Carol Miller: ‘Rural Patients…Are Disproportionately Left Without Critical Support That They Need’

2 days ago

During a House Ways and Means Committee hearing held before the congressional recess, Rep. Carol Miller (R-WV) questioned witnesses about increasing tele-health access for rural communities.

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Transcript

00:00And I recognize Ms. Miller.

00:02Thank you, Mr. Chairman.

00:04And thank you all for being here today.

00:07Rural patients, like my constituents back in West

00:11Virginia, are disproportionately left

00:13without critical support that they need to recover

00:16after major illnesses.

00:20But it also is from surgery.

00:22This lack of access to essential care

00:25not only affects their recovery, but it also

00:28increases their risks of complications,

00:31leading to longer hospital stays and a diminished

00:34quality of life.

00:36One way to address this critical gap

00:39is to expand telehealth usage in post-acute care settings.

00:44I introduced the Hospice Recertification Flexibility

00:48Act, which passed out of this committee last year.

00:52My bill would allow hospice providers

00:54to use telehealth to conduct face-to-face visits required

00:59for hospice recertification.

01:01Mr. Dongeli, not only do patients

01:04suffer from a lack of proximity to necessary care,

01:08but their families and spouses are also deeply affected.

01:12For caregivers and loved ones, the inability

01:15to regularly visit or assist in the recovery process

01:19can lead to emotional, financial,

01:21and logistical strain.

01:23With these challenges in mind, will you

01:26speak about the impact of lack of access

01:29to care in rural areas upon your patients, spouses, and families

01:34and the challenges that they face visiting their loved ones?

01:39Thank you for that question.

01:41It is a very real issue for family members.

01:45We recognize that treating patients in post-acute care

01:50is not just treating that patient.

01:51It's treating the entire family.

01:53It's making them comfortable and confident

01:55to take their family member back home once they

01:59finish their episode of care.

02:01And so I know we've tried to institute various ways

02:05to make it easier for those family members

02:08to access the care we provide at Madonna.

02:11We provide some family housing.

02:12We have the ability for family members

02:14to stay in the patient's rooms.

02:16They have access to amenities that

02:20would support their relocation for brief periods of time

02:26to our vicinity.

02:28I think that the part of the bill

02:31that Congressman Hearn talked about

02:33and that you also cosponsored is making

02:35it helpful and useful for folks to come to an LTAC

02:42and for that LTAC to receive payment for them,

02:46admitting directly from that critical access hospital.

02:50And so that would hopefully help the patients

02:53and their families receive the care that they need.

02:57Long-term care hospitals are critical for patients

03:00who require extended care.

03:03The cost to treat the complex medical needs

03:05that the LTCH patients require can be significant.

03:10The reimbursement system for the LTCHs

03:14is structured to help manage these costs.

03:17But recent changes to the high-cost outlier threshold

03:20have introduced new financial challenges.

03:24By raising this threshold, the amount

03:26of reimbursement LTCHs can receive

03:29for treating particularly costly cases has decreased.

03:33This puts additional strain on providers,

03:36and it affects the level of care available to patients.

03:40I introduced the Patient Access to Long-Term Care Hospitals

03:44Act, which will provide adequate reimbursements

03:47for LTCHs.

03:49My bill also caps the high-cost outlier amount to $50,000.

03:56With this in mind, Mr. Dungilli, what

03:58has been the impact of the increase in the high-cost

04:01outlier threshold for LTCHs on providers such as yourself

04:07and the patients you treat?

04:10Well, from a provider and patient perspective,

04:14the prior to the increase, the significant increase

04:18in the high-cost outlier threshold,

04:21for instance, when it was $27,000,

04:24I know from a financial standpoint,

04:26we were able to allow more patients who

04:30would enter into the facility who we knew

04:33would become high-cost outliers.

04:35Because that fixed loss amount was such

04:38that we could manage that and still make a relatively small

04:42margin within our long-term care hospital.

04:45And at that time, it was close to 4%.

04:48When that doubled and it went to $58,000 or $57,000,

04:55what we saw was that we had to provide more scrutiny.

05:00Even though we continue to admit those patients who

05:03would go into high-cost outlier status,

05:06the financial impact of doubling it

05:09resulted in our overall LTCH margin

05:12falling from that 4% to a minus 3%.

05:17So when you're talking about a significant number of cases,

05:21and for us at that time, our high-cost outlier threshold

05:25was about 30%.

05:29So now we have to limit that in order

05:34to just maintain financial solvency, which

05:36denies patients access to the care

05:39that they need at that point in time.

05:42Thank you for your answer.

05:43I have to yield back.

05:43I'm out of time.

Carol Miller: ‘Rural Patients…Are Disproportionately Left Without Critical Support That They Need’

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