Fighting for Essential Hospitals: A Conversation with Board Chair Katrina Keefer

I guess, yeah, we're still in D.C., we're still in the recess, so the calm before the storm, I suppose, is September hitting.

So kind of to follow up on what you were saying, I know essential hospitals are facing tremendous headwinds right now, from the looming Medicaid work requirement deadlines to funding cuts and whatnot.

Can you speak a little bit to how essential hospitals can weather these challenges? And speak to DCH as well, but then the sector at large.

Yeah, pain points.

Last Tuesday evening, I was sharing with my board that same store year over year, not taking into any inflationary measures, that we're going to have a $41 million headwind year over year.

About $15 million from the 340B drug expenses.

Medicaid supplemental payments and Medicare dish reductions of about $12 million.

The Affordable Care Act exchange product tax credit reduction is a big deal for us.

And that hit already this year, but we're beginning to see those mature.

And that's probably $500,000 or $600,000 a month, as we've just seen a 2% shift from that commercial product to self-pay.

So there are so many of these things.

And then, you know, there's GASB 68, which is a pension calculation that doesn't have anything to do with my funding, but is an additional $5 million of expense.

So, you know, I think about I'm not even a billion-dollar organization.

And so you think about major teaching facilities and major health systems and the impacts that that will bring to them.

And so I think when you ask how we're going to get through it, we're going to get through it together.

And I think it's the unified front of the policy and advocacy and education.

I think that we don't have good soundbites as health systems.

We're usually the largest employer and we're People say we're bureaucratic and all the things, but we really need to spend time educating our legislative delegations so that they can help us.

Many of these are federal programs.

Alabama was a state that did not expand Medicaid.

So we and we did not have any directed payment plans.

So we have not in the recent years been building up our balance sheets to weather these storms.

So it's continuing to be that much more acute.

And so as we're looking to.

The 340B legislation, proposed legislation, if that goes into effect in January, we're going to have to make some draconian cuts, and that is going to limit our ability to provide services in West Alabama, which just will make it a lot more acute in the Birmingham or Atlanta or Nashville markets, wherever our patients would spill over.