Local health leader explains ailing system to Medicare head

When the head of the Centers for Medicare and Medicaid Services flew from Washington, D.C. to Seattle a couple weeks ago on a fact-finding mission, the CEO of Coulee Medical Center was on hand to give her some.

Like the fact that in 2019, only fog or wildland fires could stop the transfer of a patient to another hospital for needed care, and that was rare. Now it happens from three to 10 times a week, and not because anyone is overrun with Covid-19 patients.

Chief Executive Officer Ramona Hicks said she and Diane Blake, the CEO at the Leavenworth hospital, were there to represent all rural hospitals in Washington at the request of the Washington State Hospital Association (WSHA).

Appointed by President Joe Biden as the administrator of CMS, Chiquita Brooks-LaSure was listening to the rural hospital administrators, to big city hospital leaders, to behavioral health leaders in the state and to long-term care representatives talking about how covid broke the system that now perpetuates problems, causing financial hardship and at times operational upheaval across the state.

Coulee Medical Center was asked to present on three issues, Hicks said:

• Is CMC having difficulties transferring acutely ill or injured patients? Is that traumatic for your staff?

• What does CMC pay in nursing agency fees, and why don't not just hire your own nurses?

• Why are you one of the few hospitals that still offers obstetrics; why is it important to you, and what do you need to keep doing it?

Hicks said that now it's routine that when a patient needs to be transferred to a hospital that can better handle their more acute medical condition, it takes 15 to 20 calls to other facilities to find an open bed. And the calls require "provider-to-provider" consultation, doctors on the line instead of with patients in the emergency room.

Nurses, too, are affected as they must care for patients they're not used to and maybe not trained for.

"In the last six months it has gotten worse, and it is not getting better," Hicks said.

The issue is staffing and required time off if they are exposed to, or get a case of, Covid. That ripples through the system, and every other hospital's system, causing shortages of beds.

Harbor View Hospital in Seattle, the most advanced trauma care center in the state, for the first time has stopped admitting patients with non-life-threatening conditions.

Such hospitals are also finding that if a Medicare patient needs to actually be in a nursing home, but there's no room in them, they still have to keep them in hospital, but can't bill for it.

Asked why CMC doesn't hire its own nurses instead of paying multiples of that cost to agencies who assign nurses on contract, Hicks said they'd love to "but people are not applying," a common problem across the industry for at least a year and half.

Hicks explained to Brooks-LaSure that CMC still delivers babies because the next closest facility is in Omak, 58 miles over a mountain pass, with no stoplight or even much population in between, and patients would have nowhere to go.

Hicks presented the head of CMS with a pair of earrings she bought at the Colville Tribal Museum, made by Amanda Louis-Mills. Hicks said the earrings represented missing and murdered indigenous women.

"I wanted her to know that her voice, her job is to represent the women in rural America that are in need of health care, and that we're those women," Hicks said.

Brooks-LaSure didn't say what she was working on, Hicks said.