As the federal government shutdown stretches into its fourth week, hospitals across the country are feeling the strain.
Kevin Post, DO, CMO of Sioux Falls, S.D.-based Avera Health, joined Becker’s to discuss how his focus is on supporting physicians and staff amid growing uncertainty.
Editor’s note: This interview was edited lightly for clarity and flow.
Question: How has the CMS reimbursement pause affected your hospital so far? Are you seeing any changes in patient access or service delivery because of it?
Dr. Kevin Post: The current reimbursement pause is causing increased uncertainty at a time where costs (workforce, supplies, pharmaceuticals) are rising more rapidly than reimbursement. The primary effect currently is increased caution in discretionary spending and future capital decisions. Due to even tighter financial margins being expected, hospitals and health systems are closely examining services that typically are low-volume, high-cost or with marginal profits that remain an important service in the lives of our patients, such as maternity care and behavioral health. Patient access and care delivery is being slowed or temporarily stopped where reimbursement appears to be the most uncertain, such as in telehealth services to rural patients and communities which affect patient access to specialty care in areas where it is difficult to overcome travel time and transportation challenges.
Q: How do you think this reimbursement pause will affect physicians, either in their daily work or their outlook on Medicare payment stability?
KP: The most significant effect for most physicians may be concern for their patients and communities they serve, and how can high-quality, safe care continue to be delivered with a model that is not financially stable long term. In order to maintain overall care provided, physicians may reduce services (telehealth, affected appointment types), alter care team models, or reduce access to affected patients and visit types. This can lead to moral injury for physicians and caregivers by violating their personal values and motives for entering medicine when they are unable to deliver effective care due to resource limitations from diminishing reimbursement structures that are seen as unsustainable.
Q: How are you supporting your physicians and staff as they navigate this reimbursement uncertainty?
KP: At Avera Health, we are supporting our physicians and caregivers in several ways. Keeping them informed and understanding of the current and anticipated changes, so we can move forward collectively as colleagues to continue to deliver care to the patients and communities we serve. We also give recommendations and guidance on which services and appointment types to continue to offer, and at what rate, until further clarity is known. The voice and well-being of our physicians are a high priority for Avera, so physicians have a seat at the table as we decide what is best for care delivery with the patient and our people at the center of decision making. Political advocacy in representing our care-delivery priorities at both a state and national level is also an important arm in our support for our clinicians. Additionally, providing financial stability for our caregivers and employees is important so they and their families can feel well supported as we navigate these challenges together.
Q: What would you like to see CMS or Congress do about this issue, and more broadly, when it comes to Medicare payment policy?
KP: At Avera Health, we would like to see increased listening and partnership with the healthcare system and leaders so that reimbursement more closely matches the real cost of care. Updating payment models and rates in alignment with rapidly increasing inflationary costs is also key to continued financial stability. A long-range, transparent reimbursement strategy would be helpful to guide future planning and capital expenditures so health systems can feel confident in investing in workforce, technology and facilities. For Avera, rural care is so important to who we are, so payment policies that allow us to continue to provide primary and specialty care in rural, underserved areas will be key to caring for some of our most vulnerable patients and communities. We can never forget that it is our patients and families who ultimately are affected at the downstream impact of payment policy decisions.
