Keep Illinois’ Hospitals From Falling Further in the Red!

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% of Hospitals Operating at a Loss by Region in Illinois
Source: Illinois Hospital Association

This May the SMART Act passed both houses of the Illinois General Assembly. This legislation will scale back Illinois’ Medicaid program by $1.6 billion through rate reform and utilization controls.

The Illinois Hospital Association (IHA), an organization dedicated to advocating on behalf of Illinois’ health systems, is calling on the medical community to ban together to halt the enforcement of specific detrimental provisions. Specifically, the provision that will deny payment for an entire inpatient admission if a hospital-acquired condition (HAC) occurs poses an incredible threat to individuals across the state.

This rule has the potential to jeopardize access to care, by discouraging hospitals from working with Medicaid patients with complex medical needs. Further affecting non-Medicaid patients, the financial losses from denial of payment could result in cost-shifting. In addition, this policy runs contrary to federal regulations, where payment is denied only for the increased payment attributable to the HAC.

Illinois’ Joint Committee on Administrative Rules (JCAR) will be convening to vote on this provision. As members of the healthcare community it is imperative to act swiftly and reach out to our legislators.

Take action today to help prevent Illinois hospitals from falling even further in the red! Visit IHA’s state advocacy site and use one of the templates provided to send a letter to members of JCAR. Encourage them to overturn this provision and to adopt the federal policy that ensures that hospitals will still be paid for the medically necessary care appropriately provided.

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2 Responses to “Keep Illinois’ Hospitals From Falling Further in the Red!”

  1. tliccardi Says:

    I agree this legislation prohibits equitable care for those with complex disease. It is penny wise and pound foolish. Complex care patients have multi organ disease and are more likely to suffer adverse effects from the multiple therapeutics required for treatment. If patients can only be treated and reimbursement guaranteed if there are no mistakes, then practitioners will not want to risk caring for these individuals. Care that may be required inpatient may be delayed to avoid the potential loss of reimbursement. Cost-shifting is inevitable since these individuals who are ill will still require undeniable care and care may be more expensive if in-house treatment is delayed for fear of non -reimbursement. Patient care will ultimately be more expensive.

  2. annepalumbo Says:

    Very interesting. I live in Illinois (and am well aware of the budget issues that plague the state). I practice medicine in Iowa (albeit in a hospital that has a campus in IL), and I had not heard about this. Note that they are not talking about restricting payments to practitioners (although that may be coming), but rather to hospitals. The rationale seems to start with Medicare’s policy (2008) that there are certain “never events” that are supposed to be 100% preventable. If these occur, then it is the fault of the hospital that failed to prevent them, and the hospital should suffer financially by not being allowed to recover the additional costs needed to treat these conditions. Illinois medicaid has taken this one step further, and said it will decline payment for the entire hospitalization. The state of Illinois already owes most hospitals at least several million dollars. Reimbursement from medicaid is already so low that many providers won’t accept it (so patients have limited options for follow-up when they leave the hospital.) This new policy may hit those hospitals the hardest that serve a large pediatric population. I fail to see how this could not result in cost shifting, and it seems a way to stretch medicaid dollars by denying payment for services rendered. I wonder if many hospitals are too preoccupied with rumored Medicare cuts (including not paying for rehospitalizations for the same condition that occur within 30 days) to worry about medicaid cuts, given that the program is already so far behind in payments. Urging the state to follow Medicare rules (federal) may seem the most reasonable course of action, but many in health care feel that the list of “never events” includes some events that are not 100% preventable. While a hospital should be able to put policies/procedures in place to ensure that a patient is never transfused the wrong blood, preventing catheter related infections is more complicated, and is not 100% preventable (but is a way to save money by denying payment).
    Thank you for an informative post that is certain to generate many discussions in the weeks to follow.

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