Healthcare on Elysium: the Future Foretold?

This weekend I saw the movie "Elysium," a futuristic film where the earth is overpopulated and the poorest and sickest of humans fight for the most basic healthcare. The future hospitals are portrayed as dirty, overcrowded and understaffed, with long lines and poor supplies. In contrast, the space station Elysium is inhabited by wealthy humans, living in beautiful homes that each contain a scanner-like machine that can diagnose and cure every malady known to man, in seconds. Access to this incredible medical advancement is limited to the privileged inhabitants of Elysium, who seem indifferent to the plight of their fellow humans.

While there is little to recommend this film overall, the idea of humans desperate for healthcare is not a very futuristic idea at all.

When you live in a more affluent urban area, as I do, you hardly give access to healthcare a second thought. I am surrounded by any number of hospitals and health systems, walk-in clinics, physician offices, and even clinics at the local pharmacy. If I, or my children, were to become ill, there would be no delay in the availability of quality healthcare.

I often don’t think about the rural areas of this country where access to care is limited, whether due to smaller populations, less affluence, or difficulty attracting physicians. These patients may need to travel great distances, even for basic healthcare.

It seems possible that many policymakers in this country view the ease of access to healthcare much the way I do, given a proposal this month that threatens funding at hundreds of rural hospitals across the country.

The HHS Office of Inspector General (OIG) has proposed eliminating “special payment” status from two-thirds of the nation’s 1,328 critical access hospitals - those not considered to be in remote areas - with the argument that this could save Medicare and its beneficiaries $1.1 billion a year. Critical access hospitals, which have a maximum of 25 beds, get 101 percent of their costs from Medicare. The OIG’s issue is that 846 of the country’s critical access hospitals are not at least 35 miles from another hospital (or 15 miles away on mountainous or secondary roads) the distances required for special payment status. The OIG’s proposal would remove the hospitals’ critical access status (although the federal government could decide to restore it).

The Obama administration’s proposed 2014 budget has a similar proposal to eliminate critical access status for 71 hospitals that are within 10 miles of another hospital. The proposed budget also calls for reducing payments to critical access hospitals. Combined, the moves would save $130 million next year.

Both the OIG’s and Obama’s proposals make fiscal sense, but they pose a real hardship for those communities that are affected, especially since many of these critical access providers see sicker, older, and poorer patients. It’s also possible that cutting payments to these hospitals will threaten their ability to remain open and could further burden the economies of small towns where the hospital may be the single largest employer. Finally, if hospitals end up closing, this could result in a shift of rural patients to urban hospitals, which will likely end up costing Medicare even more.

Among the many questions raised by these cost-saving measures is how far can patients travel to obtain the care they need? Will some of these patients die or be debilitated as a result? Can improvements in virtual care and telemedicine help resolve some of these issues and should funding for such programs be part of any reduction in critical access hospital funding? Are there actually too many hospitals in some rural (or semi-rural) areas of the country and should a hospital-by-hospital review be undertaken before cuts are made and not after? Should hospitals across the country have a single blanket policy applied to them without a better understanding of what each offers and why some hospitals may be “too close” in geography, but still essential to the communities they serve? Should the affect on lost jobs even be considered when the ultimate goal is to reduce healthcare costs?

While there are any number of solutions being sought to reduce costs to the Medicare program and improve efficiency and availability of care, we must always remember that behind these proposals are real people and communities. This can sometimes be easily forgotten by policymakers looking at numbers from the comfort of their own healthcare-rich districts.

Hopefully, our government will be mindful of the needs of all Americans in developing healthcare policy and will balance the need for fiscal reform against the responsibility to assure access to adequate healthcare for our entire population.