MacArthur – Menendez measure would amend Medicare hospital payouts

Categorization of New Jersey hospitals as "urban" by the Center for Medicare and Medicaid Services (CMS) sets federal reimbursements far below what's needed in medical centers that don't actually serve cities, says shore Representative Tom MacArthur (R-3). He's introduced legislation to change the structure.

MacArthur and U.S. Senator Robert Menendez (D-NJ) unveiled their Fairness For Our Hospitals Act Tuesday at Deborah Heart and Lung Center in Browns Mills. MacArthur points to its service area, caseload demographics and patient policies as a prime example of flaws in the system.

In addition to its rural setting and a preponderance of aged patients, Deborah "has never billed a client for services," MacArthur explained. "It takes what it can get from insurance and other sources. It doesn't balance-bill clients.They're very committed to that mission."

There are similar examples around the country, the Republican said on the August 29 edition of WOBM-AM's "Ask The Congressman," and it leaves them missing out on "tens of millions" of reimbursement dollars that ultimately affect their ability to maintain their standards.

New Jersey, Rhode Island and Delaware rank as the only states in the U.S. with all hospitals within their borders classifed as "urban."

A "rural" categorization requires a hospital to be in a rural area, with 100 or fewer beds during the cost-reporting period. It cannot be classified under the rural-only "sole community hospital" designation, and at least 60 percent of its patients must be Medicare subscribers.

"I tried to do it administratively, just to get CMS to recognize the problem and fix it," MacArthur said, "That didn't work, so I introduced legislation to fix it."

The Congressman holds that reorganizing reimbursements doesn't necessarily take money from one hospital to benefit another. "It's just about doing the right thing by a hospital that is serving a large number of seniors."

The glacial pace, on the federal administrative level, to apply simple remedies to obvious problems tends to drive MacArthur "a bit nuts," he conceded.

A parallel example, he noted, is the pay disparity for comparable work that existed at Joint Base McGuire-Dix-Lakehurst since its inception in 2009. It wasn't until this year that working on the Lakehurst or Wrightstown side of the installation ceased to be an issue.

"Everyone to whom I spoke at CMS agrees that Deborah should be getting paid more, for the seniors that they're seeing," MacArthur continued, "and they're not. It really hurts Deborah, which is a charitable hospital."

In statements he issued at Deborah Tuesday, Menendez characterized the pulmonary and cardiac care center as "the model of what a hospital should be."

"I will continue my efforts to ensure the Medicare program doesn't discriminate against hospitals in New Jersey and other all-urban states...This legislation will ensure that federal law equitably recognizes our hospitals."

It's co-sponsored in the House by North Jersey Democrat Bill Pascrell and Delaware Democrat John Carney, and in the Senate by New Jersey's Cory Booker and Delaware Democrat Christopher Coons.