Legislature may study high medical costs

By Ramsey Scott
Wyoming Tribune Eagle
Via Wyoming News Exchange
 
CHEYENNE — The Legislature could soon be taking a deep dive into the cost and availability of medical care in Wyoming. 
A bill heading to the state Senate for the 2019 general session would authorize a complete top-to-bottom study of health care in Wyoming, with a focus on what makes the state one of the most expensive. 
The proposed study could cover topics ranging from Medicare reimbursement rates compared to the rest of the country to what's driving Wyomingites outside of the state to receive medical care and the financial health of hospitals across the state. Sen. Charles Scott, R-Casper, put the bill forward to try to give the Legislature as much information as possible to chart a path to correct the low access and high costs in Wyoming.
Scott pointed to statistics that show Wyoming is eighth in the nation for hospital costs, and expenses from treatment in state hospitals account for 48 percent of all medical expenditures. Nationally, hospitals account for about 38 percent of medical spending and about $1,000 less per capita than here in Wyoming. 
"(This idea) has broadened into more of a study of hospital costs in general, because that's what stands out," Scott said during a Monday meeting of the Joint Labor, Health and Social Services Interim Committee. "We're different, in the wrong way, than the rest of the country. We're much higher, and we're trying to understand why." 
Scott, co-chairman of the committee, said one of the focuses of the proposed study would be to see what impact Wyomingites seeking care across state lines has on the cost of, access to and quality of medical care in the state. A 2014 study by the Centers for Medicare and Medicaid Services found almost 25 percent of medical services for residents were received across state lines. 
By comparison, Scott said the next least-populous state, Vermont, only saw 12 percent of medical services received across state lines. Wyoming's rate could have serious impacts on both the quality and availability of care in Wyoming, and on the economy of the state. 
"We're out of line with the other states. We're losing a good part of our economy over the border," Scott said. 
Sen. Ray Peterson, R-Cowley, said the reason so many Wyomingites sought care across state lines was obvious from his perspective. When Wyoming hospitals join associations with other major hospitals outside of Wyoming, more and more patients are then sent to those out-of-state facilities for every operation and test. 
"We turn around and are surprised they get sent to Billings," Peterson said. "Maybe it's the association with these bigger hospitals."
But Eric Boley, president of the Wyoming Hospital Association, pushed back against Peterson's assertion. He said associations with larger out-of-state hospitals and networks have allowed local hospitals to provide better care by bringing in specialists from outside the state to provide care here. 
Boley said he thinks the study should include looking at whether Medicaid expansion in Wyoming would have helped lower costs for hospitals and other providers. He pointed out that Wyoming is essentially an island now, as surrounding states have approved Medicaid expansion. In those states that have expanded Medicaid coverage, like Colorado, hospitals are more financially sound. 
Boley also said the study should look at how the severity of medical conditions in Wyoming affects the cost of care. A study commissioned by Wyoming found 3.5 percent of those insured in the state have average costs of $50,000 or higher. The national average for states is 1.5 percent of the population. And the prevalence of serious medical condition is higher here than the national average. 
Scott said he thinks the study could last two years, with multiple reports and a potential cost of about $250,000 to hire an outside consulting firm. But he wasn't sure if that would be enough money, given the amount of information he thinks should be involved in the study.
What the study finds would dictate what actions the Legislature could take to solve the problem, Scott said. If a major driver affecting costs is the issue of recruiting medical professionals to the state, the Legislature could look at reviving a program that gave medical staff loan forgiveness for working in Wyoming. If state employees seeking care out of state is having an impact, the Legislature could look at forcing care to be sought within state lines in certain circumstances. 
And if the study found that Medicaid and Medicare reimbursements for services in Wyoming weren't being reimbursed at a fair rate when compared to the rest of the country, Scott said it would be up to the state's attorney general to take legal action to solve that issue.