of the country, and in some areas, including Eastern Kentucky, are declining. "That's really scary," he said.

Myers said those trends mean that CAHs should add health promotion and disease prevention to their job description, and Medicare and Medicaid -- which provide 85 percent of their revenue -- should pay them for performing that function.

He said hospitals have space, expertise and equipment to serve as exercise and medical-education centers, while most rural health departments are "overwhelmed" with a wide array of duties.

The federal payments for disease prevention and health promotion could be limited to hospitals in counties that have a certain percentage of their population on government-subsidized insurance, he said.

"If it makes sense anywhere, does it not make sense in Kentucky?" Myers asked, reiterating the question to focus on the state's Fifth Congressional District, which he said has the nation's lowest life expectancy. When a questioner mentioned the district's congressman, House Appropriations Committee Chairman Hal Rogers, Myers suggested the program could be named for the Somerset Republican.

Other speakers at the seminar called for new approaches in rural health, despite obstacles.

"Change is not easy. . . . Almost all federal policy tends to shortchange rural, at least initially," said Craig Blakely, dean of the University of Louisville's School of Public Health and Information Sciences.

He said two important targets for prevention activities in rural America are smoking and obesity, which he said is exacerbated by high soft-drink consumption. Soft drinks are a $57-billion-a-year industry, jhe said, "so there's a lot of pushback we're going to be facing if we want to take that on."

Blakely added that much of rural America is poor, and that is associated with poor health, so rural health providers also need to focus on education and employment opportunities for their communities.

Expansion of the Medicaid program under federal health-care reform would have a major beneficial impact on the health of Kentucky, a doctor who ran the state and national rural-health agencies told a rural-health meeting in Louisville Tuesday.

"Medicaid expansion has a big health impact," Dr. Wayne Myers, left, told those at "Doing Care Differently in Rural Kentucky," a seminar sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association in Louisville, just before the opening of the National Rural Health Association's three-day conference in the city.

Myers said that in the three states that expanded Medicaid eligibility since 2000, one life was saved for every 176  people added to the program, according to a study by the Harvard University School of Public Health, published in the New England Journal of Medicine. If that figure were extrapolated to the entire nation, the number of lives saved would be greater than if breast, prostate and stomach cancer were eliminated, Myers said.

Skeptics argue that Kentucky can't afford the estimated 6.3 percent annual cost increase for expanding Medicaid eligibility up to 138 percent of the federal poverty level, but Myers said, "It would be nice to shift that argument from dollars to health impact." He said that if the three cancers were curable with a certain amount of money, and you argued that the nation should not spend it because of the cost, "You'd have an uphill argument."


Myers also said Eastern Kentucky would be an ideal place for Medicaid and Medicare to start rewarding small, rural hospitals for increasing their role in health promotion and disease prevention.

The federal designation of "critical access hospital" has kept open many rural hospitals, which get greater Medicare and Medicaid reimbursements in return for limiting beds, procedures and patient stays, but President Obama's proposed budget calls for revoking the CAH status of some hospitals, and rural political clout has declined with the rural share of the nation's population, Myers noted.

"The old models aren't working too well," Myers argued, saying "What people don't realize is that [critical-access] hospitals get three-fourths of their money from the outpatient department" and have relatively few traditional admissions. He said half of them have fewer than four acute-care patients per day, and fewer than two patients who are recuperating or getting skilled-nursing care.

Then he displayed maps showing that life expectancies of rural Americans are not keeping pace with the rest of the country, and in some areas, including Eastern Kentucky, are declining. "That's really scary," he said.

Myers said those trends mean that CAHs should add health promotion and disease prevention to their job description, and Medicare and Medicaid -- which provide 85 percent of their revenue -- should pay them for performing that function.

He said hospitals have space, expertise and equipment to serve as exercise and medical-education centers, while most rural health departments are "overwhelmed" with a wide array of duties.

The federal payments for disease prevention and health promotion could be limited to hospitals in counties that have a certain percentage of their population on government-subsidized insurance, he said.

"If it makes sense anywhere, does it not make sense in Kentucky?" Myers asked, reiterating the question to focus on the state's Fifth Congressional District, which he said has the nation's lowest life expectancy. When a questioner mentioned the district's congressman, House Appropriations Committee Chairman Hal Rogers, Myers suggested the program could be named for the Somerset Republican.

Other speakers at the seminar called for new approaches in rural health, despite obstacles.

"Change is not easy. . . . Almost all federal policy tends to shortchange rural, at least initially," said Craig Blakely, dean of the University of Louisville's School of Public Health and Information Sciences.

He said two important targets for prevention activities in rural America are smoking and obesity, which he said is exacerbated by high soft-drink consumption. Soft drinks are a $57-billion-a-year industry, jhe said, "so there's a lot of pushback we're going to be facing if we want to take that on."

Blakely added that much of rural America is poor, and that is associated with poor health, so rural health providers also need to focus on education and employment opportunities for their communities.

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Death rates for heart and pneumonia patients at critical-access hospitals are rising nationally, study finds

Death rates are rising at rural critical-access hospitals for Medicare patients who have heart attacks, heart failure and pneumonia, according to a study published in the Journal of the American Medical Association.

Hospitals designated as critical-access get slightly higher Medicsare and Medicaid reimbursements in exchange for limiting their size, procedures and patient stays. In 2002, they had a death rate of 12.8 percent for such ailments, under the 13 percent rate at other hospitals. But from 2002 to 2010, mortality rates at critical-access hospitals increased 0.1 percent each year, to 13.3 percent, while the rates at other hospitals fell 0.2 percent each year, to 11.4 percent.

There are 1,331 hospitals in the critical access program, Jordan Rau reports for USA Today. "Congress started the critical access program in 1997 to stave off hospital closures in places where patients had no good alternative because the next hospital was at least 35 miles away by regular roads or 15 miles by secondary roads. To qualify hospitals need 25 or fewer beds."
 
The authors of the study "suggested that the hospitals' care may suffer because they don't have the latest sophisticated technology or specialists to treat the increasingly elderly and frail rural populations," Rau reports. "Since hospitals are not required to submit performance evaluations to Medicare, the government may not realize that facilities could need additional assistance in caring for sicker patients."

Brock Slabach of the National Rural Health Association told Rau that the statistics don't always tell the complete story and that "The association's own research has found that rural hospitals do better in patient satisfaction surveys than do urban hospitals," Rau writes.

Death rates are rising at rural critical-access hospitals for Medicare patients who have heart attacks, heart failure and pneumonia, according to a study published in the Journal of the American Medical Association.

Hospitals designated as critical-access get slightly higher Medicsare and Medicaid reimbursements in exchange for limiting their size, procedures and patient stays. In 2002, they had a death rate of 12.8 percent for such ailments, under the 13 percent rate at other hospitals. But from 2002 to 2010, mortality rates at critical-access hospitals increased 0.1 percent each year, to 13.3 percent, while the rates at other hospitals fell 0.2 percent each year, to 11.4 percent.

There are 1,331 hospitals in the critical access program, Jordan Rau reports for USA Today. "Congress started the critical access program in 1997 to stave off hospital closures in places where patients had no good alternative because the next hospital was at least 35 miles away by regular roads or 15 miles by secondary roads. To qualify hospitals need 25 or fewer beds."
 
The authors of the study "suggested that the hospitals' care may suffer because they don't have the latest sophisticated technology or specialists to treat the increasingly elderly and frail rural populations," Rau reports. "Since hospitals are not required to submit performance evaluations to Medicare, the government may not realize that facilities could need additional assistance in caring for sicker patients."

Brock Slabach of the National Rural Health Association told Rau that the statistics don't always tell the complete story and that "The association's own research has found that rural hospitals do better in patient satisfaction surveys than do urban hospitals," Rau writes.

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Lame-duck Congress could cut funding for critical access hospitals; more than two dozen in Kentucky

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

Critical access hospitals, which in most states are rural facilities with fewer than 25 beds, may be under attack in the lame-duck session of Congress, former national rural-health director Wayne Myers writes for the Daily Yonder. President Obama's "budget proposes to revoke CAH status and special payments for any such hospital within 10 miles of another hospital, and to cut the extra 1 percent payment for all of the critical access hospitals," Myers writes. (Census Bureau map of CAH locations)

This would "have enormous consequences," Myers writes. "Of the hospitals that lose CAH designation probably most will close or merge with another hospital. I've seen no estimates of numbers. There are more than a few congressional budget hawks in both parties who would like to eliminate the special payments to Critical Access Hospitals entirely. If these small hospitals dodge the bullet during the lame duck session, they'll continue to be targets in the next Congress. If they are successful in reducing payments to CAHs, the net effect will be to move health care capacity and jobs from smaller to larger towns."

The issue is complex. Rural areas have less political clout than ever, because of declining population, and many rural people use urban hospitals over CAHs, even for ordinary care. "Those who do use CAHs say their experience there is just as good as that in urban hospitals, even if the quality of care isn't as good as in larger facilities," Myers writes. "Elderly patients stay at CAHs because they know the nurses and doctors and their families live close by."

Issues for CAHs arise out of how Medicare payments are made to them, Myers writes. "A long list of arcane, special funding arrangements has accumulated to try to fit small rural hospitals into a Medicare payment system designed for large city hospitals." The largest program is the "Disproportionate Share Program," or DISH, which gives $15 billion a year to states to hand out to CAHs. The program is being phased out between 2014 and 2020, along with several other programs, as part of the Patient Protection and Affordable Care Act. (Read more)

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