Preparing for impacts of healthcare reform

Rebecca Neipp

News Review Staff Writer

The early stages of implementation for the Affordable Care Act (commonly referred to as Obamacare) have brought with them a relative calming effect on the once-hot controversy over how the shift toward a socialized model of medicine will impact U.S. health care.

As the ACA is phased in, most healthcare professionals acknowledge a period of growing pains as refinements and adjustments — of mostly an unknown nature — will most certainly continue to shape quality, cost and access to care for most Americans.

Ridgecrest Regional Hospital CEO Jim Suver said that for small, rural communities such as the IWV region served by the local facility, many of the potentially negative impacts of reform can be managed by individuals approaching health care with a focus on preventive medicine, an awareness of how to leverage community assets and informed decision-making about obligations and benefits individuals are signing up for.

Suver recently outlined for the News Review some of the changes the new enrollment may bring with it. New access to health care may allow facilities such as RRH to deliver early treatment to patients, which is generally more cost-effective for providers as well as users.

However, with more individuals insured, he said, patients may experience longer wait times. He attributed that prospect in part to an acute shortage of physicians nationwide. Optimistically, this problem could correct itself in about 10 years — the length of time it takes to prepare someone for practice. However, some critics think the shortage will only get worse if the profession continues to lose incentives, and gain risks, for its practitioners.

“One impact that has been fairly positive on us as a hospital is that MediCal has been expanded to include families that were not formerly eligible,” said Suver. “And with presumptive eligibility, the hospital can enroll them at the time of service.” That not only allows patients on-the-spot treatment, but also gives the hospital a pathway to reimbursement.

“Right now that may be only 8 cents on the dollar, but it’s still better than zero.”

Suver said under the current overhaul one of his goals is to push for preventive care. “For decades medicine has been built on a sickness model — that’s where health care got its money. Under this reform, we must focus on staying well if we are going to be able to sustain our resources.”

He said that lower-income residents can use resources such as the Rural Health Clinic to establish a “medical home,” which essentially gives individuals someone to assess and treat them before conditions reach urgent or emergency status.

“This will also help us face another crisis that the reform doesn’t really address — our expenditures for healthcare are out of control. Incentivizing people for staying healthy isn’t just better for them, it really makes our limited resources go farther.”

Suver cited as one example the emergency department. Uninsured patients who can’t afford healthcare are typically turned away from clinic environments. The emergency department has both a legal and an ethical obligation to serve anyone who walks in the door. However, the cost for providing service at that level is far more expensive. “That’s why having that medical home is important. Reform has made clinical service more accessible to more people, allowing us to really do a better job of keeping people healthy.”

He did, however, point to some additional challenges that come with the current mandates for health care. “We offer a nice healthcare plan for our employees, but under the ACA it’s actually deemed too good. So we now have another $300,000 we need to find each year to cover the penalty. This is where a lot of employers have responded to this by reducing hours to avoid paying benefits. But as an employer we want to be able to grow and keep jobs and offer our employees competitive compensation.”

Suver noted that reform will also have an impact on the hospital’s “bad debt,” since patients now have a 30 percent co-pay.

“One thing I am encouraging all our patients to do is read their benefits very carefully. Out-of-pocket cost for a family making $65,000 per year is about $8,000. If your take-home is $40,000, that’s 20 percent of your pay.”

Having debt from delivering service is nothing new for the hospital, he said. But the hospital counts on services such as lab, cardiology and radiology to balance that loss. “Obviously, we want people to use these services so that we can afford to keep offering them. But this also fits with our philosophy for rural healthcare because if you are staying on top of those kinds of preventive measures, you can avoid acute incidents.”

Suver said that in the meantime the hospital continues to recruit physicians and expand services. “We had $3 million in income last year that we are pouring back into improving and expanding upon what we can offer our community.”

Story First Published: 2014-04-30