Hospital officials take patient approach to health reform
September 3, 2009
GLENWOOD SPRINGS – Any changes in the way hospitals serve patients under the health care reform measures set to be debated when Congress returns to session next week are as much a moving target as the growing debate itself, say executives from two area hospitals.
“With every change there is opportunity,” said Larry Dupper, chief financial officer for Valley View Hospital in Glenwood Springs. “We may not always like changes, but with change there is always a silver lining.
“In our community, what’s great is that we are owned by the community,” Dupper said of Valley View, which is organized as a not-for-profit hospital. “Our mission is to serve our community, and whatever happens we will adjust and adapt.”
Martie Wisdom, chief executive officer for the special tax district-supported Grand River Hospital District in Rifle, said the larger impact will be on individual consumers rather than hospitals.
“It’s very difficult to know at this time what it will mean for us,” she said. “Two out of the three bills under consideration now would include a mandate that individuals have to buy health insurance of some sort.”
Whether that’s a private insurance option or some form of public option or nonprofit health insurance cooperative, it could serve to reduce the costs for individual consumers, she said.
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But, depending on how it’s structured, it could also limit what hospitals are able to offer.
“I’m not against reform, I think we need it,” Wisdom said. “But in any decision we make, there are consequences, intended and unintended.”
If a public-payer plan were to be set at the current Medicare and Medicaid rates of reimbursement, it would do little to help hospitals recover the portion of costs that don’t get covered for those patients, she said.
“Health care would change dramatically in that scenario, and many conveniences consumers enjoy now would go away,” Wisdom said.
At a town hall meeting in Grand Junction Aug. 15, President Barack Obama acknowledged that any government-sponsored health insurance for those not covered under Medicaid or Medicare would have to collect competitive premiums and negotiate reimbursement rates, just as private insurers do.
As it stands, one of the main reasons private health insurance and health care costs in general are skyrocketing is that unreimbursed costs related to the two existing government programs and the estimated 46 million Americans who are uninsured, are being subsidized by the private sector.
“When you come to pay a bill (at Valley View, it costs more because you’re helping to pay for Medicaid and the uninsured,” Dupper said.
Reforms could help negate some of that unreimbursed cost, he said.
“I applaud the effort,” he said. “But we will still have uninsured. It’s too difficult to get the transient population to sign up for anything.”
Currently, about 9 percent of Valley View patients are covered by Medicaid based on their income. The Medicaid reimbursement rate is about 25 cents on the dollar, Dupper said.
Another 25 percent of the hospital’s patients are covered by Medicare (age 65 and older). The reimbursement rate for those patient services is about 33 cents on the dollar, according to Dupper.
“That shortfall is getting tougher and tougher on hospitals,” he said.
“Self pay” patients, the uninsured, make up about 10 percent of the patients at Valley View. That percentage has actually gone down some in recent years, he said, although the percentage of uninsured coming through the emergency room is about double that rate.
And, it’s a common misperception that those patients, often including the area’s large immigrant population, don’t pay at all, Dupper said.
“These are typically working people who want to better their lives, and they do participate in paying their bills,” he said. “It’s not nearly as big a problem as the shortfall in reimbursements for (Medicaid and Medicare) patients.”
“Most people who are self pay do make an effort to pay,” Wisdom said of the Grand River Hospital District, which operates the Grand River Medical Center in Rifle, as well as the Battlement Mesa Medical Center and the E. Dene Moore nursing care facility.
Grand River’s patient demographics are somewhat different than Valley View’s. Approximately 15 percent to 20 percent of its patients qualify for Medicaid, and almost half of all its patients fall under Medicaid and Medicare combined, according to Wisdom.
Between 12 percent and 15 percent of Grand River’s patients are uninsured, although the percentage of uninsured patients coming through the ER is closer to 50 percent, she said.
“That is a little high, but an area with socio-economics like ours is unusual,” she said.
Grand River requires the physicians that it works with to accept Medicaid and Medicare patients, so that results in its larger percentage of those patients coming to the Rifle hospital, Wisdom said.
The downturn in the economy has also had its impact, she said.
“We certainly haven’t seen a decrease in volume, but people are having a hard time paying bills,” she said. “So, there’s more charity care.”
Dupper added that another aspect of health care reform to be considered is how physicians will be treated.
“That’s one of the key things for us,” he said. “Society has made it more and more difficult to be a doctor … we have to make sure we have doctors who are able to take care of patients.”