Cabin Business

Health care reform has been a hot-button topic since the presidential election, and even more so in recent months. Although several plans are still being considered by lawmakers, the Log Cabin Democrat approached several people in the health care industry about their concerns and hopes. These discussions shed light on various issues.

A provider
Jim Lambert, CEO of Conway Regional Medical Center, said some plans being discussed call for the proposed public rate to be based on Medicare and Medicaid rates while others leave it open for negotiation. One of his concerns is that Medicare and Medicaid do not reimburse providers enough to pay for the care, he said.
One argument he heard was, “If we move (some 45 million uninsured Americans into the system), you’ll get some reimbursement where you were getting none. Will that work out? That’s a concern. That’s why we’re trying to negotiate those rates,” he added.

Patient expectations have an affect on the cost of health care as well, Lambert said.

“People want immediate access. ‘If I have to wait, there’s something wrong,’” he said. Access to technology and other services increases the cost, he said.

Lambert continued, “The current system is not sustainable economically. I think everyone agrees the current system will potentially bankrupt the country.”

Another challenge, according to Lambert, is a lack of patient understanding of the actual cost of health care.

“Some people think it costs them $25, so they come as often as they want,” which increases the cost on the system, he said.

Lambert said measures need to be taken to encourage more people to become primary physicians.
“If we give 45 million people insurance, they’re going to start looking for someone to take care of them. We don’t have enough physicians today. If you increase the number, I’m not sure how they’re going to get seen, because physicians are seeing as many as they can today, at least in our community.”

A doctor
Dr. Alan Lucas, pediatrician and chief of staff for Conway Regional Medical Center, said one of his concerns about proposed legislation to reform the health care system is that physicians have not been involved. He said legislators have some physicians serving as academic advisers, but lawmakers have not asked physicians in the general public to be involved.

“I could tell them (areas to cut costs) if they ever asked. We’re as frustrated with private insurance companies as any government plans. They need to get back to the grass roots and ask the people who do it every day, ‘What do you need.’”

Lucas said there are imbalances in the rates of doctors’ reimbursements. For instance, procedures are reimbursed at a higher rate than office visits that require more cognitive skills. One simple procedure that takes very little time pays much more than an hour-long discussion with a parent about behavioral problems, he said.

“I think there are obvious ways to save money,” he said.

Another concern of Lucas’ is the issue of tort reform. Leaders have said it won’t be part of the plans now being formed, but doctors have concerns that it has an impact on the cost of health care, he said. For example, he said, doctors may order excessive testing to determine if a particular course of treatment is the right one because they are afraid of being sued. Excessive testing increases the cost on the system.
Lucas said he is also concerned about whether doctors will be reimbursed at a rate that will pay their costs.
“If you are reimbursed less, the only way to increase revenue is to see more patients. Most doctors are already seeing more than they are comfortable with,” meaning they do not have time to adequately discuss each patient’s illness, he said.

Insurance
Local State Farm agent Jay Bernard said, “I have concerns over any government program that reduces or affects free market competition. The public needs to be involved in this conversation, getting the experts from all arenas. I think a doctor has to be involved in this conversation. I’m excited that we’re trying to address it for the betterment of our country. This is a healthy discussion that I think all parties need to be actively involved in.”

Bernard said tort reform is a concern for the insurance industry as well.
“Physicians have to protect themselves. Excessive lawsuits drive the cost up for liability. We, the public, have to pay for (the cost of lawsuits to insurance companies) through our premiums,” he said.
He described the “vicious cycle” as a carnival ride.

“If you can only think of a Ferris wheel, and the following people are on it — the insurance companies, the doctors …” lawyers, and the public, he said.

“In my opinion, the Ferris wheel is out of control,” he added.

Bernard said re-educating the public about the cost of health care could help with some of the costs to the health care system.

“We have trained the public that you can run to the doctor and pay $20 for a runny nose or sore throat. What we’re working on with small business owners is that philosophy — take a larger deductible. In return, you’ll have a health savings account, where this account grows tax free and is utilized for the normal doctor visit. The benefit is that you are lowering your premium cost by absorbing more of the risk.”

Also, Bernard said he is concerned about how the proposed federal government plans will be paid for.
“Small businesses are already paying, in my opinion, an exorbitant amount of federal tax. How are they going to pay for it without additional taxes? The government is not a business. They are not required to meet and balance budgets to stay in business. All they have to do is basically raise taxes to pay for their expense.”
Cal Kellogg, chief strategy officer for Arkansas Blue Cross and Blue Shield, said, “The primary driver of the cost of health care insurance is the cost of health care itself. If you look at every dollar we collect in revenues and premiums, well over 80 percent of those end up going back to the cost of health care provided. Until you address the cost of health care, we’re never going to be able to address the cost of insurance.

“We understand part of the reason for the number of uninsured people is the affordability issue, but until we tackle the main issue of what drives up costs, we will never be able to stabilize or lower costs so that everyone can afford to have access. We’d love for everyone to have access, whether it’s through us, whether it’s through some other option already existing, but until we make it affordable, that’s going to be really tough to do.”

Kellogg said he supports doing away with pre-existing conditions and making health care affordable for everyone, but individual responsibility will be key.

“(The) young and healthy who would rather use their money for something else, they stay out of the pool. You end up with only the older or those who really need it. If you spread the risk out over the healthy and those who really need it, you have a much more workable situation, but it’s a temporary solution until we address the issue of cost. Costs will continue to go up, and that’s what drives the rates. Until we can address the costs, we will only have a temporary solution in terms of getting people covered.”

Independent living
Jackie Fliss, executive director of Independent Living Services in Conway, said she hopes affordable health care for everyone becomes a reality from the legislation being discussed.

“It would help us greatly with our part-time employees. We are going to offer them a health policy, but the coverage is not extensive.”

As for the agency’s consumers, Fliss said she does not know of any changes.

“We’re controlled by the Centers for Medicare and Medicaid. Our funding is predominantly Medicaid. As far as I know, we have not been pulled into health care reform,” she said.

Fliss added ILS is a member of nationwide and statewide associations of providers that research proposed bills, and she has not received any information on health care reform.

Nursing homes
Rhonda Stout, administrator of Conway Health Care and Rehabilitation, said she has seen cause for concern in a proposed bill.

The America’s Affordable Health Choices Act of 2009 would cut Medicaid reimbursements significantly in long-term facilities, she said. In Arkansas alone, over a 10-year period, the cuts would mean a $370.4 million reduction in labor spending, she said.

“Since labor represents 70 percent of nursing home expenses, we would be forced to look at layoffs, reducing salaries, reducing benefits. The way I see it, at the end of the day, the only people we will be hurting are our seniors, because it’s their quality of care that will be affected.

“It affects our seniors, but it affects our total economy because of the jobs that will be lost. My fear is that we’ll have no choice but to cut back to minimum (staffing), and we don’t staff at minimum here; we staff above.

“You want to be able to provide the top quality of care. The number of staff depends on your residents’ needs. Probably 30 percent of our residents need total assistance with activities of daily living.”
Vickey Kirkemier, administrator at Salem Place Nursing and Rehab Center, said she does not believe nursing homes are at great risk of losing funding.

“I feel like the nursing home, and rehab portion especially, is very accessible, and we’re able to do it at a fraction of the cost of other institutions. And we’re very successful with people going home. The majority go home in about 45 days. I think the success rate speaks for itself.”

She said the needs of patients in nursing homes have changed over the years. Those who are fairly independent have moved to independent living facilities, leaving nursing homes serving those who need a high level of care, she said.

“They may limit therapy people can have, but as long as they are receiving therapy, how could you weed out something successful and keep something that’s going to cost more money? I have more people that get rehab and go home. I really think that’s where the success is going to be.”