In a visit to Jefferson City, Republican U.S. Sen. Roy Blunt picked apart what he perceives as flaws in the American health care system and listened to concerns of local health professionals.
Blunt held a town hall meeting that drew about 40 to St. Mary's Hospital on Wednesday. He discussed piece-by-piece improvements, and later told reporters he doesn't feel Congress has enough votes to repeal the Affordable Care Act without budgetary repercussions coming from President Barack Obama.
"What we need to talk about now is how you move forward from here, what has happened here that surprised people and what's limited access to health care instead of improved it," Blunt said, referring to the Affordable Care Act. "What do you do to get back to a system that's more about patients and doctors and choices, rather than the government thinking what kind of insurance you need."
As the chairman of a committee funding health and human services, Blunt said recovery audit contractors (RAC) are repeatedly an issue when talking with health professionals. The Recovery Audit Program was put in place to fix incorrect Medicare payments, collect Medicare patient overpayment and find underpayments.
"(Being chairman has) given me an opportunity to talk to them about things like recovery audits that clearly have been a huge failure on the part of the federal government - both to come up with a plan that made sense and a system that allowed the appeals that you would need," he said. Eventually the federal government gave up on the system and asked if everyone would settle for some percentage less than 100 percent, he said.
Jim Stratton, SSM's regional chief financial officer, said the theory of RAC was to recapture fraudulent claims, but program was so backlogged the SSM system decided to take a settlement at 67 percent of the total appealed amount. Despite having a higher appeal success rate (at 75 percent), Stratton said the settlement was more cost effective and $300,000 went back to St. Mary's Hospital in Jefferson City and $700,000 to the hospital in Mexico.
Another fault in the health care system cited by Blunt is the two-midnight rule - a stipulation in classifying a person as inpatient. Upon a patient's second time in the hospital at midnight, the patient is considered inpatient, considering he or she also meets other criteria.
This can have an effect on cost, and it's not always logical for emergency services, said Alice Chatley, vice president of acute care and chief nurse executive. If an emergency patient comes in at 10 p.m. and isn't assessed by a doctor until 1 a.m., the patient has already considered to have spent his or her first midnight in the hospital.
The time necessary for a physician to determine if a patient meets inpatient criteria based on government regulations, Stratton said, takes too long.
"It takes a lot of resources from a physician's standpoint and hospital administrative time; it just seems like wasted resources and dollars could be better spent to take care of patients," he said.
Looking ahead, Blunt said he plans to assess the status of disproportionate share hospitals, including those in urban areas.
A St. Mary's employee asked for Blunt's support of rural hospitals. And St. Mary's President Brent VanConia sought the senator's backing of reimbursement for Telemedicine, a telecommunication system that allows rural patients to connect with doctors digitally. He added Telemedicine is considered a preventative health measure and can keep people out of the emergency room.
Blunt also stated his desire for the health care system to be more focused on cures than treatments. This could be possible, he said, thanks to the advanced understanding of the human genome.
"Instead of trying to keep people well, you're focused totally on treatment," he said. "I think there's a big revolution about to occur in health care anyway where we have many more options than we used to have looking at designer medicines, looking at cures versus treatment - you have to rethink how you look at health care for that to work."