00:00I recognize Mrs. Fischbach. Thank you, Mr. Chair. And I, like Mr. Smith, I serve a very rural area. Dr. Basil, thank you so much for being here today and for your work with Avera Health, which serves so many of my constituents across the 7th District.
00:18And if you're not familiar with it, I am the western half of Minnesota. So I border Canada, North Dakota, South Dakota. So there are a lot of Avera facilities in my district. And I appreciate that Mr. Smith from Missouri, you know, had brought up some of the rural issues, the rural patients, and some of the other folks have too.
00:38But given your unique perspective overseeing the regional Medicare Advantage plan and the clinical operations across the 38 rural hospitals, I'm wondering on how prior authorization policies specifically affect rural areas, the rural discharge planning.
01:00And we've seen data showing that MA enrollees face longer hospital stays. And I think you mentioned maybe some of that during some of your testimony due to delays and to approve the post-acute care.
01:14Can you speak to some of these, how these delays affect patient flow and hospital capacity in your rural facilities in particular?
01:23Yeah. So the main issue here is going to be prior authorization delays for skilled nursing care.
01:29A lot of our rural areas, we actually utilize skilled nursing care a little bit higher. When you live 45 miles away from the nearest hospital, you're more likely to send somebody to a skilled facility than you are if you live two miles away from the hospital.
01:42And so those delays in getting people out of the hospital and into that convalescent mode, it affects direct patient care.
01:50Hospital is no place to rest. You know, it's no place to regain your strength. And so getting them to that next level of care is important.
01:56And so that's one piece of that directly affects the patient.
02:00The other care is it clogs up the hospital systems. And so we've got beds that we can't put another patient in, especially, you know, if it's in our tertiary care center, they're usually running at capacity.
02:10And we have to get one patient out before we can transfer in that patient from the rural hospital for the needed higher intensity of care.
02:15And then the cost piece of it as well. It's like if they're spending more days in the hospital, they're costing us considerably more.
02:23And can you maybe speak to or if recent federal efforts to streamline any of that at that prior authorization has made any kind of meaningful difference on the ground?
02:34So obviously, I can't tell you what it would have been like without any of those changes, but I can tell you the trend.
02:40We have not seen any bend in the curve. In fact, if anything, there's an escalation in the number of denials and delays that we're seeing year by year.
02:47So we've certainly not seen any appreciable effect that I can tell.
02:50OK, thank you.
02:51The other thing and I'm going to shorten this up because we're short in time, but from from your perspective, which of the which of the supplemental benefits, because you mentioned earlier, not transportation, those kinds of things.
03:06And I just want to tell you the transportation is a huge issue.
03:09I mean, when you look at my my district and across rural areas and I just want to just add is, you know, transportation is an acute issue.
03:19I've seen I've seen wives not accompany their husband in the ambulance because they don't know how they're going to get home.
03:25And and that's and I know that we can't necessarily cover it, but it is part of people's care that they have their loved ones with them.
03:31And that's that was heartbreaking for me when I but which of the supplemental benefits have proven most impactful in those rural benefit in those rural areas?
03:43So if you look at some of the ones like I would like to be able to say that it's some of the health club benefits and stuff like that, because that should lead to more exercise, which should improve health.
03:54And fortunately, I think those are underutilized by all aspects of our society.
03:58And so I don't know that I can say that probably some of the dental and vision plans are what you see most broadly and makes it feel a little bit more like commercial insurance that people are are used to.
04:08And certainly dental health is tied to medical health.
04:11And so that would certainly be one of those that I would point to.
04:15And again, thank you for being here.
04:17I appreciate the perspective, given that, you know, health care in my district very well.
04:22And so I appreciate you being here.
04:24So thank you.
04:24And I yield back.
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