joint dodhudhhsusdadol model rural wounded warrior_concept

8/7/2019 Joint DODHUDHHSUSDADOL Model Rural Wounded Warrior_CONCEPT

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PROPRIETARY INFORMATION: Bobrow-Williams Group, LLC, 3237 Ramsgate Road, Augusta, Georgia 30909

Strategic

Directions

Plan

Concept

City of Sparta Georgia

Housing Authority

Prepared by

BWG, LLC

Joint DOD/HUD/HHS/USDA/DOLModel Rural Wounded Warrior

Long-Term Care Center

Prepared By

Bobrow-Williams Group, LLC

3237 Ramsgate Road

Augusta, Georgia 30909-3215

Phone: 706-729-9710 * Fax: 877-651-2288




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1THE PROBLEM: Throughout rural America and across rural Georgia manyhospitals have closed or barely hanging on since 1980. At the same time, theadvancements in “battlefield medicine” have many soldiers surviving injuries thatwould have been fatal in prior wars. However, these soldiers are returning home withmany “traumatic injuries” requiring long-term medical care. Many soldiers from ruralcommunities are unable to return home because of lack of medical care.

2

THE SOLUTION: The future survival of rural hospitals across the nation and inGeorgia is tied to their ability to create the “right mix of services” to make themeconomical viable. Many successful rural hospitals have the right mix of services:

adult long-term care and day care units; federal-funded community health centers;and urgent-care medical centers to name a few. With the need and opportunity tocreate “rural wounded warrior long-term care units in rural regions, we can use theclosed and/or barely surviving rural hospital to address this problems. Just like amall, These units can be the “anchor service” to make these facilities viable.

3

The Funding and Financing Plan: The Congress and Administration needs to re-

think funding and financing of many needed services in rural America. Creating joint

agency funding for many health, education, job training and human services would

make them more financial feasible. This is how we see addressing this problem. The

Rural Wounded Warrior Service would be funded and financed through a Jointagreement between the Department of Defense (DOD), Housing and Urban

Development (HUD), Health and Human Services (HHS), U. S. Department of

Agriculture (USDA) and Department of Labor (DOL). This Joint

DOD/HUD/HHS/USDA/DOL Model Rural Wounded Warrior Long-Term Care

Center would be a model for Georgia and the rest of the Nation.

Strategic

Directions

Plan

Concept

City of Sparta Georgia

Housing Authority

Prepared by

BWG, LLC

MEMORANDUM To: Board, Staff and Partners of City of Sparta Georgia Housing Authority From: Bobrow-Williams Group, LLCDate: August 24, 2010

Subj: Joint DOD/HUD/HHS/USDA/DOL Model Rural Wounded Warrior

Long-Term Care Center




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August 22, 2010

Rural hospitals face challenges across the state

Charles Oliver [email protected]

DALTON — The economic downturn, cuts in state and federal health care programs, and attempts by private businesses to rein in their own health care costs have combined to create a “perfectstorm” that threatens small rural hospitals across the state, according to Jimmy Lewis, CEO of HomeTown Health, which represents 55 rural hospitals in Georgia including Murray MedicalCenter.

“We could wake up tomorrow and have 10 hospitals about to close,” said Lewis.

Forty-one Georgia hospitals have closed since 1980, according to the Georgia HospitalAssociation, many of them small rural hospitals.

The problem that rural hospitals face is that their “payer mix” is typically heavy in patients onMedicare and Medicaid and those without insurance.

At Murray Medical Center, for instance, 43 percent of revenue comes from Medicare, the federalhealth program for seniors. Another 17 percent comes from Medicaid, the joint state and federalprogram that provides health care for low-income people. And 19 percent of revenue comes fromthose who have no health insurance, according to Hamilton Health Care System, which operatesthe hospital.

“Typically, we can get about 95 cents on the dollar from Medicare. We have been collecting 85cents on the dollar or less from Medicaid. We collect about 2 cents on the dollar from self-pay(those without insurance),” said Lewis with HomeTown Health. “Right or wrong, small hospitalshave had to subsidize themselves through their commercial customers to try to cover their lossesfrom the other payers.”

At Murray Medical Center, just 21 percent of revenue comes from commercial customers, patients

with private health insurance.

“Murray, like most rural hospitals, has a very traumatic payer mix,” said Lewis. “They can have$18 million in revenue and lose $2 million a year simply because they have excesses in Medicare,Medicaid and self- paid, and they don’t have enough commercial to cover those losses. That’s auniversal problem.”

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Murray Medical Center had about $54 million in revenue in 2009 but also had to write off justunder $10 million for bad debt or charity care, according to Hamilton officials. Murray MedicalCenter’s total projected loss this year was $2.4 million, though officials said recent cuts in staff should get it to break even.

“Unfortunately, the problems at Murray Medical Center are not unique,” said Kevin Bloye,spokesman for the Georgia Hospital Association. “Sixty-two percent of the rural hospitals in the

state are in the red.”

Rural hospitals require subsidies

Rural hospitals have long had to be subsidized either by local governments or by larger partnerssuch as Hamilton Health Care System. Larger hospitals have been willing to cover the losses of their smaller partners because those hospitals have brought patients into the larger system that usediagnostic equipment and medical specialists, allowing the larger system to spread those costsover a larger base.

“But their need for subsidies has grown beyond what anyone could have imagined,” said Lewis.

That’s due largely to the downturn in the economy.

Rising unemployment has left many people without health insurance. In addition, rising healthcare costs have caused many companies to raise the premiums paid by employees, leading manyworkers to drop health insurance. That has driven up the number of self-paying patients.

“Regardless of where they are, hospitals are challenged in the current economic climate. Butcertainly, Northwest Georgia has been hit hard recently,” said Hamilton President and CEO Jeff Myers. “In the last several months, unemployment has been up to 13 percent in Murray andWhitfield counties, which means more and more of the patients are uninsured or are unable to

pay.”

Further, health insurance companies have begun cutting payments to hospitals, making it harderfor those hospitals to continue subsidizing their losses from Medicare and Medicaid.

That hammers both small hospitals and large.

“The larger partners are suffering from the economic downturn just like the little guys. They haveto scrutinize how they subsidize units like Murray,” said Lewis. “We are seeing this across thestate. Larger hospitals are scrutinizing their affiliations with smaller hospitals. That’s not peculiar to Murray and Hamilton.”

Rural hospitals capture small part of market

Like the rest of the Hamilton system, Murray Medical Center isn’t in the preferred provider networks of most major insurance plans. Hamilton officials say they don’t believe that has playeda role in the financial problems at Murray.

But Lewis says it might make it more difficult for Murray to increase the number of patients




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treated there who are covered by insurance and to improve its payer mix.

“There’s no question that has a significant impact on patients covered by those plans. At the sametime, it’s important to note that the major hospital has to make a decision on how low it can go onits rates,” he said. “The commercial carriers want to cut and cut and cut their rates while thehospital system has relied on the commercial payers to offset the other losses.”

Hamilton officials say that about 70 percent of Murray County residents who are hospitalized gooutside the county for treatment. But Lewis says that is typical for rural hospitals, which typicallycapture just 30 to 35 percent of their market share.

Lewis says Murray Medical Center does face one problem unique among the state’s ruralhospitals: It isn’t considered a rural hospital by federal regulators.

In 2004, the federal government designated the Dalton area as a metropolitan statistical area(MSA) including Murray County. As a result, Murray Medical Center lost about $891,000annually in federal reimbursement for indigent medical care.

Future is uncertain

Hospital administrators across the country are keeping a close eye on the health care law enacted by Congress earlier this year. Most of the provisions in the law don’t take full effect until 2014, sothe administrators say it’s hard to predict if it will help or hurt hospitals.

“The bill promises health insurance coverage to 32 million Americans, which would obviously bea positive,” said Bloye, since it would reduce hospitals’ losses for uninsured patients.

On the other hand, the government plans to pay for covering those patients by cutting $500 billionfrom Medicare, which officials say does not fully compensate them now.

Hospitals are also keeping a close eye on what state lawmakers do to health care spending. Thisyear, for instance, lawmakers proposed cutting Medicaid spending by $350 million to close thestate’s budget gap.

Lewis said that could have forced 20 rural hospitals across the state to close.

“When they realized they were going to close 20 economic engines across the state, they choseanother way to close their deficit,” he said.

But Lewis and Bloye say hospitals are still worried that state and federal lawmakers will deal withtheir own budget issues by shifting costs onto private hospitals.

And what that means for hospitals such as Murray Medical Center remains to be seen.

“We know there are going to be a lot more insured patients, but a lot of it depends on what thegovernment is willing to

Related Photos




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According to Hamilton Health Care System 43percent of revenue at Murray Medical Center comesfrom Medicare, the federal health program for seniors.

Another 17 percent comes from Medicaid, the jointstate and federal program that provides health care forlow-income people. And 19 percent of revenue comesfrom those who have no health insurance. (MistyWatson/ The Daily Citizen)

(Misty Watson/ The Daily Citizen)

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joint dodhudhhsusdadol model rural wounded warrior_concept

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