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Representative Scott Tipton, in Delta last Thursday, discussed health care and economic issues with the county commissioners.
During the session, Tipton acknowledged that rural areas and their hospitals are "paying the price" for Obamacare's many inadequacies as a new world of health care emerges from more than 2,000 pages of legislation that created it almost three years ago.
The program is officially known as Patient Protection and Affordable Care Act (PPACA).
Two top administrators from Delta County Memorial Hospital, CEO Jason Cleckler and chief clinical officer Jody Roeber, told Tipton how burdensome regulation and punitive enforcement of minor rules infractions are making health care delivery more difficult for the hospital, and for other providers.
As an illustration, they told the true story of a physician who moved his practice here from another state. He located in a severely under-served area. Government regulators somehow discovered that the doctor had unknowingly missed a procedural rule by not notifying his previous state that he was leaving. While medical bureaucrats reviewed the matter, the doctor and his patients were denied federal reimbursements for three months.
Tipton got a reality check report from the two hospital administrators who told him how the implementation of PPACA is having the opposite of its intended effect on small, rural hospitals.
"The goal was to control skyrocketing costs," Cleckler said. Instead, he and Roeber cited specific examples of how the health care management regimen unfolding under PPACA is burdening DCMH with regulatory compliance and threats of punitive sanctions that don't advance patient care.
They made several other points during the presentation, including the following ones:
• Federal reimbursements for service are being cut by the government. This will force more practicing professionals to cut back service to patients on the federal programs, or to close their practices entirely.
• The reimbursement cuts are having a disproportionate effect on rural areas, institutions and people. There are fewer doctors to accept patients from those who cut back. Physician pay in rural areas is lower, and working conditions are more severe and unpredictable than in urban areas. PPACA is exacerbating the trends.
• Federal program cuts especially impact DCMH which derives 51 percent of its care income from Medicare. Even that income could be put at risk for a minor rules infraction.
• Another 13 percent of care income comes from Medicaid, "and that will keep increasing, to 25 percent or higher," Cleckler said.
• Hospital operations everywhere are coming under heavier regulatory scrutiny. With more scrutiny come tougher penalties for rules infractions. Various performance audits that DCMH must undergo are able to look through hospital records for the past three years. Rules infractions can be penalized by requiring 100 percent payback to government for procedures. But, the hospital is rarely reimbursed for underpayments discovered in the audits.
• The Recovery Audit Contractors (RAC) who perform audits on DCMH and other hospitals are in a conflict of interest. They receive pay based on the amount of money they recover from hospitals they audit.
• Up to 45 days of work compiling hundreds of pages of documents and records for a RAC audit is solely the job of the hospital and its staff. The additional work time is not compensated by the audit process.
• The federal government says that only 1 percent of hospitals receive audits each year. But Cleckler named five hospitals in Tipton's 3rd Congressional District that were audited in the past year. DCMH itself was audited a total of eight times by various agencies during 2012.
"We feel as if we are under attack," Cleckler said.
Tipton said he is aware of the shortcomings of Obamacare and recognizes that "patient accessibility to health care services is being threatened." The same is true "throughout rural America," he said. However, the Republican congressman gave little indication that improvements in Obamacare are coming.
Other subjects besides health care were on the agenda for Tipton's hour-plus stop in Delta. They include the following:
• The county oil/gas liaison Bruce Bertram said that "some factions" locally are making it difficult to administer oil and gas regulations because they see "no middle ground." He told Tipton, "We are running harder and harder against a brick wall of folks who oppose oil and gas development. They make it very difficult to discuss proper regulation."
• Tipton said there is "faulty science" being used in a study supporting threatened status for the Gunnison sage grouse. He supported the county's request to delay hearings by the U.S. Fish and Wildlife Service on threatened status for another 60 days until May.
• County commission chair Doug Atchley reminded Tipton of the vital importance of the coal industry to the local economy. He said the industry is at risk due to federal policies. Some 1,000 local jobs depend on the three North fork Valley coal mines.
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