In 2015, Congress voted in favor of bipartisan legislation to protect existing off-site (defined by Medicare as being more than 250 yards from a hospital), hospital-based physician clinics and services from “site neutral” policies that would have substantially cut Medicare reimbursement. The legislation protected OMC’s entire Sequim campus and our primary care clinic on Eighth Street in Port Angeles from significant cuts.
The effect of the 2015 law was especially important to Sequim residents because it “grandfathered” Medicare payments for services at OMC’s Sequim clinics, which helped preserve access to local health care services.
A federal agency rule-making process now threatens to reverse this 2015 law.
The Centers for Medicare and Medicaid (CMS) recently proposed a rule to cut reimbursement for OMC’s previously grandfathered Sequim clinics by 60 percent. That is not a typo. Physician clinic practice expense reimbursement would be cut from $118.35 per visit to $47.34, a 60 percent cut.
This will result in OMC receiving a reimbursement cut of $3.4 million in 2019 and more than $47 million over the next decade.
This is a devastating proposal for many reasons, including:
Access to local health care will suffer
With its site-neutral policies, CMS proposes to cut OMC’s reimbursement to match a rate that is paid to “free-standing” or independent physician practices. Site neutral policies do not work in rural communities such as ours because long ago these free-standing physicians determined they could not operate at such a low Medicare reimbursement.
In our Sequim and Port Angeles communities, residents currently face a shortage of physicians available who are accepting Medicare reimbursement.
OMC provides vital access to care for these Medicare (and Medicaid) patients, and health care services for residents of Clallam County should not be restricted by misguided policies.
Clallam County’s economy will be harmed
Site-neutral payment cuts of $47 million over the next decade, if implemented, will result in fewer jobs and fewer health care services for Clallam County citizens.
Our future economic development depends on having a healthcare delivery system that can grow with our population and meet healthcare needs adequately. OMC is the largest employer in Clallam County with more than 1,500 employees and we need to continue to grow to help fill healthcare shortages.
The proposed reductions in Medicare payments threaten to impede our economic development.
Shortage of health professionals made worse
In Clallam County, we lack needed physicians, registered nurses, physical therapists, medical assistants and other medical professionals. These large cuts will significantly hurt OMC’s ability to recruit and retain the needed workforce to provide excellent care to our patients and to deliver value to the Medicare program.
Future services for Sequim patients, limited
CMS proposes to cut reimbursement by 60 percent for new services at previously grandfathered clinics. This severely restricts the ability of rural and safety net hospitals to meet their patients’ needs in the future. For example, OMC would not be able to add a rheumatologist, which the Sequim community needs, given that this 60 percent reimbursement cut would make this economically unfeasible.
Further curtailing new services that can be offered in Sequim is wrong.
With less primary care access, visits to the emergency department will increase
Site-neutral policies will result in less primary and preventive care, and more emergency department and hospital utilization. By cutting the facility fee by 60 percent, CMS will deprive OMC of needed resources to invest in wellness, prevention and chronic disease management services, all which help reduce and prevent emergency department and hospital utilization.
OMC has partnered with our local YMCA to provide wellness and chronic disease management services at the Sequim YMCA facility. These services are important to offer Sequim residents and reduce the overall cost of health care by keeping patients healthier through attention to primary care and wellness.
Taking action
The Centers for Medicare and Medicaid will be taking comments up to Monday, Sept. 24. CMS will finalize this rule in November unless we can change their minds.
I am optimistic if CMS hears from our community that rural health care needs to be protected from this proposed rule, we can stop the Medicare cuts from harming access to the health care services we need in our community!
Go to www.olympicmedical.org/default.aspx?ID=244 and learn how you can comment to CMS, tell your personal story about the importance of access to health care in our rural community, and help stop these extremely harmful Medicare cuts.
Eric Lewis is Chief Executive Officer for Olympic Medical Center For more about OMC, see www.olympicmedical.org.
