If freestanding emergency centers (FECs) are to survive and help underserved rural communities, they should be allowed to receive Medicare and Medicaid reimbursement, which they cannot currently do, an FEC executive told members of the House Ways and Means Health Subcommittee Monday.
“The model doesn’t work unless we can get Medicare and Medicaid,” Robert Morris, CEO of Complete Care, a company that runs 15 FECs in Texas and Colorado, said during a subcommittee field hearing held at Global Medical Response, a ground and air transportation service provider in Denton, Texas. “But there’s a lot of us in this space that would love to go out to those underserved areas.”
Millions in Uncompensated Care
FECs are one type of rural emergency care provider that has sprung up in the wake of many rural hospital closures. They are state-licensed facilities that offer the same level of care as hospital-based emergency departments, with doctors, nurses, and radiology technologists always on site, Morris, who is also president of the National Association of Freestanding Emergency Centers, said in his written testimony.
“Our facilities provide advanced imaging, laboratory, and pharmacy services. FECs diagnose, treat, and stabilize all major medical emergencies, including heart attacks, strokes, fractures, lacerations, and trauma,” Morris noted. “We comply with the No Surprises Act and believe patients should be protected from unexpected medical bills by limiting patient financial responsibility to in-network cost-sharing amounts.”
However, the lack of acceptance of these facilities by CMS means they’re not eligible for Medicare or Medicaid reimbursement, which is a problem because those two programs comprise about 56% of rural hospitals’ net revenue, he said.
As a result of being locked out of those programs, “we provide millions of dollars in uncompensated care,” Morris testified. “If we have medically screened someone — for example, a Medicare beneficiary — and ruled out a life-threatening emergency, we will talk to them about the fact that we’re not a Medicare provider … and give them the option to pay cash … But plenty of times, you can’t have those conversations [because it’s] an emergency situation and we’ve got to take care of the patient. So it’s very difficult.” Morris supports the Emergency Care Improvement Act, which would require Medicare and Medicaid to cover services provided by FECs.
Rep. Greg Murphy, MD (R-N.C.), criticized CMS for not dealing with this issue. “CMS doesn’t know what the hell it is doing,” he said. “It’s grown into this massive burgeoning bureaucracy that grows year after year after year, that is so out of touch with payment reform, with regulation reform, it’s killing medicine … You should absolutely be able to bill Medicare and Medicaid.”
Taking a Different Route
On the other hand, Ted Matthews, CEO of Anson (Texas) General Hospital, is very satisfied with the path his hospital took by becoming a rural emergency hospital (REH). REHs, which are eligible for Medicare and Medicaid reimbursement, provide only emergency and observation care, although they can provide other types of care as long as the average length of stay does not exceed 24 hours.
Matthews described how his hospital was on the verge of closure due to its older, sicker patient mix; its aging facility; and its difficulty in recruiting providers. “The choice was basically that we stay the course — which would have meant our hospital would close — or become a rural emergency hospital,” he said. “We elected to become that rural emergency hospital and that has made all the difference in the life of our hospital. We now have a future.”
The role of ambulances also came under discussion. Matt Zavadsky, chief transformation officer of MedStar Mobile Healthcare, which provides emergency medical services (EMS) to the Fort Worth area, described his frustration over the lack of Medicare reimbursement for services provided by emergency medical technicians at non-hospital locations.
“One of our programs is a high-utilizers group program,” he said. “It’s designed to help frequent 911 callers learn how to better manage their health conditions and connect them to community resources. Since 2013, 22,000 patients have been enrolled in this program, and those patients have reduced their 911 use by 51.2% … But yet we have not been paid by Medicare for one of those patients because it’s not a covered service.”
“On the 911 side, we have been working with Congress to sponsor legislation to provide EMS the flexibility to navigate patients to the right care at the right time and in the right setting through treatment-in-place programs,” he continued. However, “currently, the EMS economic model incentivizes transport to an ER [emergency room], since treatment in place is not a covered benefit and we don’t get reimbursed for that service.”
Issues With Emergency Abortions
Another type of emergency care also came under discussion; the committee heard testimony from Lauren Miller, a Texas resident who became pregnant with twins but said she learned at her 12-week visit that “while one of the twins was thriving, the other was not” and had “large fluid masses where his brain should have been developing,” Miller said. “Speaking with our team of doctors, nurses, and genetic counselors, we kept arriving at the same awful conclusion. This twin was going to die; it was just a matter of how soon, and every day that he continued to grow, he put our healthy twin and myself at greater risk.”
However, because of Texas’s abortion ban law, “my doctors were terrified to suggest an abortion of the one unviable twin, even though this would have saved the other one. There were no next steps. There were no treatment options.” She ended up having to go out of state to get the abortion, and had a successful singleton birth.
Rep. Don Beyer (D-Va.) said he found Miller’s testimony hard to listen to because it was so depressing; he asked about her mental health during her pregnancy. “I felt like I was a walking coffin,” she said. “It just haunted me through the rest of my pregnancy, and when Henry was born, my first words to him were not, ‘Welcome little one. I’m so glad you’re here.’ It was just this feeling of relief, and I just breathed out and said, ‘You made it.'”
Please enable JavaScript to view the