Hospitals facing a no-win situation

Monday, July 7, 2003

You've heard about a "Catch-22" situation. It's a term which came from a book by Joseph Heller, in which he describes a situation that you can't win, no matter what you do.

In a way, that explains the dilemma faced by mid-sized Nebraska hospitals. In the outpouring of federal health care legislation, the hospitals were left in the lurch. Why? Because when the U.S. Senate and House passed bills to reimburse health care facilities for Medicaid and Medicare expenses, the hospitals with between 15 and 50 acute care beds were overlooked.

The seven Nebraska health care centers "caught" by the oversight are Community Hospital of McCook, Beatrice Community Hospital, Box Butte General Hospital in Alliance, Columbus Community Hospital, Jennie Melham Memorial Medical Center in Broken Bow, Phelps Memorial Health Center in Holdrege and Tri County Hospital In Lexington.

The problem is that the hospitals are too big to receive "Critical Access Hospital" payments, as do hospitals with less than 15 acute care beds; and they are too small to qualify as "Rural Referral Centers," as do hospitals with larger patient counts. So what can be done? How can the mid-sized hospitals get out of the under-compensated, mid-sized dilemma?

After suffering through the situation for several years, the hospitals turned to U.S. Sen. Ben Nelson and U.S. Rep. Tom Osborne for help. "Every time the senator and congressman visited our communities, we (hospital administrators and financial officers) talked with them about the situation," said Gary Bieganski, the president of Community Hospital in McCook. The hospital officials' efforts paid off. It is not official yet, but Bieganski and other hospital leaders are greatly encouraged. Their optimism is based on an important victory that Nelson scored last week when he won Senate approval for cost-based reimbursements for the seven hospitals.

At a cost of $22.2 million, his plan is included as a part of the Prescription Drug and Medicare Improvement Act. Congressman Osborne guided similar legislation through the House, and now the two bills are in conference committee, with President Bush pushing for final action before the August recess.

In McCook alone, the legislation could mean more than $750,000 in additional funding per year. That's crucial, because Medicare and Medicaid patients now account for more than 50 percent of the hospital's expenses. "Sen. Nelson and Congressman Osborne did a great job for us," Bieganski said. "We are very grateful to them for presenting our case and earning support for our cause in Washington."

How do you get out of a "Catch-22" situation? It's not easy, but in the case of seven Nebraska hospitals, it will certainly help if and when they "catch" $22.2 million in new federal funding.

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