A pair of hospital studies presented to lawmakers Thursday painted a bleak picture for Wyoming health costs and access to physicians in rural areas, problems that aren’t new to the state’s leaders.
The reports — one prepared by an outside firm and the other drafted by Department of Health staff — offered broad overviews of care in Wyoming. In the outside firm’s report, data showed Wyoming paid more for units of care than the national average, all nearby states and California and New York. The study also showed that 53 percent of commercial care — meaning care covered by private insurers — took place out of state.
That’s an especially concerning statistic, given that those commercial payers are the best source of revenue for hospitals because they pay more than Medicaid and Medicare.
But the thrust of the reports — and the Joint Labor, Health and Social Services Committee’s take on them — was that care is higher here than our neighbors. Sen. Charlie Scott, the co-chair of the committee, repeatedly said it was a crucial topic for lawmakers.
The studies also highlighted the low number of providers per 100,000 people in Wyoming. Of 26 specialties examined, Wyoming was below the national average on 22 of them. In 11 cases, Wyoming had the lowest number of providers of the eight states near the Equality State, in addition to being well below the national average.
The issue isn’t particularly hard to diagnose — Wyoming’s hospitals, particularly the small ones, don’t have enough patients to keep services at a lower price. The facilities are also largely self-contained, meaning they’re not part of a larger hospital system that has enough purchasing power to obtain medical equipment at a lower rate. There are a few exceptions — Laramie’s Ivinson and Cheyenne Regional, both of which are affiliates of larger systems. Notably, both had solid margins, according to the reports.
Franz Fuchs, the Department of Health’s financial analyst who delivered the state’s report to the committee, boiled it down at the beginning of his representation.
“You can have things good, fast or cheap,” he told the committee. “Pick two.”
He told the lawmakers that he wanted to hammer home a fundamental problem lawmakers must consider: balancing access versus cost. It’s an uncomfortable conversation: It’s essentially asking whether smaller areas need every specialist and if having them is worth the cost. If the answer is yes, Community A wants every specialist, and if it’s a rural area with few patients, then costs will be higher.
Fuchs proposed a model to the committee that could address this issue. It would merge some government intervention with the free market. Under this model, the state would subsidize “time-sensitive” care — meaning care that is not shoppable, like emergency service treatment. Meanwhile, the shoppable services — like a hip replacement — would be open to free-market competition and pricing.
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That way, Fuchs reasoned, the state could ensure facilities have the essentials while allowing the free market to determine other needs. He noted that, as it is, the free market doesn’t really exist with emergency care anyway; a man having a heart attack isn’t exactly in a position to choose the hospital. What’s more, there are so few hospitals that he doesn’t really have a choice anyway.
Whether the model is palatable to the committee is unclear. Fuchs has a recent history of drafting ambitious plans to tackle costs; he was the architect of a unique plan that seeks to lower air ambulance prices.
But the committee mostly digested the report, asking a few questions about the data. These lawmakers were charged with studying why health care costs in Wyoming are so expensive. Through the two reports, they’ve now done that. As Thursday was the committee’s final meeting before the full Legislature meets early next year, the committee has no bill to address it.
However, the committee could bring a bill — whether it’s Fuchs’ proposal or something else — out of committee during the session, or an individual legislator could sponsor a measure.
The studies went beyond costs. The state’s report, for instance, showed that 10 of 23 counties here had fewer than one doctor per 1,000 people. Even more troubling, most counties had seen that figure stagnate or even decline in recent years. Another graph showed that Wyoming is among the worst states in the U.S. in terms of access to physicians. That trend is also not getting better, the report showed.
Indeed, the statistics demonstrate that there’s a growing gap in care depending on where a person lives in Wyoming. Teton County, one of the wealthiest counties in the nation, had more than four doctors per 1,000 people, the highest rate in the state. It also had the highest share of specialists in the state.
Meanwhile, in 12 counties, there is no OB-GYN. In several more, there’s only one per 10,000 people. There’s a similar dearth of specialists and other health care workers scattered across Wyoming’s more rural areas, which make up a majority of the state.
The gap in care is extensive. The state report also examined how far pregnant women in various counties had to drive for uncomplicated births. Between 350 and 400 women on the Wind River Reservation had to drive at least 30 minutes. As many as 100 woman in Pinedale had to drive for at least an hour.
If there was a positive in the reports, it was that several Wyoming hospitals are in decent shape financially. The outside firm’s report showed that 13 of 22 hospitals had positive revenue streams (meaning the sum of payments from Medicare, Medicaid and private insurers was in the black). Hospitals typically lose money on Medicare and Medicaid, and they make up that deficit with those who have private insurance.
The state report, meanwhile, showed 13 hospitals with positive margins. The same report found 13 hospitals were also well-positioned to liabilities, like debts.