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Medicare Program Causes Confusion Among Kansas Hospital Network

Posted on: Tuesday, 30 August 2005, 00:00 CDT

Aug. 30--When Cheryl Mason, chief financial officer of Salina Regional Health Center, met recently with a representative of an insurance company to discuss the company's Medicare Advantage program, the representative was quick to say what the company would pay for certain diagnoses.

But when Mason asked about reimbursement for such things as rehabilitation and psychiatric services, the representative was at a loss.

"They had no answers," Mason said. "They don't understand how we are paid by Medicare now, so they couldn't compare."

The confusion about the federal program was one topic discussed Monday as about two dozen representatives of hospitals in the Sunflower Health Network met with Rep. Jerry Moran, R-Kan., to discuss health-care issues.

The Sunflower Health Network is a group of 17 hospitals in central and north-central Kansas that works to improve patient care and reduce costs.

Mason wasn't the only hospital representative to bring up the Medicare Advantage program.

She explained after the session that the program allows people to opt out of the traditional Medicare program and sign up with a private insurance company. Private insurance companies market their plans to hospitals, negotiating for lower charges for services based on patient numbers.

Mason said there was a similar program many years ago, but people in the rural areas were reluctant to participate. The current program is new, Mason said, so it's difficult to say how many Medicare patients will sign up.

So much confusion Thus far, administrators in Kansas are reluctant to negotiate with the insurers. There's so much confusion that the Kansas Hospital Association has planned an workshop for hospital officials in September.

Ron Bender, administrator of the Clay County Medical Center, told Moran he doesn't plan to sign any contracts with insurers until after that session.

Bender said it's tough to negotiate with insurers, because the contracts -- which can be 20 to 30 pages long -- are difficult to interpret.

Roy White, administrator of the Cloud County Health Center in Concordia, said he's heard from three insurance companies but has not signed any contracts.

At the end of each year, an audit is completed; if the reimbursement was higher than the costs, the hospital returns money, and if the reimbursement was lower than costs, more money is given. There is no such audit and settlement at the end of the year with the insurance companies.

Several people also spoke about the effect the return of the 1st Infantry Division to Fort Riley will have on area hospitals.

Bender said he's concerned that the Clay Center hospital might have to expand its outpatient services.

Charlie Grimwood, vice president of regional development at Salina Regional, said he's already seen wage inflation for nurses, physical therapists and other professionals with the anticipation of the influx of people.

The growth is expected to worsen a nursing shortage, and Grimwood fears area hospitals will rob from one another, rather than recruit from elsewhere.

Moran said he would be willing to do what he could to encourage the University of Kansas School of Medicine and other nurse educators to accept more nursing students to try to ease the shortage.

Rep. Joshua Svaty, D-Ellsworth, who attended the session, said many veterans would prefer to receive health care in their home communities, rather than travel to large Veterans Administration Medical Centers in large cities.

Moran said the opening of community clinics in Salina, Hays, Dodge City and elsewhere was an effort to bring care closer to veterans, and those centers have been successful. The Veterans Administration has resisted efforts to allow veterans to be treated at home, he said, because they don't want their hospitals to lose patients.

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Copyright (c) 2005, The Salina Journal, Kan.

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Source: The Salina Journal

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