Ingram's December 2022

URBAN PILLAR | Research Medical Center, serving the heart of the Kansas City region, is the flagship hospital for HCA Midwest Health, which provided $113.1 million in uncompen sated care in 2021.

Excel-medical.com, in a report rele ased in September, showed that Amer ica’s insured population is picking up most of the tab, in the form of higher premiums and out-of-pocket costs. And they are getting less for that increased investment: Uncompensated care costs are a leading cause of hospital closures, an issue that’s particularly relevant to most of Kansas and Missouri. In just a three-year span—between 2013 and 2015—the AHA says 156 rural hospitals closed their doors. Perhaps most disappointing to many in the health-care community is that, more than a decade after passage of the ACA, the uninsured rate still stands in double-digits: 13.5 percent of those

$42.7 billion cost incurred by hospitals nationwide in 2020, according to the American Hospital Association. Even when those dollars do show up, they cover just 75 percent of what otherwise would have been received in what are known as Medicare dispro portionate-share hospital payments— which already fall considerably below the rates paid by third-party insurers. Becker’s Hospital Review , among the most respected authorities on health care issues, noted recently that hos pitals had endured an exceptionally difficult financial year, with lower op erating margins overall and a reduced chance of wrapping up 2022 in the black. The November “National Hospital Flash Report” by Kaufman Hall, drawn form data from more than 900 hos pitals, pegged the median operating margin through October of this year at a slight loss, -0.5 percent, with operat ing margins falling 2 percentage points from the previous month, and 13 per cent year-over-year. Labor expenses, in particular, were driving that trend, up 10 percent for the year, with a huge 3 percentage point surge from September to Octo ber alone—an annualized increase of

36 percent. Non-labor expenses helped drag down the overall numbers, but were themselves up 5 percent through October. Compounding all of that, staff short- ages were making it increasingly dif ficult to discharge patients, increasing length of stays. Meanwhile, emergen cy-room visits were up 3 percent in October, and operating-room minutes up 2 percent, and medical authorities nationwide say emergency-room ser vices are strained to a crisis point. “Every aspect of patient care—from being admitted, to treatment, to dis

“It is especially important for smaller hospitals, as they will see greater impact when Medicaid pay ments increase at the same time uncompensated care decreases.” — BOB PAGE, CEO, UNIVERSITY OF KANSAS HEALTH SYSTEM LETTER TO LEGISLATURE

charge—is affected by the labor short age and as we head into the virus season and potential new waves of COVID-19 the pressures on hospitals and their staff could mount,” said Erik Swanson, senior vice president of data and ana lytics with Kaufman Hall.

between the ages of 18 and Medicare eligibility at 65. While that’s an im provement from the 17.5 percent rate before ACA, the act has failed to meet its original goal of securing coverage for all Americans.

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I n g r a m ’ s

December 2022

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