Tuesday, April 15, 2014

TOP STORY >> Hospitals see more insured with new law

Leader senior staff writer

While stressing the perils of extrapolating from such a small data set and in a short period of time, the percentage of uninsured patients coming to his hospital has declined each month since Medicaid expansion began on Jan. 1, according to Dan Riley, University of Arkansas for Medical Sciences’ chief financial officer.

“Historically, our uninsured levels are 12 percent to 14 percent,” Riley said. “December’s uninsured rate was 13.8 percent. January, despite startup problems (enrolling on the federal website), moved to 11 percent, a pretty precipitous drop. It usually moves slowly.”

Riley said the percentage of uninsured — which translates into millions of dollars in uncompensated care — dropped again, to 7.5 percent for February. In March, it fell to 6.5 percent — less than half of the uninsured rate in the month before the January launch of the private option and the federal health exchange.

Riley again stressed that the numbers could be an aberration — the 6.5 percent could be the nadir, he said, although the numbers of uninsured could keep dropping.


“But we can see affordable care in totality is having an impact on our uninsured numbers. We’re hoping it is a harbinger,” he said.

Riley said emergency room visits during that time have remained relatively stable. “All things being equal, we’re on the right trail,” Riley said.

Other providers agree it’s too early to evaluate the effects that Arkansas’ private option and the federal health care program will have. But, just weeks after the enrollment deadline, some local hospitals are reporting emergency room visits are up while uncompensated or charity care is down.

236,742 COVERED

Arkansas’ private-option applicants totaled 195,341 by March 22, according to Kate Luck, director of communications for the Department of Human Services, and — as of this week — 41,401 applicants through the federally facilitated health-insurance marketplace have been determined eligible. Their data has been processed by the state.

Together, that’s 236,742 Arkansans insured under the Affordable Care Act Medicaid expansion.


“Patients who come in with the private-option plan are still a little confused,” said Cindy Stafford, North Metro Medical Center chief executive officer.

“Many don’t have the primary-care physician,” she said, so they still go to the emergency room.

She said private option hadn’t been in effect long enough to know if it is financially helping North Metro.

“Potentially, it’s a good thing,” Stafford said. “We just have to see how it plays out.”

Dr. Joe Thompson, Arkansas Surgeon General, told a legislative subcommittee that estimated savings to hospitals for the first two months of the year were hundreds of thousands of dollars, attributable to implementation of both Arkansas’ unique private option and the federal Affordable Care Act.

That’s according to House Speaker Davy Carter (R-Cabot), a chief architect of the private option.


“Uncompensated care for hospitals raises insurance premiums for everyone and places a greater revenue burden on the state,” according to Carter.

Stuart Hill, vice president and treasurer, said, “White County Medical Center saw an increase in emergency department visits by 2.5 percent, or 600 visits, more than expected, since Jan. 1.”

But ER visits are only one measure of the effect the new insurance is having, he said.

“Also, our hospital admitted 5 percent more patients with commercial insurance, 20 percent more Medicaid patients and 6 percent fewer self-pay patients, since January 1, than had been projected,” he said.


Meanwhile, the number of Arkansans enrolled in the federal health-insurance marketplace part of the new insurance increased about 23 percent in the two weeks between March 24 and April 7, according to public information manager Heather Haywood with the Arkansas Health Connector Division of the Insurance Department. Statewide, 41,401 are now enrolled in the federal portion.

New numbers and numbers by county for the private option portion haven’t been released.

In Pulaski County, 5,647 out of an estimated 32,472 eligible people signed up for the federal program — a 25.1 percent increase from the 4,514 who signed up by March 24.

In Lonoke County, enrollment increased 23.4 percent, from 692 to 854 over the two weeks. In White County, the number signed up increased from 795 to 970, or 22 percent.


Statewide, emergency room use may be “up a little bit,” because there is a lot of re-educating to do, according to Paul Cunningham, executive vice president of the Arkansas Hospital Association.

“People need to get used to going to their physician after years or decades of treating the emergency room like a family clinic,” he said. “We just don’t have any hard information yet.”

The new policies went into effect Jan. 1.

In the first quarter, Baptist Health Center’s emergency room numbers were up 10.6 percent, according to vice president Mark Lowman.

“The private option is a critically important issue to the health of all Arkansans and critically important to the hospitals in the state,” Lowman said. “In 2013, Baptist provided $50 million in charity, bad debt and discounted care.” He also said that was the net amount, not gross.

“Insuring people won’t come close to equalizing that number, but it will help, and particularly in small rural hospitals,” Lowman said. “It’s well thought out and starting to work.”


The Baptist system, including the North Little Rock branch, saw an increase of 38 percent — 3,785 — for in-patient, out-patient and emergency room visits by Medicaid patients compared to the first quarter of 2013, Lowman said.

Nearly half of all visits were to the emergency room, he said.

In the first quarter, 2,161 private-option patients came to Baptist Health, a third of them to the emergency room.

At St. Vincent’s Infirmary, the number of first-quarter emergency room visits had increased 25 percent, from about 4,000 a year ago to about 5,000 this year, according to spokeswoman Margaret Dedman.

Dedman said that was the only information the hospital would provide and that “There won’t be an opportunity for an interview.”


In a recent column, Carter wrote: “It is easy to become confused with the private option and the marketplace, but there are some very important distinctions that Arkansans need to know.

“The private option is available to individuals making less than 138 percent of the federal poverty level. That is roughly $30,000 for a family of four and $15,414 for an individual. Premiums for the private option are paid for with federal Medicaid dollars. There is no deadline to enroll for the private option. However, you can still be penalized for not having coverage for an extended period of time.”

He said the deadline for enrollment in the marketplace exchange was March 31. The next open enrollment period will begin Nov. 15. Those looking for coverage under the exchange are being directed to www.healthcare.gov.

The marketplace exchange offers health-care plans with prices based on income and household size. The plans are available to anyone making from 138 percent to 400 percent of the federal poverty level. That is, an individual making up to $46,680 a year or a family of four making up to $95,400.

Advance tax credits are also available to help pay the cost of premiums to those who qualify.