The flagging economy has impacted organizations across all sectors, including the so called “recession proof” health care industry.  The tightening of the credit markets and investment losses have affected everyone, including hospitals big and small.  However, unique to health care are the reimbursement pressures as unemployment rises and more become uninsured or eligible for Medicaid.  Hospitals nationwide are tightening their belts, as are state governments.  Many state legislatures and administrations were in a holding pattern for months while they anxiously awaited news from the federal government about the American Reinvestment and Recovery Act (ARRA).   There should be a quick ramp up in activity as states figure out how and when to access these needed funds.

In addition to the ARRA, the first federal moves on health care reform were made when Obama selected Kansas Governor Kathleen Sebelius to hold the top job at Health and Human Services.  In addition, the president plans to hold five White House Summits on health care reform designed to cross pollinate ideas and build consensus around key issues such as coverage and payment.  Vermont and Massachusetts co-hosted the only New England summit on March 17th, with over 400 invitees and countless advocates protesting outside.  While a lot remains uncertain, system integration, payment reform and increased reporting on performance are three areas of focus we can expect from the federal government.

The Vermont Legislature
Revenue downgrades and program cuts dominated the first half of the session.  Third term Republican Governor James Douglas has kept steady pressure on members of the House and Senate Appropriations committees to not rely too heavily on federal stimulus dollars to fill significant budget gaps.  He believes the state must solve structural budget problems by putting programs like Medicaid and public education on a more sustainable path.  However, the democratic legislature has focused on gay marriage and Vermont’s nuclear power plant.  All attention will turn to the must-pass budget as the second half of the session quickly slips away.   

Health care reform has become a perennial issue in the Vermont State House and controlling health care costs is the theme for this session.  For example, H.24, the colorectal screening bill, started as a vehicle to require health insurers to cover colorectal screenings, but now includes a provision to study capping hospital charges on a defined set of diagnostic services.  Two separate bills would propose studies to evaluate Vermont’s health care infrastructure to determine if the state has the right number and size of hospitals and to consider the impact of hospital closure or consolidation of hospital leadership.  The Vermont Association of Hospitals and Health Systems is also tracking bills on palliative care, regulatory refinement, mental health, mandatory overtime and safe patient handling.

Vermont Hospitals have been very engaged in targeted advocacy on these issues and have developed “Rapid Response Advocacy Teams” made up of hospital trustees and employees that are ready to respond to urgent advocacy needs.  In addition, hospitals have been meeting one-on-one with their local delegations and business leaders to tell the “health care safety net story”.

For more information, please contact Megan Castonguay, Director of External Affairs, Vermont Association of Hospitals and Health Systems at (802) 223-3461 x107 or by email at Megan@VAHHS.org.
 
The Rhode Island Legislature
This month, the Rhode Island General Assembly enters the second half of its legislative session.  The overwhelming priority this year has been the state budget deficit, which some predict could reach $1 billion for fiscal years 2009 and 2010.  This shortfall has spurred the submission of a 2009 supplemental budget proposals from Gov. Donald Carcieri (R) and a 2010 budget that dramatically cuts funding to health and human services organization and programs, including hospitals.

While the governor has proposed the use of federal stimulus funds to close the 2009 budget gap, some legislative leaders are opposed to this remedy and the ultimate decision lies in the hands of the overwhelming Democratic General Assembly.  Without this remedy, hospitals stand to lose more than $30 million in funding.  In addition, more than $35 million in hospital payment reductions have been proposed for 2010.

With one out of every ten Rhode Islanders out of work, the state’s unemployment is the second highest in the country.  The fragile economy is placing unprecedented stress on hospitals and having a tremendous impact on their financial viability.  Acute care hospitals in Rhode Island lost more than $24 million in the first four months of the fiscal year.  Hospitals are also experiencing a decline in discharges, patient days and emergency department visits.

In response, HARI and its members are working hard to tell the hospital story.  It is more important than ever that the hospital community embraces advocacy.  Policy makers must understand the positive impact that hospitals have on their community and the unique role they play in achieving a healthy, strong and robust state.

For more information, please contact Amanda J. Barney, Vice President, Communication, Rhode Island Hospital Association at (401) 946-7887 ext. 111 or by email at AmandaB@HARI.org.

The New Hampshire Legislature
The New Hampshire Hospital Association is tracking many bills related to health care this legislative session.  Among the highlights of recent developments…

The state budget bill, HB 1, remains front and center for NHHA’s member hospitals, with steep Medicaid cuts. Since hospitals have several hits to Medicaid reimbursements in recent months, NHHA is asking the House Finance Committee to use the new federal Medicaid stimulus funding to restore hospital payments to their pre-November 2008 levels.  Governor John Lynch, however, proposes to use these funds - $250 million through 2010 – to fill holes in the General Fund, despite the fact that the increased funding was intended by Congress to alleviate the strains the economy is placing on health care providers.  If the Medicaid stimulus funding is redirected to the General Fund, hospitals will see cuts of $37 million in FY 2010 and $41 million in FY 2011.

The House Health & Human Services Committee recently passed a bill requiring hospitals and ambulatory surgery centers in NH to report “adverse events.”  Modeled after a Minnesota law, HB 592 requires hospitals and ASCs to report to the Department of Health & Human Services (DHHS) any of 28 adverse or “never” events. The bill requires DHHS to publish an annual report describing, by facility, the adverse events reported.  In our testimony, NHHA highlighted hospitals’ ongoing efforts to prevent adverse events, and noted that such a reporting system is just one piece of a broader initiative to improve quality of care.  The bill now moves to the Senate. Hospitals will comply with the law should it pass.

For more information contact Andrea C. Alley, Director of Communications, NH Hospital Association and Foundation for Healthy Communities at 603-225-0900 x239 or by email at aalley@nhha.org

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