- Associated Press - Wednesday, April 25, 2018

Billings Gazette, April 23, on examining Montana Medicaid expansion:

A typical Stat Air Cooperative flight from Glasgow to Billings costs nearly $8,000, Medicaid pays $3,500. The fixed-wing service owned by six northeastern Montana hospitals has seen a 21-percent increase in Medicaid patient flights since Montana expanded the program for low-income folks in January 2016. Meanwhile, Stat Air saw an 18-percent drop in Indian Health Service flights and business from other sources that pay better than Medicaid.

The loss is shared by all the air ambulance owners: Frances Mahon Deaconess Hospital in Glasgow, Phillips County Hospital in Malta, Northeast Montana Health Services in Wolf Point and Poplar, Roosevelt Medical Center in Culbertson, Fallon Medical Complex in Baker and McCone County Health Center in Circle.

Despite low air ambulance reimbursement, Glasgow hospital administrator Randy Holom says his board of directors remains solidly in favor of the expanded Medicaid program.

“The main reason we supported it in the first place and we continue to support it is because we know when people don’t have coverage, they avoid seeking service at the right time in the right setting,” Holom said in a telephone interview with The Gazette last week. “We are well run; we do OK. This is a great hospital and we want our people served.”

Like all but the largest Montana hospitals, Frances Mahon Deaconess is licensed as a Critical Access Hospital, which means it’s the only hospital in its community and qualifies for cost-based reimbursement from Medicaid and Medicare. However, reimbursement from those two government programs doesn’t cover all costs.

Holom was among the Montana hospital leaders who reported to an interim legislative committee this month on the effects of Medicaid expansion. Lawmakers were told that, overall, Montana hospitals saw financial improvement with the expansion of Medicaid to 94,000 very low-income adults, but the picture is complicated.

Bob Olsen, vice president of the Montana Hospital Association, presented the committee with a report based on data provided by about half of the state’s community hospitals, including these points:

- Uncompensated care (charity and bad debt) fell by a whopping 46 percent between 2016 and 2017, dropping by $119.7 million.

- Total patient charges attributed to Medicaid jumped to 17.78 percent, while the self-pay category dropped to 2.31 percent. (Self-pay patients typically are uninsured.)

- Operating costs increased by 7.48 percent with payroll up slightly more at 7.8 percent.

- Collectively, between 2016 and 2017, the hospitals counted a 1.7 percent increase in inpatient admissions, a 2.8 percent boost in inpatient days, a 2 percent drop in outpatient visits, a 2.3 percent increase in emergency room visits and an increase of 12.7 percent in ambulatory surgeries.

- Critical Access Hospitals saw a 10.9 percent loss on patient care in 2017. Adding non-patient revenues, donations and all other revenues, these small hospitals fell just short of break-even in 2017 with a collective loss of 0.2 percent. In 2016, these same small, rural hospitals posted a loss of 16.28 percent on patient services.

- The eight larger hospitals reporting to MHA did better, improving from a 0.51 percent patient margin in 2016 to 3.09 percent in 2017.

“Some policymakers predicted that expanding Medicaid coverage would produce a financial windfall for all hospitals as formerly uninsured patients would have a pay source,” Olsen reported. “Instead, the data show a combination of positive and negative changes in the revenue picture. Uninsured patients gaining Medicaid coverage has no doubt produced additional revenue for hospitals. This change is offset by some patients covered by commercial insurance prior to expansion becoming Medicaid eligible.”

The Affordable Care Act allowed people with income between 100 percent of poverty level and 138 percent (about $16,000 annual) to enroll in private marketplace plans with federal premium subsidies based on their income. Once a state expands Medicaid, the law says people at those income levels cannot get private premium subsidies; their only coverage option is Medicaid, which costs the government less.

As the debate on reauthorizing Medicaid expansion heats up, let’s bear in mind that the data so far shows huge gains for Montanans and our statewide economy. But the program hasn’t made every Montana health care provider a winner. It’s worth delving into the details to understand how Medicaid is working. Beware of rhetoric that fixates selectively on one or a few examples. When health care for nearly 1 in 10 Montanans is at stake, the focus must be on the big picture.

Editorial: https://bit.ly/2JnMZeP


Bozeman Daily Chronicle, April 22, lauding schools for proactive, measured response to school shootings:

The impacts of mass school shootings on the places where they occur are profound. Classes are suspended - often indefinitely. Counselors are made available to treat affected students. Buildings are torn down because the memories they evoke are just too devastating. And all of that is understandable. Losing children to acts of mass violence within what is supposed to be safe place is unthinkable.

Beyond the schools where they happen, the impacts are also major. Proposals to arm teachers are fielded and countered. New gun regulations are suggested and shouted down. Mass school shootings leave scars on the entire nation.

In Bozeman public schools, the response has been more muted. There are no plans to give guns to teachers and train them to kill. School officials haven’t adopted a siege mentality that degrades educational quality.

But they haven’t been sitting on their hands, either. The schools’ safety committee has shifted some of its focus away from longstanding problems of bullying and alcohol and drug abuse and toward the threat of a mass shooting. The group was tasked last month with coming up with ideas. And last week, committee members met with the School Board and suggested adding more police officers to patrol schools, retrofitting buildings to make them easier to monitor, locking down schools during the day and buzzing in only approved visitors and training students to recognize fellow students at risk of committing violence, among many other recommendations.

And over the past three years, more than 400 Bozeman public school employees - teachers and administrators, of course, but also custodians and other non-instructional workers - have participated in a daylong training program called Run, Lock, Fight. The program teaches self-defensive ways to neutralize an active shooter and how to adopt “pack mentality” that exploits the advantage of numbers.

These are reasonable measures that are doable without exorbitant costs. More effective means of keeping schools safe may emerge in the future. But this is a start.

Mass school shootings demand that officials everywhere react. But it is critical that they do not overreact. Bozeman school administrators are commended for not succumbing to more radical measures that would literally change the educational experience for our children.

Editorial: https://bit.ly/2Hp7JGm


Missoulian, April 22, on the University of Montana’s enrollment strategy:

The Montana Kaimin, the University of Montana’s campus newspaper, recently put together a video that vividly demonstrates the difference between UM’s approach to student recruitment and that of Montana State University. The video notes that MSU budgets about $2.2 million for student recruitment compared to UM’s $1.4 million, and then shows how this affects student outreach.

The Kaimin did this by requesting prospective student information from both schools. MSU responded promptly and followed up repeatedly, eventually sending a total of 12 emails and eight pieces of mail, complete with an invitation to apply. UM sent no emails, and only one piece of rather unimpressive mail.

The Kaimin published its video in mid-March, which, coincidentally, was about the same time UM announced that it plans to restructure its enrollment duties and will not renew its contract with Vice President for Enrollment and Student Affairs Tom Crady. UM President Seth Bodnar announced that in the future, enrollment and communications will be combined under one vice president, who will hopefully be hired sometime this fall.

Thus UM continues to spin its wheels on its most critical problem. Declining enrollment is the driving force behind budget cuts, faculty reductions and program reprioritization. While it’s certainly smart to take a hard look at the university’s various departments and make sure they are meeting the academic needs of today’s students, it’s all for nothing if UM cannot figure out how to attract and retain more of these students in the first place.

The university has struggled to get a handle on the enrollment problem for far too long. Overall enrollment at UM has fallen by 28.5 percent since 2010. Meanwhile, enrollment at MSU has risen by 23.4 percent. Now, UM is facing the prospect of starting yet another academic year without a clear enrollment strategy. Crady’s contract will end on June 30.

When he was selected in 2016 to fill the newly created post of vice president for enrollment and student affairs, Crady was offered an unprecedented $70,000 recruitment bonus in recognition of the significant challenge he was tasked with overcoming. But at about that same time, UM cut $1 million from its enrollment budget. Essentially, the university spent a lot of money on a new head of enrollment and then gave that person reduced resources with which to tackle its most pressing problem.

Nevertheless, the number of incoming freshmen did steady under Crady’s watch, even though total student numbers fell after an even larger number of students graduated.

Meanwhile, the university learned that $1 million would be restored for enrollment over a period of a couple of years. Then, earlier this year, Vice President of Finance Rosi Keller reported that the full $1 million would be added back into the enrollment budget.

The budget fluctuations, reorganizations, hirings and firings demonstrate that UM still does not have a clear direction on enrollment. It has undoubtedly missed out on opportunities to boost enrollment as it circled aimlessly.

What exactly is the university’s enrollment strategy?

Not a moment too soon, the university has been handed a significant new opportunity that may answer this critical question. Jim Messina, a UM alum who served as Barack Obama’s campaign chief of staff and then as President Obama’s deputy chief of staff, is volunteering the services of his company, The Messina Group, to help the university lick its enrollment problem at last.

Messina first approached the university about three years ago but no one followed up on his offer to help. The only reason UM now has a second chance is because of Chelsea Elander, who once worked with Messina and maintained ties with him over the years. This time, when Messina offered to help, Elander acted as a liaison and made sure the university did not forgo this valuable opportunity again.

The university has not yet shared any student information with Elander or The Messina Group. As it pursues this new prospect, the university needs to make sure it is on firm legal and policy ground. Before things go any further, it must define both Elander’s and The Messina Group’s roles, and communicate them to the larger community. Because Elander is married to the university president and is apparently acting with some authority from Bodnar’s administration, the President’s Office ought to release a public statement explaining what her role will be with regard to enrollment.

Currently, UM is working on a draft contract with The Messina Group that should similarly describe the specific terms of the company’s work. UM should have binding agreements in place regarding the use of any student information, and in the interest of transparency, the agreements should be made public. The university must take special care that every legal detail is accounted for and every policy is strictly followed.

The entire university spent months undergoing an intensive reprioritization process to ensure any program changes were made in as targeted a way as possible. Last week, Bodnar presented a proposal to reorganize some departments and cut about 50 faculty over the next three years.

The proposed cuts follow two rounds of voluntary buyouts as well as repeated attempts to notify some lecturers that their employment was being terminated; those notifications were rolled back twice after the University Faculty Association alleged that they were made in violation of university policy, but ultimately about a dozen of them stuck.

Hopefully, UM has learned the importance of dotting every legal “I” and crossing every policy “T.” It cannot afford to continue to bumble around on enrollment.

The university community and its supporters stand ready to support its student recruitment and retention strategy - once we know what that is.

Editorial: https://bit.ly/2HOT2vS

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