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Providers keeping an eye on federal reform

Controversy is the one thing that has been a constant of the federal healthcare reform act as the uncertainty about its future continues. Mississippi healthcare providers will be watching closely to see what the courts and Congress do in 2011 as new members take their seats.

The Mississippi Hospital Association (MHA) is partnering closely with the American Hospital Association on reform advocacy efforts. As the voice for the state’s hospitals, executive director Sam Cameron says the MHA sees both benefits and challenges with this legislation.

“We will maintain regular communication with our members, legislators and Congressmen as we approach new developments surrounding healthcare reform,” he said. “We are unable to predict what Congress or the Supreme Court will decide. MHA is moving forward to make sure our hospitals are prepared for the changes that would accompany this legislation if it is fully implemented.”

Member hospitals are watching closely, too. Gulfport’s Garden Park Medical Center CEO Brenda Waltz notes the Dec. 14 ruling by a federal judge in Virginia that states part of the law is unconstitutional by compelling Americans to buy health insurance. “This marks the first time a high court has struck down any facet of the massive new law to overhaul the nation’s healthcare system,” she said. “In addition, due to the change in the leadership on Capital Hill, we can only guess what other changes may occur. To say this healthcare law will be fully implemented, changed or repealed at this time is truly an unknown.”

However, Waltz feels the possibility of a fully insured population is a good thing even though a federally mandated enforcement of it is a challenge. “Hospitals will definitely see a change and what that change looks like continues to evolve,” she said.

The Mississippi Nurses Association (MNA) did not take an official position on the reform act, although the American Nurses Association supported it and lobbied extensively for it, according to Ricki Garrett, executive director of the MNA.

“I don’t think anyone knows what may happen. I think the likelihood is that although the Republicans in the House and Senate may not be able to repeal the legislation, they will be able to use the appropriations process to either reduce or alter portions of it,” she said. “It could very well be significantly changed before portions of it are fully implemented.”

Garrett points out that Mississippi is moving ahead with an insurance exchange, knowing the number of people eligible for healthcare coverage will expand considerably. “That is going to put a significant strain on the existing primary care providers in our state,” she said, “making it even more important for advanced practice nurses to be able to practice without unnecessary restraints. It is also going to significantly affect the state budget as more and more individuals become eligible for Medicare and Medicaid.”

She feels the bill has some positive implications for nursing in this country and hopes in the process of examining reform those important steps forward will remain a part of the legislation. “They help assure that healthcare is safe, effective and affordable,” she added.

Cameron feels the legislation has positive effects for hospitals and patients. “If implemented, it would expand coverage to 32 million people, enact significant insurance market reforms and lay a foundation upon which we can continue to build,” he said. “However, rising uncompensated care costs continue to be a significant burden for Mississippi hospitals. Gaps in insurance coverage and a weak economy continue to affect our hospitals’ ability to collect payment for services.”

In 2008, U.S. hospitals had $39.1 billion in uncompensated care costs, according to an American Hospital Association study. The MHA hopes healthcare reform legislation’s promise for an increase in coverage would also equal to a decrease in uncompensated care costs, Cameron said.

He also points to anticipated cuts by Congress in Medicare and Medicaid over the next decade as they struggle with the federal deficit. Hospitals in the U.S. would have $155 billion in cuts to help implement healthcare reform legislation. “Even if the law does reduce the number of uninsured to 23 million, public hospitals still could be busy caring for new Medicaid enrollees and the newly insured in 2014,” he said. “There are definitely capacity issues that will need to be looked at by 2014 to make sure people have access to care.”

Cameron said MHA hospitals must be prepared to handle capacity, integration, patient safety and quality measures that are critical to healthcare reform implementation. The association is working to help educate hospitals in these specific areas.

Physicians in Mississippi are also watching closely to determine what the impact will be to patient care and their practices. In an interview earlier this year, Tim J. Alford, M.D., president of the Mississippi State Medical Association (MSMA) said members have concerns while recognizing that reform is needed. They see the need for better patient coverage and for healthcare costs to stabilize.

He said adding more people to Medicaid in a state where a large percentage of the population is already on the program and physicians are unhappy with the government reimbursement formula will be a difficult scenario.

“Congress has not taken action on changing this formula, which is tied to the national gross product,” Alford said. “It’s a fatally flawed formula and was from the beginning. Each year the hole gets deeper and deeper. Physicians are going to have to sustain a 21 percent cut this year – that’s an outright cut in the way they get paid. No business can sustain that kind of cut.”

Alford, a family physician in Kosciusko, says the MSMA and American Medical Association have been lobbying Congress for years to change the formula instead of enacting a quick fix.

“We understand our own Mississippi senators’ concerns about adding to the federal deficit, but in a state like Mississippi where so much healthcare depends on the government, it seems like the senators would come off the Republican hard line. That argument rings hollow,” he said. “It’s discouraging and demoralizing for our physicians. I think we’ll see more and more become intolerant and stop taking new Medicaid patients. For others, it could be the final hassle that pushes them into retirement.”

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About Lynn Lofton

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