Thursday, July 31, 2014

Medical officials: Health care law ‘stifling’ industry

By DOUG CARDER, Herald Senior Writer | 1/20/2014

Larry Felix told U.S. Sen. Jerry Moran, R-Kan., that he recently apologized to his board of trustees.

Felix did something he had not done in 14 years as chief executive officer of Ransom Memorial Hospital, 1301 S. Main St., Ottawa, he said.

Larry Felix told U.S. Sen. Jerry Moran, R-Kan., that he recently apologized to his board of trustees.

Felix did something he had not done in 14 years as chief executive officer of Ransom Memorial Hospital, 1301 S. Main St., Ottawa, he said.

“Our costs are continuing to go up to the point that the 2014 budget is the first time I’ve submitted a budget to my board of trustees with a huge operating loss, over a $1 million operating loss,” Felix said. “In the last decade, we’ve improved facilities and equipment without acquiring debt, so I feel like we are in as good a position as we can be to weather this, but I’m concerned not only about this place, but for all hospitals.”

Moran talked with Felix, doctors, administrators and some hospital board members for about an hour Monday afternoon during his visit to Ransom Memorial Hospital. The senator said he was visiting with hospital administrators and staffs across the state about the impact the Affordable Care Act, also known as Obamacare, is having on their operations.

Between the Affordable Care Act’s reimbursements cuts in the federal Medicaid Disproportionate Share Hospital Program to treat indigent patients and the increased red-tape and costs associated with Centers for Medicare and Medicaid Services’ electronic health record incentives, Felix said, the challenges have become immense.

“The computerization mandates are stifling,” he said. “Doctors are sitting at computers rather than being with patients. Quite frankly, computer vendors have taken these mandates and tried to put a product together that’s not ready.”

The Medicare and Medicaid EHR incentive programs provide financial incentives for the “meaningful use” of certified electronic health records technology. To receive an incentive payment, providers have to show they are “meaningfully using” their certified records technology by meeting certain measurement thresholds, according to the Centers for Medicare and Medicaid’s government website.

“The system has needed a lot of molding,” Dr. John Gollier, an Ottawa physician, said. “It takes an extra 20 to 30 minutes to see each patient, and if you see 15 patients a day in the hospital, you’re adding three or four hours to the day.”

Affordable Care Act cuts to the federal Medicaid Disproportionate Share Hospital Program were designed to help pay for the cost of expanding Medicaid, according to the federal administration, but the cuts were predicated on the assumption that all states would expand Medicaid. Tom Bell, president and chief executive officer of the Kansas Hospital Association in Topeka, said that hasn’t been the case because the U.S. Supreme Court ruled in June 2012 that states could opt out of the expansion. Kansas is one of the states that did not expand Medicaid.

Dean Ohmart, chief financial officer of Ransom Memorial Hospital, told Moran the cuts in the disproportionate share program were taking a toll on the hospital.

The senator said he was going to work to get the disproportionate share payments reinstated.

“Every time Congress and this president try to save money, it’s a reduction in reimbursements,” Moran said. “I want to reinstate the disproportionate share [payments]. That would be a Band-Aid. It doesn’t solve the system problem, and it doesn’t really solve the doctors’ problems, but it keeps the hospital viable until we can get this fixed.”

Dr. Rod McCalla, Ottawa physician, asked Moran what Congress could do to fix the problems with the Affordable Care Act now that the train has left the station.

“The goal was to use the pool of healthy individuals who really don’t need to drive a Cadillac every day but they make them drive a Cadillac every day so people who don’t have coverage can also drive a Cadillac,” McCalla said.

Moran said Congress would have to do its best to fix the myriad of problems with the Affordable Care Act.

“Surely we can improve the situation for people who fall through the cracks without doing damage to the people who are generally satisfied with what they have,” Moran said.

Another point that is being lost in the national discussion, Ohmart said, is that reimbursements from third-party payers is getting to be too cumbersome.

“They are making their money on denials and delay tactics to providers,” Ohmart said.

The cut in payments is frustrating, Felix said, because the hospital serves a number of indigent patients.

“I call managed care the great failed experiment, because right now you have people that are not physicians telling our physicians they cannot treat the patient according to their medical training, and that’s just crazy to me,” Felix said. “The frustration I see coming from doctors in general is tremendous.

“We’ve always taken care of those without means, and now we are taking these huge, huge cuts in our reimbursements, and we’re still taking care of [the indigent] and they are still not insured,” Felix said. “We’re doing the right things for the right reasons and getting good outcomes, but we are choking to death financially. Slowly. The [projected operating loss in 2014] will be the first spiral for us.”

Moran said it’s important that Congress ensure rural communities can maintain their access to quality health care. He said the president was good at delaying everything but the individual mandate.

“Wether or not you survive determines whether or not Ottawa survives,” Moran told the group of health officials. “It’s certainly true here and in my hometown of Plainville [in Western Kansas]. If you don’t have access to health care, young people are not going to live here and senior citizens can’t stay here. Every day, we need to look at what we can do to make things better to increase the chances that what we have going here doesn’t disappear.”

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