OAHHS Hospital Voice Fall/Winter 2019

19 Fall/Winter 2019 continues  portion of their medical bills. In some ways we’ve traded one challenge for another. And in my opinion, that is why there is so much focus these days on the cost of healthcare services vs. the cost of health insurance. It’s hitting everyone at all income levels in ways it did not ten years ago as they are having to pay more and more out of pocket, despite being covered. Oregon is not one of the states that is losing rural hospitals. Why is that? The way that rural hospitals in Oregon are paid to deliver care is unique in a few key ways. First, Medicare reimburses hospitals that meet certain criteria at “cost,” and I’m using air quotes. It’s a very complicated formula, but small rural hospitals that meet certain size and geographic requirements are being paid a better rate structure from the Medicare program then our larger hospitals are. These 26 “Critical Access Hospitals” have found this program to be instrumental in terms of their financial picture over the last 20 years as their patient population ages and more are now getting their insurance through the Medicare program. In addition, in Oregon, our Medicaid program also pays our small and rural hospitals, though their CCOs, at a higher rate than their larger colleagues in more urban areas. And today, we have many rural hospitals that are partnering with their CCOs, physicians and their communities to share risk based on patient outcomes and the health of their communities. That’s a big darn deal. These risk- based payment models are a rarity in rural communities across the U.S. But not here in Oregon. It’s a testament to Oregon’s hospital and health system leaders and their being willing to try new models. It’s been a terrific learning experience for me to watch our rural members sort out how their missions align with the changing healthcare payment models. They have been bold! In the 14 years I’ve been at the association, we haven’t had any rural hospitals close, despite a trend in other states. I don’t know what the future holds in this regard for Oregon. I think the biggest question before rural communities is this: if we’re not a full-service acute care hospital, what would we look like? And the only way to answer that is to have a conversation with your community, to look at the data and understand the value and cost of the services that are made available.