State News

The highest numbers of vulnerable rural hospitals are in the South and Midwest, reports Advance Local. Researchers from the healthcare analytics firm Chartis Group issued a report that found that 12 of Alabama’s 45 rural hospitals are considered “most vulnerable” to closure based on several factors, including revenue, system affiliation and the lack of Medicaid expansion. Seven rural hospitals have closed in Alabama since 2010, and the overall percentage of rural hospitals nationally operating in the red has increased from 39 to 47 percent in the last five years, with Alabama being one of the most affected states for closures. 

In accordance with an unfortunate national trend, the non-profit hospital Jackson Hospital filed suit against at least 1,302 Alabamians in 2019, according to AL.com. At least a half dozen patients were sued for less than $200. As a non-profit hospital, Jackson has obligations to provide charity care for needy patients in exchange for tax exemption; however, there are few specific requirements for the level of charity care or how aggressively hospitals may pursue debt collections. Jackson Hospital sued more patients than any other non-profit hospital in Alabama in 2019.

Texas ranked low on healthcare affordability in a 2020 scorecard from Altarum, in part because it is “among the most expensive states, with private payer prices well above the national median.” Almost half of Texans had problems with out-of-pocket expenses and one third had trouble paying medical bills. Another report also found that Texas ranked last on access and affordability, according to Dallas News. The state legislature, and specifically its committee appointed to study healthcare costs, has an opportunity to identify state-based strategies that would address residents’ affordability and access needs. 

Kansas families struggling to pay exorbitant healthcare costs are falling prey to predatory collection practices by law firms representing local providers, according to CBS News. In rural Coffeyville, residents with unpaid medical bills must appear in court every three months for a "debtors exam." Failure to appear may result in jail time and bail money is commonly used to pay debt collectors and healthcare providers, rather than being returned to defendants when they appear in court.

North Carolina’s Medicaid system has found a way to save as much as $6,000 annually per patient with the help of a unique care management program, reports Health Data Management. The management program – provided by the Community Care of North Carolina (CCNC), a public-private partnership of healthcare providers and payers – focuses on providing medical homes, community support and data analysis to meet the needs of Medicaid beneficiaries in the state. CCNC’s report notes that the organization uses administrative data to create an “impactability score” for Medicaid members that focuses on Medicaid utilization patterns that go beyond medical care to include social determinants of health and other variables. 

Doctors and others who provide mental health and addiction services in Maryland under the Medicaid program have had millions of dollars in bills go unpaid this year because a new state payment system is malfunctioning, according to the Baltimore Sun. The Maryland Health Department, which oversees the payments, notified providers last week that it planned to begin sending estimated payments that total about $32 million a week as it works to fix the system serving more than a quarter-million people. This snafu affects about 2,500 doctors, hospitals, clinics and other facilities that offer behavioral health services in the state.

NYC Care, New York City’s answer to calls for universal healthcare, is now available in Brooklyn and Staten Island, according to amNY. The city expects to enroll 15,000 new NYC Care members in both boroughs over the next six months – since the launch in the Bronx in August 2017, 13,000 residents have enrolled in the program that offers free or low-cost health services. New members will be offered a primary care provider within two weeks of enrollment, have access to patient care overseen by NYC Health + Hospitals, have access to 24/7 customer assistance and a hotline for an on-call clinician to speak about patient needs, like prescription refills.

Western Maryland Health System is now officially UPMC Western Maryland, merging into the UPMC hospital network, according to the Cumberland Times-News. UPMC has committed to make certain capital investments to enhance services and upgrade facilities in the Western Maryland region, to ensure they will continue to provide quality healthcare for residents and remain one of the largest employers in the region. The new affiliation does not affect patients’ insurance coverage, and UPMC Western Maryland has reaffirmed its commitment to work with multiple payers in the future.

Joshua Bates was rushed to an emergency room in North Carolina for what turned out to be acute apendicitis; however, the hospital turned out to be out-of-network with the insurance plan provided through his employer. In this edition of Kaiser Health News' Bill of the Month, we learn that Joshua was charged $41,212 for his surgery, one night at the hospital and the emergency room charges. After payments by both Joshua and his insurer, the hospital sent him a bill for the balance, just over $28,000. Joshua was "balance billed" because he went to an out-of-network hospital - even though this was an emergency, he fell through the limited protections in existing law. A balance bill is the difference between what insurers pay toward a bill and a provider's "list charges," what facilities set themselves and often bear little or no relationship to actual costs. Joshua would be helped by a federal law providing consumers with protection against balance billing, because his employer-sponored insurance is regulated by the federal government, meaning that state regulations for state-regulated plans do not apply to him.