Leaders of five of the six hospitals in the Big Horn Basin had a united message for area legislators on Thursday: We need Medicaid expansion.

That message was voiced by Eric Boley, past chairman of the Wyoming Hospital Association, during the Big Horn Basin Healthcare Legislative Forum in Powell.

“We have 26 states in the country that have adopted Medicaid expansion,” Boley said. “Those states that have adopted Medicaid expansion, their hospitals are doing much better. Charity care, uncompensated care, has dropped drastically in those states.”

Lawmakers, in turn, assured attendees that they are working on a plan that could be in place as early as April.

The forum, which took place in the Yellowstone Building at Northwest College, was planned and organized by Powell Valley Healthcare.

“We’re at an important point in time,” said Bill Patten, PVHC chief executive office. “We thought it would be a good idea for the folks who are in a position to both oversee and impact healthcare in our state, in our area, to have a chance to get together to talk about the issues.”

The goal, he said, was for everyone “to walk away with an understanding of the things that, from a health care facility perspective, we would appreciate our elected officials pursuing.”

The meeting was attended by representatives of West Park Hospital in Cody, North Big Horn Hospital in Lovell, South Big Horn Hospital in Basin and Hot Springs Memorial Hospital in Thermopolis.

Legislators attending were Reps. David Northrup and Dan Laursen, both R-Powell, Rep. Elaine Harvey, R-Lovell and Sen. Ray Peterson, R-Cowley.

Boley said hospitals in Wyoming provided $232 million worth of uncompensated care in fiscal year 2013, at an estimated cost of $125 million.

“Those are our costs, not charges,” he said.

Of the total, $76 million was charity care for people with low incomes. Statistics show 60 percent of them are employed but can’t afford insurance, he said.

“This is a problem that is not going to go away,” he said. “I think it is time in our state that we do something here.”

Medicaid expansion could relieve some of that financial stress, he said.

In addition, it would allow people to receive care on a preventative basis, before medical problems becomes so severe that they require a visit to the emergency room, he said.

Medicaid expansion is going to be a hot topic and a tough one in the Legislature, Boley said. He noted that debate on an alternative plan similar to Indiana’s will start in the Senate, where it will be explained by Sen. Charlie Scott of Casper.

In addition, although the proposed Share Plan failed the Joint Labor, Health and Social Services Interim Committee on a 7-7 vote, “I have heard that there are some representatives that are going to introduce that individually, and it will be looked at during the Legislature,” Boley said.

“I don’t really care which plan passes,” he said. “I just think we need a plan passed that will take care of these uninsured people.”

Peterson and Harvey, both of whom serve on the Joint Labor, Health and Social Services Interim Committee, said work on an alternative plan is progressing.

“Wyoming has the advantage of three years of studying,” Peterson said. “This alternative plan is our best solution so far. ... It’s a good fit, the Wyoming way ... something that’s realistic.”

Because it has waited, “Wyoming has the advantage of having the ability to see effects (of Medicaid expansion) in other states,” Peterson said. “These states are feeling some strong-arming of the government. Costs are uncontainable. ... When the federal government does pull out — and they will, they always have — we’re going to be left holding the bag. Where is that money going to come from?”

As examples, he cited of abandoned mine lands (AML) funding and coal severance taxes, both of which have been withheld from the state by the federal government.

“That’s half a billion (dollars),” he said.

Peterson said it was no great surprise that the Share Plan died in committee, as a similar proposal was defeated last year.

Harvey, who co-chairs the Joint Labor, Health and Social Services Interim Committee with Sen. Scott, said the Legislature, as a last resort last year, directed the Wyoming Department of Health in a budget bill footnote to come up with a plan to be negotiated with the federal government.

“Of the things in the budget bill, only half of those things were addressed in the Share Plan,” she said.

The department provided its report the day before Thanksgiving, and the committee hasn’t had time to formalize the envisioned plan, she said.

“We have talked with people on the ground (who) have seen firsthand what the unintended consequences are. We have ... looked at many different plans and picked the things that we liked from other states. ... We couldn’t publicly come out and say we think we got it.

“Charlie (Scott) and I put together our notes, and I took those notes to Washington, D.C., and met with the director of (Health and Human Services),” she said. “Only one thing is a bit controversial. Everything else, the HHS has passed in some states. When you hear, ‘Oh, they’ll never accept that, or ‘It will take months to negotiate, well — it’s already been negotiated.

“I was told in Washington, D.C., if we pass a bill in February, there is no reason we can’t have Medicaid expansion in practice in April.”

One of the sticking points, Harvey said, is determining who contribues to health savings accounts.

“That’s going to be the individual and Medicaid,” she said. “It’s already happening in other states.”

I just want to let you know that we are with you here. We’re going to give people a hand up. We don’t have a bill yet, but I promise you it’s coming. We’re going to stay with you, and what it’s going to take is communication.

Convalescent care

Another topic of discussion at the meeting was a bill that would allow surgical centers to provide up to three days of convalescent care, making it possible for them to perform do joint replacements and other more complicated surgeries.

Currently, surgery centers can keep patients for only one day, after which patients must be moved to hospitals.

Boley said the Wyoming Hospital Association opposes the bill because it gives an unfair advantage to surgical centers, which erode the bottom line for hospitals by “cherry-picking” — taking the most profitable surgical procedures away from hospitals without the need of providing emergency room service or charity care. 

“They’re claiming they can do it cheaper,” he said. “They would discharge the patient to a motel, then have a nurse go in and check on them. It’s cheaper ... because they don’t have the overhead.

“If there were safety nets where they had to take care of emergencies, the uninsured, etc., I don’t think we would have as much concern,” he added.

Boley noted that surgery centers are not allowed to care for Medicare patients, who must be undergo surgery in hospitals.

“We would be able to keep those — the lowest-paying (patients),” he said.

Pat McConnell, chief financial officer for West Park Hospital, said, “This would devastate West Park Hospital. Right now, that’s the majority of surgeries we do, those categories. There is a strong financial incentive for those surgeons to move to centers they have part ownership in. I would have to advise my board that we would have to curtail certain services we provide at a loss. The community would lose those services.”

Patten said a hospital he formerly managed was 90 miles from an ambulatory surgery center, and even from that distance, it affected the hospital.

“The surgery center had to call 911 to transfer patients to a hospital when they couldn’t care for them. We couldn’t call 911 — we are 911.

“I would suggest a convalescent care center is a surgery center on steroids,” he said. “Make sure there is a level playing field — that’s all we ask.”

Protect critical access hospitals

A list of health care priorities also asked lawmakers to help strengthen small hospitals.

Boley said critical access hospitals — hospitals with 25 or fewer beds, including all hospitals in the Basin — are financially fragile now, and 12 of the 16 critical access hospitals in Wyoming are losing money, largely due to changes in federal health care regulations.

He asked lawmakers to do what they can to protect critical access hospitals, which are vital to small communities in the state.

Harvey said the federal government’s health care rules don’t work for small, rural frontier states. Those rules aim at streamlining medical delivery and getting rid of critical access hospitals in favor of economy of scale.

“It works great in New York and California. It doesn’t work in Idaho, Wyoming, Montana or Colorado. I think that we are being set up to fail on multiple levels.”

Steve Bahmer, vice president of the Wyoming Hospital Association, summed it up: “If we lose hospitals, we lose lives.”