America’s hospitals and health systems are facing challenges and threats that are uncommon in the age of modern medicine. As they do all they can to keep up with the influx of patients due to COVID-19, they are threatened with being overwhelmed, generally underfunded and working overtime to provide the best care possible. According to Becker’s Hospital Review, hospital staff like nurses perform “over 100 tasks per shift while being interrupted every three minutes; the reality of being a nurse in today’s health care delivery system seems overwhelming and sometimes impossible.”
Usually, the right play is for the government to get out of the way. This time, given the nature of the pandemic and its spread as well as the economic consequences of the lockdown, it’s up to Uncle Sam to step in and provide the resources required to fight COVID-19. Regrettably, the Trump administration and Congress, as generous as they’ve been with the taxpayers’ money over the last several months, haven’t done everything right.
Seemingly overnight, the administration ordered a restructuring of how hospitals are to collect and input patient data. This added to the responsibilities of already overworked frontline responders without giving hospitals the time and the additional resources they needed to comply. As a result, the administration is threatening to cut off Medicare reimbursements.
It’s a powerful incentive to comply but one that’s not likely to work. There’s no way a cut in funding could improve data collection. According to published reports, Medicare accounts for about 40% of hospital costs. Private insurers cover 33%. If the administration carries through on its threat, the average hospital may lose 40% of its funding. That is simply unsustainable under normal circumstances, much less during a pandemic even if, as the numbers are starting to suggest, it’s dying down.
Part of the problem with data collection has been the indecisiveness from the administration about what it wants. In February 2020, Washington said states were responsible for collecting and reporting their COVID-19 cases, so states set up their own individual data-collection systems. In March, the White House decided it wanted its own data, so it asked hospitals — via the American Hospital Association — to collect the data and send it in.
By the end of March, the AHA system was stopped in favor of a move to a federal data collecting system. That lasted a week, at which point Secretary of Health and Human Services Alex Azar sent a letter to hospitals announcing there were now five ways instead of three to submit data. Which lasted only until a contract was awarded to a private company which then became the only way to send data about COVID-19 cases to the government.
Now things have gotten to the point hospitals are under threat that they may lose their Medicare money unless the data collection improves. As a CMS press release put it, “hospitals will face possible termination of Medicare and Medicaid payment if unable to correct reporting deficiencies.”
That’s a misguided effort, one that completely discounts the role governors like Andrew Cuomo and Phil Murphy and Gavin Newsom have played in making it nearly impossible to get an accurate count since they’ve pushed as has been documented elsewhere, to have any deaths in which COVID-19 might have been remotely involved included in the count. That’s bad policy and bad science.
A hospital’s main job is to make sure its patients receive the best care available, an especially difficult task under the current strenuous circumstances. Their focus has been pulled in many directions, as the Trump administration continuously changes its mind on best practices, appropriate care and requirements from hospitals. Even before COVID-19, this problem of keeping hospitals alive existed. Since 2005, at least 170 rural hospitals in 36 states have shut their doors, according to a University of North Carolina study.
Hospitals know data collection is important. So does the government. The priority in all circumstances however must be patient care. The fact the demanded data has changed repeatedly during the pandemic as has the process for collecting it. Health care providers trying to save lives can’t keep up let alone understand at any given moment what the governors and feds want from them and without any additional funding or staff to help with this. They were set up to fail at data collection from the very beginning, and they are now being punished for focusing on patients first.
Following through on the threat coming from CMS will reduce access to care and probably a loss of life. President Trump — who in October 2019 firmly and rightly stated his opposition to Medicare for All — is now, in August 2020, holding out the possibility of Medicare-For-None if he follows through and cuts off Medicare funding for hospitals if they don’t get in line on data collection. This threat to cut funding is ridiculous and should be rescinded.