Den­ver Health could lose $85 mil­lion if Amer­i­can Health Care Act passes

The Denver Post - - DENVER & THE WEST - By John In­gold

When Robin Wit­ten­stein steps into Den­ver Health Med­i­cal Cen­ter on Wednes­day for her first day as the new CEO, she will be walk­ing into a hospi­tal fac­ing a po­ten­tial fund­ing cri­sis.

Half of Den­ver Health’s pa­tients are on Med­i­caid, mean­ing gov­ern­ment dol­lars play a ma­jor role in the safety-net hospi­tal’s bud­get. Al­ready this year, Den­ver Health is try­ing to trim $48 mil­lion from its bud­get be­cause of ex­pected cuts to the hospi­tal provider fee, a com­pli­cated mech­a­nism to pay back hos­pi­tals for tak­ing in poor and low­in­come pa­tients that has also be­come em­broiled in state Capi­tol bud­get fights.

But the big­ger threat, Den­ver Health lead­ers say, could come if Congress passes the Amer­i­can Health Care Act, the Repub­li­can­backed plan to re­place Oba­macare and over­haul how Med­i­caid works. Peg Bur­nette, Den­ver Health’s chief fi­nan­cial of­fi­cer, said the bill could mean a rev­enue hit in 2020 — when the bill’s more sig­nif­i­cant Med­i­caid pro­vi­sions kick in — of between $50 mil­lion and $85 mil­lion.

“It would ob­vi­ously throw us into the neg­a­tive for op­er­at­ing in­come,” Bur­nette said.

If that hap­pens, Bur­nette and Wit­ten­stein said Den­ver Health will have to find places to cut back to keep from go­ing broke. That could mean tin­ker­ing with em­ployee ben­e­fits or scal­ing back new con­struc­tion projects. Or it could mean slash­ing some ser­vices for pa­tients.

“We’re go­ing to have to look at all of the ser­vices we pro­vide … and see how we pre­serve the core of our mis­sion,” Wit­ten­stein said.

As a safety-net hospi­tal, Den­ver Health’s

core mis­sion to is pro­vide care for the city’s need­i­est pa­tients, while also op­er­at­ing as one of the re­gion’s premier trauma cen­ters. Be­fore the Af­ford­able Care Act, the health law also known as Oba­macare, nearly two-thirds of the pa­tients who walked through Den­ver Health’s doors were unin­sured or on Med­i­caid.

The Af­ford­able Care Act, which ex­panded el­i­gi­bil­ity for Med­i­caid among other things, didn’t ac­tu­ally change that com­bined per­cent­age. But it did shift its com­po­si­tion.

Prior to the law go­ing into ef­fect, 36 per­cent of Den­ver Health’s pa­tients were on Med­i­caid and 27 per­cent were unin­sured — mean­ing Den­ver Health was un­likely to re­ceive any pay­ment from the pa­tient for the treat­ment pro­vided. Since the ACA, though, 51 per­cent of Den­ver Health’s pa­tients are on Med­i­caid, while 13 per­cent are unin­sured, said Kelli Chris­tensen, a hospi­tal spokes­woman.

The shift has dra­mat­i­cally low­ered the amount of “un­com­pen­sated care” Den­ver Health pro­vides. And Den­ver Health has used the ex­tra money to build new school-based health cen­ters and a new pri­mary care clinic, as well as add staff at com­mu­nity clin­ics.

Wit­ten­stein said these moves are im­por­tant be­cause they al­low Den­ver Health to treat pa­tients more proac­tively, rather than just through costly emer­gency vis­its.

“It’s high qual­ity and lower cost,” she said.

The Amer­i­can Health Care Act would phase out the Med­i­caid ex­pan­sion while also cap­ping how much money the fed­eral gov­ern­ment gives to states to pay for the re­main­ing peo­ple still on Med­i­caid. The changes would save the fed­eral gov­ern­ment hun­dreds of bil­lions of dol­lars over the next decade. The Colorado Health In­sti­tute has es­ti­mated that Colorado would re­ceive $14 bil­lion less in Med­i­caid fund­ing by 2030 un­der the AHCA than un­der the cur­rent law.

If Colorado can’t find a way to re­place that fund­ing, Wit­ten­stein and oth­ers worry that the cuts will ul­ti­mately fil­ter down to hos­pi­tals, doc­tors and the pa­tients they care for. No mat­ter what, Wit­ten­stein said the hospi­tal will fight to make sure it has the re­sources to care for Den­ver’s need­i­est — even if it means she has to come into the job swing­ing.

“I feel very com­fort­able that we will have an op­por­tu­nity to con­tinue to tell the story of why the in­sti­tu­tion is im­por­tant,” she said.

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