Hop­ing for a re­cov­ery

Modern Healthcare - - SPECIAL REPORT - —Paul Barr

While pub­lic hos­pi­tals can ex­pect an­other chal­leng­ing year oper­a­tionally, Dr. Bruce Siegel, pres­i­dent and CEO of the Na­tional As­so­ci­a­tion of Pub­lic Hos­pi­tals and Health Sys­tems, says there might be some good news ahead.

“I think it’s a year of eco­nomic re­cov­ery,” which trans­lates into po­ten­tially fewer unin­sured pa­tients and fewer pa­tients on Med­i­caid.

Safety net hos­pi­tals rely heav­ily on the rel­a­tively low re­im­burse­ment rates of Med­i­caid, but an im­prov­ing econ­omy would re­duce that re­liance.

More­over, some pro­ce­dures and elec­tive care that has been put off for fi­nan­cial rea­sons could get a sec­ond look as more peo­ple gain

jobs with health in­surance cov­er­age, giv­ing a boost to vol­ume.

“Peo­ple have been hold­ing back and I think that may change,” Siegel says.

Some pro­vi­sions of the Pa­tient Pro­tec­tion and Af­ford­able Care Act that hos­pi­tals will need to pre­pare for in 2013 also are at­trac­tive to pub­lic hospi­tal ex­ec­u­tives, such as ef­forts to get health­care providers in hos­pi­tals, clin­ics and else­where work­ing to­gether on a pa­tient’s care.

It’s some­thing that ver­ti­cally in­te­grated pub­lic health sys­tems have done for years, Siegel says. “They’re al­ready there. They’re al­ready used to this” ap­proach, he says. “The days of the hospi­tal that only wor­ries about its own four walls is go­ing to pass.”

Mean­while, the NAPH and its mem­bers are still fight­ing to avoid a loom­ing 2014 cut to Med­i­caid dis­pro­por­tion­ate-share hospi­tal pay­ments tied to the Af­ford­able Care Act.

For crit­i­cal-ac­cess hos­pi­tals, 2013 will in­clude a heavy fo­cus on achiev­ing the stan­dards for the mean­ing­ful use of elec­tronic health records, says Brock Slabach, se­nior vice pres­i­dent for mem­ber ser­vices at the Na­tional Ru­ral Health As­so­ci­a­tion, Kansas City, Mo.

The fed­eral government is aim­ing to get 1,000 of the coun­try’s small ru­ral hos­pi­tals— in­clud­ing crit­i­cal-ac­cess hos­pi­tals—qual­i­fied for mean­ing­ful use by the end of 2014. The government is award­ing up to $30 mil­lion to re­gional ex­ten­sion cen­ters to help up to 1,500 hos­pi­tals work to­ward mean­ing­ful use, which would rep­re­sent about 90% of hos­pi­tals that qual­ify as a small ru­ral hospi­tal by the government’s def­i­ni­tion.

And like other hos­pi­tals, ru­ral fa­cil­i­ties are go­ing to be mon­i­tor­ing closely the devel­op­ment of health in­surance ex­changes among the states, Slabach says. Ru­ral res­i­dents may have ac­cess to health plans, but a big ques­tion is whether or not those plans give them ap­pro­pri­ate ac­cess.

Cov­er­age isn’t worth much if pri­mary care and other es­sen­tial providers in a ru­ral res­i­dent’s com­mu­nity are not a part of that cov­er­age, Slabach says. “Are they go­ing to use the lo­cal hospi­tal, the lo­cal doc­tors?”

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