During a House Ways and Means Committee hearing held before the congressional recess, Rep. Adrian Smith (R-NE) discussed the effect of mandates on rural healthcare centers.
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NewsTranscript
00:00Mr. Smith from Nebraska, you're now recognized.
00:03Thank you again to our panel, our entire panel,
00:06certainly members for paying attention here today.
00:09I think these are important topics, and I'm glad that we can convene and discuss these.
00:15It's, I think, important to remember that America is a big country, different needs in different places.
00:21Yes, I represent a rural district, and rural means different things in different places across America.
00:27And, in fact, means different things in different places across my own district.
00:32That Nebraska as a whole, which my district is most of the land area of Nebraska,
00:39we only have three long-term care hospitals in the entire state.
00:43They're all in the east.
00:46The population certainly is weighted that way, but that doesn't mean we don't exist in other parts of the state.
00:52And so it is my hope that we can pursue policies that are more flexible,
00:57that actually meet the needs that exist in more parts of our country than we currently do.
01:06You know, it's come to my attention that even small oversights in our current policies
01:10can have a very significant impact on an individual's ability to access post-acute care.
01:17For example, patients with primary immunodeficiencies are typically unable to receive necessary IV-IG treatments
01:24because facilities are simply unable to absorb those high costs of their special therapies
01:29with a standard skilled nursing facility payment.
01:33That's why I introduced the PI Post-Acute Access Act last Congress
01:39to include these treatments in a limited list of high-cost outliers
01:43which are paid outside of the standard skilled nursing facility payment.
01:49I want to mention that I frequently hear from Nebraska hospitals about their frustrations with delays
01:55discharging patients ready to leave the hospital because of their inability to gain access
02:00to an appropriate post-acute care site.
02:03Some of those delays are caused by administrative issues such as prior authorization,
02:07but in many cases this is because there just aren't any skilled nursing facility beds
02:12available nearby for a patient who really needs one.
02:15One way to address this lack of access would be to look at new, innovative ways
02:19to expand the universe of hospital discharge options.
02:22I'm currently working on a new bill which would create a skilled nursing facility at home option
02:27modeled after the success of the ongoing hospital at home demonstration.
02:34Since the COVID pandemic, we've seen just how much new technologies have expanded the ability of patients
02:39to receive care in their homes instead of the traditional facilities.
02:44We hear a lot about various things.
02:46We heard earlier reference about nursing care staffing mandates by the previous administration.
02:55I would say those were political decisions, very expensive ones, I might add,
02:59and it has really stressed, if not caused the closure of many nursing facilities
03:07and the closure certainly would if allowed to continue,
03:10but I'm concerned that the stresses on facilities, especially in rural areas,
03:14the federal government ought not make it even more stressful,
03:18especially with unfounded mandates that come out of Washington.
03:23I think we can do better than that.
03:25The American people expect us to do better.
03:27But Ms. Grabert, you mentioned the impact a unified post-acute payment system
03:32could have on the post-acute landscape.
03:34How would such a system make it easier to provide a skilled nursing facility at home option for our seniors?
03:41Thank you for the question, Mr. Smith.
03:43I do think that what you've described is a perfect model that fits under the umbrella of regulatory relief
03:49that can be done in tandem with a post-acute care unified PAC PPS.
03:53It's a model that would thrive under such a system.
03:57Okay, thank you.
03:59Mr. Dongeli, again, thank you for your participation here today.
04:04Legislation was proposed last Congress to address several key concerns of long-term care hospitals,
04:09which included a number of different provisions, such as admitting patients from critical access hospitals,
04:14concerns with the high-cost outlier payments,
04:17ensuring access for patients with certain complex conditions and other payment modifications.
04:22Which of these do you think would have the greatest impact on your ability
04:25to continue serving long-term acute care patients at Madonna?
04:32Thank you for the question, Congressman Smith.
04:35Both of those issues would allow greater access for individuals to come and receive services in a long-term care hospital.
04:45The high-cost outlier issue is one that is dramatically impacting both access for patients to come into an LTCH,
04:56but also the ability for an acute care hospital to manage their ICU and other beds.
05:03Currently, when an individual is on a ventilator, say, and requires additional high-cost services, like dialysis, for instance,
05:15losing $77,000 before receiving an outlier payment because that patient has stayed so long because of the care that they need
05:23would deter that LTCH from admitting them.
05:27And as a result, that patient might have to stay longer in the acute care hospital
05:32and hopefully transition out of receiving the dialysis service before they commit into the LTCH.
05:38So addressing the high-cost outlier provision would allow greater access,
05:44but so would allowing patients to come directly from a critical access hospital.
05:51Both are important.
05:52Very good. Thank you again, and thanks to our entire panel. I yield back.