Health Care Reform

Hospitals in this country have a legal obligation to care for patients that is unlike the obligation of any other business or individual. We are obligated by federal law to care for everyone, regardless of their ability to pay. EMTALA requires every Medicare participating hospital with an emergency department to screen and stabilize (i.e., treat) each and every patient who comes to the hospital ED seeking care. No exceptions.

An estimated 764,000 South Carolinians are currently uninsured, and before federal health reform was enacted, that number was projected to reach nearly 900,000 by 2014. That is the key reason that hospitals in this state and across the nation supported the new health care reform law.

The Affordable Care Act (ACA) provides broad concepts and direction, but much of the implementing detail will be developed through the regulatory process over the next few years. As Congress continues to debate the many divisive issues and the courts argue constitutionality of the individual mandate and Medicaid expansion, we encourage legislators to find common ground to improve and build upon the delivery system and payment reforms included in the ACA. As this debate unfolds, SCHA will continue to work with our congressional delegation, state representatives and other collaborative partners across the state to ensure South Carolina is ready for reform.

The recent health care reform law makes several key delivery system changes to help reduce costs, expand coverage, improve quality and care coordination, and promote innovation. Many hospitals are already moving toward reengineering and improving care coordination in this state. South Carolina is ranked by the federal government as one of the top five states making the most improvement in quality and safety of health care and is leading the nation in improving health care safety and responsiveness.

Following are some specific issues of concern to hospitals in South Carolina.

• Exclusion of Critical Access Hospitals (CAHs) from IPAB: The law establishes an Independent Payment Advisory Board that will develop and submit proposals to Congress to extend the solvency of Medicare, slow Medicare cost growth, and improve the quality of care delivered to Medicare beneficiaries. PPS hospitals are scheduled to receive such reductions and therefore are exempt from payment reduction proposals. Critical Access Hospitals were not included in this exemption but should have been.

• Expansion of 340B Drug Program: The ACA expanded eligible participants in the 340B drug discount program; however, the program was not expanded to include inpatient drugs. The discounts should be extended to the purchases of drugs used during inpatient hospital stays, thus allowing hospitals to further stretch their limited resources and relieve them of the burden of carrying two separate inventories and pricing structures for inpatient and outpatient drugs.

• IT Multi-Campus Systems Rule:Hospital systems with multiple campuses will not be eligible for more than one federal incentive payment if they share a single Medicare provider number. The federal incentive payments need to be available for all hospitals in a multi-campus system.

• IMD Exclusion: The ACA provides a $75 million grant proposal to establish a three-year demonstration program for states to allow coverage to Medicaid patients in freestanding psychiatric hospitals. South Carolina is strongly positioned to participate in this program, and SCHA will work with our congressional delegation and other advocates to advocate that South Carolina be chosen for the demonstration program.

• Clinical Integration:Hospitals and physicians must work together to improve the quality and efficiency of our health care system; however, current legal barriers impede many of these efforts. The nation needs laws and regulations that encourage collaboration among hospitals and physicians. Therefore, SCHA and AHA are seeking changes to overcome the legal hurdles presented by antitrust, Stark, Civil Monetary Penalty and anti-kickback laws as well as the Internal Revenue Code. Our two organizations will work with our congressional delegation and the regulatory agencies to modify these unnecessary barriers so that hospitals can continue to improve the quality and efficiency of care for all patients in their communities.