Saturday, March 09, 2013

TOP STORY >> Medicaid plan could benefit North Metro

Leader staff writer

Medicaid expansion is expected to benefit hospitals, but administrators here aren’t sure of the specifics, according to Jodi Love, the chief executive officer of North Metro Medical Center in Jacksonville.

“There are still so many unknowns,” Love said.

Uninsured people make up 10 percent of the patients North Metro sees each month, according to the CEO. Another 6 percent have Medicaid coverage.

The hospital collects a flat fee — $850 per day per Medicaid patient — regardless of services rendered, Love continued. She said it is “very hard” for North Metro to collect payments from uninsured patients.

One of the recent announcements concerning the expansion was that Health and Human Services Secretary Kathleen Sebelius has approved a new government-paid, private-sector insurance proposal.

Love said, from what she understands, “it’s still Medicaid, but (lawmakers are) calling it something different.”

Like the CEO, state legislators are waiting on more information about the alternative.

The new proposal, if approved, would mean insurance companies receiving Medicaid funds, rather than Medicaid paying doctors and hospitals directly.

“I’m hopeful. Everything really seems to be good for hospitals,” she said.

The working poor between 18 and 64 and their families — about a quarter of a million people in the state — would be the primary population to benefit from the expansion.

Love said what is hopeful about the proposal is that the reimbursement rates hospitals receive for providing services to Medicaid recipients is expected to be better.

But one of the most pressing questions administrators like her have is what the new insurance policies will cover in 2014.

Essential health benefits on the table right now, Love said, are ambulance services, emergency services, hospitalization, laboratory services, maternity and newborn care, mental health and substance abuse disorder services, prescription drugs, rehabilitation and habilitative services and devices, preventative wellness services and chronic disease management and pediatric services, including oral and vision care.

The Affordable Care Act requirement that every patient have a primary-care doctor will help hospitals because the services they provide to patients would be preventative and less expensive than emergency-room visits, Love explained.

She said most uninsured patients only see a doctor when they have to go to the hospital’s emergency room for serious conditions.

Those costly trips to the ER could be avoided with preventative measures prescribed by primary care doctors, Love continued.

That means the reimbursement North Metro gets would be more likely to completely cover what the patient needed done, the CEO added.

Also, many uninsured patients are asked to bring some money to a doctor’s office so they can pay up front for a visit. Many of them don’t have that much money on hand and won’t keep an appointment, Love noted.

The Affordable Care Act requirement would eliminate that practice.

But there is also a drawback to this portion of the act, Love said.

One of the concerns the administrator had is the availability of primary care physicians. Many primary care doctors are older and not accepting new patients, she explained.

The CEO is also worried that people will be confused about the new process.

“It will have to be made simple,” Love said.

Sequestration cuts are another looming factor, she noted. The expected cuts, especially to civilian positions at Little Rock Air Force Base, will have a ripple effect on North Metro, the CEO said.

Love said her husband, who works on base, is looking at losing 16 of the 80 hours he puts in every pay period.

People who have incomes that take that kind of hit won’t purchase elective procedures such as knee surgery from North Metro, the CEO explained.