By BECKY GILLETTE
The Patient Protection and Affordable Care Act of 2010 (ACA) is supposed to save the U.S. health-care system by providing adequate health care for more people, requiring people who are employed to purchase insurance, and reducing costs for the Medicaid and Medicare systems. But there is concern that declines in reimbursements for hospitals and other healthcare providers in Mississippi could have an opposite effect of decreasing access to healthcare—and causing grave economic harm—if it causes small, rural hospitals to close.
ACA is a challenge for everyone, said Tim Moore, president and CEO of the Mississippi Hospital Association.
“Our biggest concern is the decrease it is causing in reimbursements from Medicare and Medicaid,” Moore said. “If we look at the reimbursement projected over the next 15 years, Mississippi is losing $2,477,112,000. The 2015 cut for Mississippi was roughly $119 million, and we have another $164 million to be cut in 2016. And in 2017, it is $210 million in scheduled cuts.”
ACA is also supposed to change the way that health care is delivered in the country by focusing more on preventative care, encouraging healthy lifestyles to prevent expensive medical conditions and managing care to prevent duplication of services or lack of coordination of services. But hospitals and other providers largely aren’t getting reimbursed for wellness programs and managed care.
Moore said it is important to change the payment model to line up with delivery model.
“I’m all for population health and managing care, but there no mechanism now to compensate providers for that,” Moore said. “Moving forward and trying to implement a model simultaneous with reimbursement cuts is very difficult. Some hospitals are taking part in new models of Accountable Care Organizations. There have been some things put in place, but how do you go about making these changes without a lot of risk? Margins have been cut so thin on hospitals it is difficult to take a lot of risk and completely change the way we things do.”
Even prior to the ACA, it was a struggle to find ways to keep small, rural hospitals open. Elderly and low income people often don’t have transportation to travel to a larger town to get health care. And hospitals are often one of the largest and best paying local employers.
“Having access to basic health care in small communities is critical,” Moore said. “If we lose hospitals in a community, we lose a major attractant not just to businesses but to new residents such as retirees. Education and hospitals are the first things new residents and businesses look for when they come into the community.”
The problem is not unique to Mississippi, and groups such as the American Hospital Association and the Rural Health Association are working hard to find new ways to approach the problem. A bill called the Rural Emergency Acute Care Hospital Act has been filed by Sen. Charles Grassley, R – Iowa.
“It has a lot of good information in it, and is a good approach,” Moore said. “It is certainly something we all need to look at and try to tweak. I don’t know that one model is going to work across the country. Communities have different needs. A one-size-fits-all approach isn’t going to get us to where we need to be. But it is encouraging that we are starting to get more attention on the federal level. Our rural hospitals are in trouble. If we are going to maintain access and provide care in rural areas, we have to find another way to do things.”
When small rural hospitals close, there can be a cascading impact from fewer property and sales taxes to fund services, and declines in volume for other businesses in town. It can even cause businesses like a manufacturer to leave the area. School enrollment can decline.
“Losing a rural hospital has a negative impact,” Moore said. “You must have healthcare. Access to health care is vitally important to having the healthy productive workforce that is essential to business activity. We are working on state and national level for a model that provides that access. Very likely it will be much different than what we see today.”
Another critical issue is the need for additional behavioral health services across the country. In some other states, behavioral health patients have ended up in the emergency room for five or six days because of lack of available psychiatric services.
“That is scary,” Moore said. “That is a patient going without care because the ER staff is not trained to handle psychiatric or behavioral health patients. Having those providers available is a huge issue. That is a whole other discussion.”