Hospitals forge on despite unknowns

Northwest Arkansas hospitals and clinics will continue growing despite the open question of how Republicans in Congress and the White House will alter health care policy, several executives said in recent weeks.

House Republicans last month failed to agree on an alternative to the Patient Protection and Affordable Care Act, also called Obamacare, and President Donald Trump then said he’d like to move on to other priorities. But some Republicans last week proposed another try, and Trump on Tuesday told CNN “we are going to have a big win soon because we are going to have health care and that’s going to happen.”

The back and forth and the proposals’ uncertain future put hospitals in the position of making routine budget and business plans without knowing what kind of coverage, if any, many of their patients will have.

The nonpartisan Congressional Budget Office found Republicans’ first proposal would cause tens of millions of people to lose or forgo Medicaid and other coverage, while last week’s version could lead to skimpier or more expensive coverage in some states for the people who need the priciest or most specialized care.

“There is great uncertainty, and probably more so than most of the time,” said Eric Pianalto, president

of Mercy Northwest Arkansas, noting health care always has some unknowns. “Frankly, if we waited for there to be certainty, we’d never do anything.”

He and other executives agreed the biggest concern in their near-term planning is the area’s growing population and needs, even as many keep an eye out for federal action.

“All of our initiatives, such as expanded facilities and services, are based on community need: introducing a new service not previously available locally, adding more capacity to improve patient access, enhancing an existing service,” Bill Bradley, CEO of Washington Regional Medical Center, wrote in an email early this month. “We do not expect any material change to Washington [D.C.]’s health care policy this year.”

About 32 people per day moved into or were born in the Fayetteville-Springdale-Rogers metropolitan area from 2015 to 2016, according to the latest census estimates, and health systems have responded with new locations, hires and services. Northwest Health and Washington Regional both have boosted their maternity and childbirth services and other specialties, for example.

Additions like those will continue, system leaders said. Mercy is in the middle of an expansion the system says will add 1,000 jobs and a 150-bed patient tower, and recently broke ground on a clinic in Pea Ridge.

On a smaller scale, Medical Associates of Northwest Arkansas, a physician-owned network of doctors, is adding a radiologist, rheumatologist and other physicians in and around Fayetteville this year, spokeswoman Carole Masterson said.

The free WelcomeHealth clinic in Fayetteville for low-income patients plans to add children’s dental and medical care this summer.

“Right now there are no changes in sight, so we’ll continue to serve those who need to see us,” WelcomeHealth director Monika Fischer-Massie said of the federal debate. “We’re here to provide access to care to those who can’t afford it anywhere else, or who cannot find a provider anywhere else.”

The changes proposed by Republicans so far have been substantial. The proposal that fell apart would have led to somewhat lower premiums for people in the individual insurance market in the next decade, the Congressional Budget Office projected, but it would accomplish that with higher prices on older people and growing cuts to Medicaid for people with low incomes.

Democrats opposed the plan en masse because of those potential losses, and it divided Republicans into several groups, including in Arkansas’ delegation. Republican Sen. Tom Cotton said it didn’t address the rising costs of health care itself, for example, while fellow Republican Rep. Steve Womack said it’d be better than Obamacare and give states more control over their policies.

Bradley and other executives said a drop in people with coverage would mean a straightforward drop in payments for care, unless the number of patients grows enough to make up for it. The loss would exacerbate the millions of dollars health systems already take on as charity or uncompensated care and keep many patients from needed help, the executives said.

“We encourage our elected leaders to be thoughtful and focused in their deliberations to sustain coverage for our fellow Americans and improve our healthcare system,” Northwest CEO Sharif Omar wrote in an email. More than half of the system’s patients fall under Medicare or Medicaid, he said.

Last week’s tentative proposal would allow states both to trim the required benefits covered by insurance, such as prescriptions or maternity care, and to let insurance companies charge sicker patients more, Politico and other news outlets reported. Those patients could then turn to high-risk pools with coverage subsidized by the states. Such pools were common before Obamacare and often sharply limited care or rejected many applicants, according to The New York Times.

Legislators and experts across the political spectrum broadly agree Obamacare could use at least some tweaks, and local executives offered some they’d like to see. Bradley said the law should do more to control manufacturing and medicine costs and give patients incentives for preventative medicine and maintaining good health.

Pianalto agreed on the latter point, saying Obamacare made only a little progress toward helping the health care system make a fundamental switch: paying hospitals for good outcomes, such as helping a patient overcome a particular ailment or preventing it from happening at all, instead of paying for every test and procedure. Pianalto and others around the country say this method could keep people healthier at lower costs.

“The [outcome-based] economic model isn’t sustainable if the way we get paid doesn’t match that,” he said.

Whatever changes come forward, some members of Congress have said they want the political process to go differently, and perhaps with bipartisan cooperation.

“You’ve got to get a buyin from Congress and in this go-around I think you can get a buy-in from the American public,” Republican Sen. John Boozman said in North Little Rock last week. “I think there is going to be a lot of sticker shock as we go into the next premium cycle for the next year, so I think events will cause us to have to do something. And at some point, Democrats and Republicans working together can come up with a solution.”

About 32 people per day moved into or were born in the Fayetteville Springdale-Rogers metropolitan area from 2015 to 2016, according to the latest census estimates, and health systems have responded with new locations, hires and services.