Health Equity blog

The Center for Healthcare Payment & Quality Reform (CHPQR) reports that over 100 rural hospitals have closed during the past 10 years. Rural hospitals in the Midwest and southern states are particularly at risk of immediate closure. The end result is that millions of people living in rural areas will be without access to more specialized inpatient and outpatient care. And it is not just the patients themselves who are impacted; family members will have to travel up to two hours to visit or accompany them to appointments. Myriad reasons contribute to these hospitals’ financial challenges, including trouble recruiting and retaining sufficient qualified staff for certain service lines; ceasing to receive extra federal assistance that was available during the COVID pandemic; receiving insufficient payor reimbursement to cover the larger overhead costs experienced by rural hospitals; and lacking sufficient financial reserves to ride out economic downturns.

CMS’s proposed annual hospital outpatient and ASC reimbursement rate schedule was published in July. This year’s proposed rule includes initiatives to address disparities in care. Among the proposals are requiring 12 months of continuous eligibility for children enrolled in Medicaid/CHIP; expanding the hospital outpatient, rural emergency hospital, and ASC quality program measure sets to incorporate equity measures consistent with other provider types; and providing an add-on payment to the All-Inclusive Rate for certain Indian Health Service (IHS)/tribal facilities that will increase access to certain high-cost drugs; and supporting individuals returning to the community from incarceration through the elimination of Medicare enrollment barriers.

New University of Southern California (USC) School of Medicine and Los Angeles County Department of Public Health joint research indicates, unsurprisingly, that areas of LA County with the highest reported COVID case rates also experience a corresponding higher incidence of depression. By some accounts, just as unsurprising was data indicating that in areas more afflicted with COVID, non-Whites incurred an increased risk of depression compared to Whites residing in those same locations.

In 2022, California announced its plans to revamp the Medi-Cal program into one that would be more equitable, focused on the individual and improved coordination among available providers and services. The two hallmarks of the effort are the Enhanced Care Management (ECM) and Community Supports programs. Earlier this year, ECM was expanded to include “justice-involved” individuals and Medi-Cal launched the ECM Birth Equity Population of Focus (POF). As of 2024, every county in the state will have at least 8 Medi-Cal managed care program (MCP) sponsored Community Supports at their disposal and 19 counties will have all 14 Community Supports, in both instances a notable increase from 2023.

The Centers for Medicare and Medicaid Services (CMS), through its FY 2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule, issued policies aimed at furthering the Biden Administration’s goal to improve the health of communities historically underserved and lacking vital resources, as well as incentivizing value based care. By employing social determinants of health (SDOH) in making policy-related decisions, CMS is able to fine tune its allocation of resources to target those individuals most in need of improved access to equitably delivered care. One such development includes enhanced reimbursement for hospitals treating patients facing housing insecurity. Another CMS measure is to extend a separate payment to small independent hospitals–many of which are rural–that establish and maintain access to a buffer stock of essential medicines, thereby helping to lessen the risk of drug shortages and improve patient care. In addition, both LTCHs and certain qualifying general acute care hospitals will receive broad reimbursement hikes under their respective prospective payment systems.

On June 13, the U.S. Supreme Court released its decision in FDA v. Alliance for Hippocratic Medicine, overturning the opinions of the lower federal courts in the case that ruled mifepristone was unsafe. Since it was first approved by the FDA in 2000, mifepristone, commonly used in combination with misoprostol, is a widely accepted and commonly used oral abortion medication. As expected, the Court’s decision has either been heralded or lamented, depending upon which side of the abortion aisle one sits.

Kaiser Family Foundation’s (KFF’s) most recent Survey on Racism, Discrimination, and Health, shows that, although mental illness reported by Hispanic, Black, and Asian adults is comparatively less than among White adults, the figures may be misleading due to such factors as lack of culturally sensitive screening tools used in diagnosing mental illness. The survey’s data includes responses indicating that people of color encounter difficulties locating health care providers with shared backgrounds and experiences, lack access to mental health information, and experience stigma and embarrassment obstacles to seeking mental health care in the first place. According to KFF, this data suggests that enhancing knowledge of culturally competent care among mental health care providers and diversifying the mental health care workforce are desperately needed. In addition, targeted outreach and education efforts among specific communities could increase awareness of mental health resources and help eradicate the stigma associated with seeking mental health care.

During the past ten years, many California hospitals – 17 in L.A. County alone – have been shuttering their labor and delivery programs because of devastating financial losses compared to other service lines. In L.A., however, nonprofit Martin Luther King Jr. Community Hospital is defying the odds by continuing to offer these desperately needed services to the largely non-White community it serves in furtherance of its charitable mission. Although some of these closures are attributed to large national for-profit hospital systems concerned about their bottom line being negatively impacted, low Medi-Cal reimbursement rates have definitely been a culprit as well. The consensus among California hospital administrators appears to be that the labor and delivery crisis will continue, jeopardizing access to maternal care in many already underserved communities, until Medi-Cal reimbursement for these services at least enables hospitals to break even.

For the first time, U.S. News & World Report has identified 53 hospitals that have produced enviable health care outcomes, while at the same time serving significant numbers of disadvantaged people of color, in an overt commitment to ensuring equitable access to care. Each of these hospitals was previously recognized by U.S. News in its Best Regional Hospitals rankings for its laudable health care outcomes without taking into consideration the impact such additional Social Determinants of Health (SDOH) factors might have had on patient outcomes. To make this new list, each hospital had to meet at least two of three additional criteria: at least 40% of Medicare inpatient visits involved patients living in socioeconomically deprived communities, the hospital serves a sizable Medicaid population, and its patient population reflects the racial and ethnic diversity of the surrounding community. 

In 2022, the Center for Medicare and Medicaid Innovation (CMMI), as part of its Advance Health Equity objective, rolled out a new health equity initiative. Its stated goals are to increase safety-net provider participation, develop new models and revise existing models to promote and incentivize equitable care, monitor and evaluate models for health equity impact, and increase collection and analysis of equity data. Notable achievements have been made with respect to each goal. New work this year includes payment innovations to narrow disparities in care, a focus on safety-net provider participation in models to improve care for more beneficiaries, and data collection that advances a comprehensive approach to care.