When legislators return to Capitol Hill this fall, they will push for more Balanced Budget Act corrections – a move designed to bolster rural and small hospital budgets, U.

Saturday, August 12, 2000

When legislators return to Capitol Hill this fall, they will push for more Balanced Budget Act corrections – a move designed to bolster rural and small hospital budgets, U.S. Rep. Ted Strickland said.

"We never intended to cut as deeply as we did and, consequently, some services like therapies and Medicare reimbursement rates, were reduced and that has created a hardship," said Strickland, D-Lucasville.

Congress recognized that last year and passed a corrections bill, appropriating about $13 billion in additional funds to boost healthcare funding, he said.

Hospitals, including River Valley Health System, argue that 1997’s budget cuts have led to increasingly difficult yearly budget problems and Medicare cuts should be re-examined even further.

Strickland agreed, although the issue about how to do it might get complicated.

Congress passed the Balanced Budget Act in 1997 to reduce deficit spending, which cut monies across broad regions of federal funding.

Legislators arrived at the decision to cut Medicare funding for several reasons, Strickland said.

There had been Medicare abuse and fraud in some cases as well as cost shifting, meaning hospitals would raise rates in non-Medicare services to balance low Medicare payments in other services, he said.

Also, in general, legislators wanted hospitals to not use Medicare as a financial reliance, he added.

At the time of the BBA, there was a perception that some services were not quality and had been started to pull down money, especially in home health care, Strickland said.

"But I think our response has gone a little too far," he said. "The fat’s gone and now we’re cutting into the meat and bones of the (healthcare) delivery system. There is a recognition in Congress, on both party sides, that there needs to be a correction."

Congress does not intend to eliminate the Balanced Budget Act altogether, last year’s correction or all cuts to Medicare, though, he said.

"The debate now is what areas and at what levels should we increase resources to hospitals."

Committee hearings in Washington, D.C., have already examined a direction that changes to the budget act should take, Strickland said.

"I feel quite certain there will be a relief bill passed but there’s still a disagreement among committee members how much to give and to which services," he said.

Worries about future Medicare fraud have been stymied somewhat by caps placed on some services.

Plus, private insurers have started to follow Medicare’s spending limits – a sign that Medicare is heading in the right direction, Strickland said.

Yet, that’s a two-edged sword because hospitals have seen an impact coming from those private insurers’ payments, he said.

Strickland met in Portsmouth with hospital administrators from around southern Ohio three weeks ago to hear concerns. Congressmen across the nation have held similar meetings in their own districts, he said.

"Smaller and more rural hospitals have, frankly, suffered more than others because many are in high poverty areas," Strickland said.

They also serve an aging population that uses more Medicare services and it’s hard to make up the difference in reimbursement cuts with private payers, he said.

Congress will discuss the issue, and might even make exceptions for hospitals serving more rural areas and more elderly patients, Strickland said. Or, legislators could look at what can be done for hospitals provided large amounts of uncompensated care.

Whatever happens, the priority will rest with what can be done to make sure people can access the healthcare they need and hospitals can provide it, Strickland said.