Rand Paul, Brett Guthrie make stop at HealthSouth

As lawmakers battle over changes to Medicare in Washington, one health provider is feeling the squeeze of federal restrictions in Hardin County.

Neal Cardin

U.S. Rep. Brett Guthrie, center, talks Tuesday with HealthSouth CEO Lori Jarboe and Chief Nursing Officer James Farrell as they tour the facility's rehab gym. Guthrie met with senior staff to discuss federal regulations.

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Neal Cardin

U.S. Sen. Rand Paul, left, meets Tuesday with members of the Kentucky Ambulance Providers Association at HealthSouth. Paul later met with senior staff members of HealthSouth to discuss federal regulation restrictions.

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Neal Cardin

U.S. Rep. Brett Guthrie, left, talks with HealthSouth client Dave Duda and physical therapist Barbara Jozwiak on Tuesday during a visit to the facility.

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Officials at HealthSouth Lakeview Rehabilitation Hospital on Tuesday urged two Kentucky legislators to pursue modifications to a federal regulation they say restricts access to acute rehab services for patients and deals a blow to patient volume.

In response, U.S. Rep. Brett Guthrie and U.S. Sen. Rand Paul said they would work to bring modifications to the system and stressed the need for a Medicare overhaul, creating a market-based system they believe could rejuvenate the ailing program.

“I think it would help save the system,” said Guthrie of a GOP Medicare plan that would allow future retirees to receive federal subsidies to purchase health care policies on the private market. Paul said the plan he envisions would give seniors access to the same plan he has through Congress, which offers a variety of private health care plans.

Lori Jarboe, chief executive officer of the Elizabethtown facility, said HealthSouth is willing to carry its share of the national deficit but said the hospital system is facing potentially harmful cuts through health care reform and sequestration, a proposed plan to implement massive cuts to defense and non-defense spending. Jarboe said nearly 75 percent of the facility’s payments comes from Medicare.

HealthSouth, a national provider of acute rehab services with another location in northern Kentucky, also shoulders the burden of the “60 percent rule,” a federal standard requiring inpatient rehab hospitals to maintain 60 percent of their patient population during a fiscal year from 13 diagnoses, Jarboe said. These conditions include strokes, brain injuries, amputations, spinal cord injuries, femur fractures, neurological disorders, multiple traumas, congenital deformities and burns. Jarboe also said the facility must ensure half of its population is comprised of Medicare patients.

Should the hospital fail to meet the regulations, she said, it would be stripped of its status as a rehab hospital.

James Farrell, chief nursing officer at HealthSouth, said a 75 percent rule was enacted in 1983 but was found to be crippling when fully enforced and restricted patient access to rehab services. According to documents obtained from HealthSouth, the rule was reduced to 60 percent in 2007. But Farrell said there is no research or studies that support the percentage or show the 13 diagnoses need more rehabilitation than other conditions.

“It’s arbitrary,” he said.

And Jarboe said the rule confuses patients who are turned away because the facility is below its 60 percent patient quota.

“They think we’re being selective or cherry picking but we’re not,” she told Paul during his afternoon visit. “We just have regulations to follow.”

Jarboe presented documentation showing no measurable growth for the facility since the 60 percent rule was introduced. Inpatient rehabilitation hospitals made up $6.7 billion, or 1.2 percent, of the $546.5 billion spent on Medicare in 2011, according to her report.

“We’re not the spending problem in Medicare,” she said. “We’ve remained flat.”

Now, she said, there are talks of rolling back to 75 percent while another plan has been discussed to reimburse acute rehab hospitals based on lower nursing home rates, Jarboe said.

The rate reduction, she said, is restrictive because nursing homes average lengthier stays per patient and have fewer regulations to follow. Rehab hospitals also send a higher percentage of patients home and see fewer than 10 percent of patients return to the hospital on average, she added.

Guthrie said the government must stop squeezing providers for cost savings while Paul said certain standards and changes proposed to health care and Medicare could destroy rural hospitals and doctors. The Bowling Green Republicans said Medicare reform introduced by the GOP would infuse the competitiveness of the free market and Paul said it could eliminate government-imposed fees because it lacks the competency to set adequate rates.

“The Soviet Union went under because it couldn’t set a price on bread,” Paul said.

Paul said he would be in favor of pushing for a modification on the 60 percent rule so HealthSouth could meet its bottom line easier and ease restraints for treatment of non-Medicare patients.

During his visit to the facility, Paul also met with the Kentucky Ambulance Provider’s Association, which asked for his assistance to change standards increasing the costs of ambulances and restricting the speed at which ambulances can drive, modifying fee rates from government insurance providers and removing paperwork perceived as unnecessary.

Paul said he would like to see higher deductibles and copays on government-provided insurance to take some of the burden off taxpayers.

“If people can buy cigarettes and beer, they can afford to pay $5 when they go to the doctor,” he said.
Guthrie told HealthSouth he also is willing to assist in making changes.

We have to work together on a solution, Guthrie said, “Otherwise, our kids won’t have a future.”  

Jarboe said she has no intention to disparage other sectors of healthcare because they all have a role, but she said it can be discouraging to see services stifled.

“It’s frustrating because we’re providing such a high level of care, and we’re sending people home (better),” she said. “We’re doing a great job for our community and we’ve been here for 25 years. I’d like to be here a little longer.”

Marty Finley can be reached at (270) 505-1762 or mfinley@thenewsenterprise.com.