Urge Congress to Protect Patient Care in Final Days of Session 

Hospitals’ Financial Challenges Put Access to Care at Risk

Background

• Recent data show that despite some small improvements in hospitals’ financial conditions, the majority of California hospitals are still struggling.
• Severe losses hospitals incurred during the pandemic have never returned to normal levels, and sharp spikes in the cost of delivering care (salaries, medications, medical supplies, physical plant overhead, and more) continue to outpace revenue growth.
• Nearly half of all hospitals in California lose money every day delivering care. Another 12% are barely above break-even.

Key Messages

• The biggest driver of these challenges at HOSPITAL NAME is that government payers — Medicare and Medi-Cal — don’t cover the actual cost of care delivery. INSERT HOSPITAL PAYER MIX HERE AND DISCUSS PATIENT TRENDS (LONGER LENGTHS OF STAY, UNDERINSURANCE, ETC.)
• This is a national trend, and we’re seeing this play out in frightening ways. Maternity units and behavioral health care, those services that see the biggest gaps between reimbursement and cost are closing at an alarming rate. Here at NAME OF HOSPITAL, we are looking at some difficult decisions around XXXX and XXXX just to remain open and available for patients.
• We need your help on a number of issues — preventing dangerous DSH cuts, opposing changes to Medicare’s site-specific payment policies, and protecting low-cost medication support through 340B — to help preserve and stabilize care in NAME OF COMMUNITY.

Resources

• Hospital Care at Risk – Infographic
• How Hospitals Are Financed – Infographic

Rural Hospitals, Vital to Their Communities, Need Federal Support

Background

• Nearly 2 million people live in California’s rural communities, which provide food, water, power, and recreation to the state — but their access to life-saving hospital care is at risk due to significant underpayment by the Medicare and Medicaid programs.
• Many small and rural hospitals in California are mirroring a troubling national trend — on average, they have seen their operating margins drop by a frightening 8 percentage points from 2019 to 2023. Between January 2013 and February 2020, more than 100 rural hospitals nationwide closed, including two in California — Corcoran District Hospital and Madera Community Hospital.
• When a rural hospital closes, those in poor health, seniors, and people experiencing poverty suffer the most (the national median poverty rate for rural communities with a hospital closure is 13%). 

Key Messages – Critical Access Hospitals

• The Preserving Emergency Access in Key Sites (PEAKS) Act, H.R. 7931, would help critical access hospitals maintain access to ambulance services in their communities.
• NAME of HOSPITAL maintains our own ambulance service because there are no other providers in our community. STATISTICS HERE ON TRANSPORTS IN THE PAST YEAR, GROWING DEMAND, ETC.
• We need the PEAKS Act to enable us to continue this vital service.

Key Messages – Rural Hospitals

• The Rural Health Care Facilities Revitalization Act, H.R. 5989, would allow Community Facility Loans and loan guarantees under the U.S. Department of Agriculture to be used by rural health facilities, including NAME OF HOSPITAL.
• This funding is vital to keep rural hospital doors open to serve their communities.
• H.R. 5989 makes minor adjustments to an existing, proven, and cost-effective program that will make a major difference to rural hospitals.  

Resources

• CHA letter PEAKS Act 
• CHA Letter Rural Revitalization Act 
• Rural Infographic 
• To find out whether your representative has supported the PEAKS Act, check CHA’s Federal Legislative Tracker   

Site-Neutral Payment Policies Jeopardize Patients’ Access to Care

Background

• Congress is considering legislation that would reduce payments to hospitals for certain procedures provided in hospital outpatient departments (HOPDs), making them equivalent to payments made for services provided in physician offices.
• Proponents of these “site-neutral” proposals suggest that the care provided is the same, regardless of setting, and therefore the price should be the same.

Key Messages

• HOPD services are more expensive for important and legitimate reasons.
  • HOPDs have more comprehensive licensing, accreditation, and regulatory requirements than independent physician offices and ambulatory surgery centers.
  • Hospitals treat all who walk through their doors, regardless of coverage.
  • Patients who receive care in HOPDs typically have more complex medical needs and benefit from the additional clinical services available in these settings.
• This is especially true at <HOSPITAL NAME>. Our patients are XX% Medicare beneficiaries and XX% Medi-Cal beneficiaries — and many are dually eligible. They need the additional support and care we provide.
• HOPDs provide critical services, like <list examples> that may not be readily available in other community settings. Preserving access to care for the vulnerable populations served by Medicare and Medi-Cal must be paramount.

Resources

• AHA Chart
• AHA Myth Fact Sheet
• CHA Letter
• AHA 2024 Advocacy Messages

Medicaid Disproportionate Share Payments are Critical to Ensure Access for California’s Most Vulnerable

Background 

• More than 150 hospitals in California participate in Medicaid’s disproportionate share hospital (DSH) program, a financial lifeline for hospitals that care for the most vulnerable — children, impoverished, disabled, and elderly.
• Payments from this program are vital to preserving access to services such as trauma and burn care, maternal and child health, high-risk neonatal care, and more. DSH resources are also vital to deliver care to those without any health coverage at all.
• Without congressional action, major cuts to this essential program are scheduled to take effect on Jan. 1, 2025, and would reduce payments to California’s hospitals by as much as $1.3 billion. 
• Congress, understanding how essential Medicaid DSH funding is to these hospitals, has repeatedly delayed the implementation of Medicaid DSH cuts with strong bipartisan support. To preserve access to vital services, Congress must take action again.

Key Messages 

• As a safety-net provider, NAME OF HOSPITAL relies on Medicaid DSH payments to help us ensure access to care for our community. 
• Our Medicaid patient population is XXX. SHARE MORE DETAILS OF YOUR HOSPITAL’S SERVICES, PATIENTS, COMMUNITY, ETC. – THEIR UNIQUE NEEDS, AND HOW YOUR HOSPITAL SUPPORTS THEM 
• NAME OF HOSPITAL ensures access to vital health care services for those most in need. We provide essential services for everyone — regardless of whether they have health insurance — such as primary and specialty care, trauma care, neonatology, burn care, pediatric care, and behavioral health. 
• Please ensure that Congress extends the delay in the cuts to Medicaid DSH program once again, so NAME OF HOSPITAL can continue to be here for our community and people we both serve.

Resources 

• Coalition Letter
• DSH Fact Sheet

340B Allows Hospitals to Stretch Limited Resources, Improve Patient Care for Vulnerable Populations

Background

• Congress created the 340B program to help covered entities stretch scarce resources, reach more patients, and provide more comprehensive services through the outpatient drug discount program.
• Despite having a 0.1% operating margin, California’s 175 340B hospitals provided over $7.1 billion in benefits to the communities they serve at no additional cost to taxpayers.
• Funding went to programs like medication therapy management, diabetes education and counseling, behavioral health services, opioid treatment services, and providing free or discounted drugs to those in need.
• Including the 340B discount, which only accounts for 3.1% of pharmaceutical company revenue, the top 10 manufacturers still had an average operating margin of more than 28%.

Key Messages

• As a safety net provider, NAME OF HOSPITAL, we rely on savings from the 340B program to help us maintain access to care for the most vulnerable in our community.
• The 340B program allows NAME of HOSPITAL to provide services such as (examples might include, but are not limited to Federally Qualified Health Center support, reducing homelessness, health screenings for at risk populations, co-pay assistance and free medication programs for uninsured, chronic disease prevention/management programs, etc.) XXX, XXX, and XXX, to individuals in our community who have health related social needs.
• Congress should protect the 340B program from harmful changes to ensure access to more affordable drug therapies and programs by passing the 340B PATIENTS Act. Please cosponsor H.R. 7635.

Resources

• CHA 340B SUSTAIN Act RFI Response
• AHA 340B “Fact vs. Fiction”
• CHA 340B Letter to Delegation
• CHA 340B Overview
• To find out whether your representative has supported the 340B PATIENTS Act, check CHA’s Federal Legislative Tracker  

Congress Must Take Action to Ensure Timely Access to Care for Seniors

Background

• Bicameral, bipartisan legislation that would streamline prior authorization (PA) requirements for Medicare Advantage (MA) plans is under consideration by Congress.
• The Improving Seniors’ Timely Access to Care Act, H.R. 8702 and S. 4532, would establish standards for an electronic PA process, thereby reducing the amount of time a plan is allowed to consider a PA request. Additionally, the act will require plans to report on their use of prior authorization. 

Key Messages

• This legislation will address pervasive problems in certain MA plan practices that lead to inappropriate delays and denials in patient care, as documented in an April 2022 report by the U.S. Department of Health and Human Services Office of Inspector General.
• Many Medicare beneficiaries live on modest incomes and have multiple chronic conditions that limit their activities of daily living. Delays in access to care can cause irreversible harm and limit beneficiaries’ ability to live independently.  
• Currently nearly 3.4 million Californians are enrolled in MA plans, representing 50% of the state’s Medicare enrollment. and 11% of national MA enrollment. At NAME OF HOSPITAL, XX% of our patients are currently enrolled in MA plans, and we expect that percentage to increase.   
• Burdensome MA prior authorization practices also lead to higher administrative costs for hospitals as they are forced to pursue lengthy appeals processes to justify medically necessary care for the patients they serve.     

Resources

• CHA letter supporting H.R. 8702 and S. 4532
• Report: Some Medicare Advantage Organization Denials of Prior Authorization Requests Raise Concerns About Beneficiary Access to Medically Necessary Care (U.S. Department of Health and Human Services Office of Inspector General)
• To find out whether your representative has supported the Improving Seniors’ Timely Access to Care Act, check CHA’s Federal Legislative Tracker