Health care providers talk about act's impact

Affordable Care Act or not, Roosevelt General Hospital and Plains Regional Medical Center officials say they already serve the uninsured and underprivileged in Roosevelt and Curry counties.

If President Barack Obama's health care bill were to be fully enacted in 2014, officials noted the changes they would see wouldn't be in who they serve, but how they serve.

According to Hoyt Skabelund, administrator of Plains Regional in Clovis, about 10 percent of their patients do not have any form of insurance and that is not including those below 200 percent of the poverty limit.

"Our belief is, we provide care regardless of (a patient's) ability to pay," Skabelund said.

Under the individual mandate of the health care bill, their uninsured patients will be required to have some form of health care.

"(The individual mandate) will increase the number of paying patients, relieving pressure off health care providers and increasing the reimbursements issued to (providers)," Skabelund said.

He added that the bill has provided clarity for how they will operate come 2014.

"We've been waiting to find out what's our future and how to coordinate higher quality care," Skabelund said.

Skabelund highlighted other impacts Obama's health care bill will have on Plains Regional:

• Having more insured patients will prevent cost-shifting.
• Hospitals will be committed to reducing expenses and improving quality care at lower costs.
• Plains Regional will be offered financial incentives to provide quality care to Medicare beneficiaries — 1,100 in the Clovis area — while keeping costs down. Payments to hospitals can also be reduced if they don't deliver.

"Under this act there is a need for integration between health care entities that has not historically been required," Skabelund said about hospitals becoming an Accountable Care Organization (ACO). "Physicians will now have a need to integrate together to succeed."

Larry Leaming, chief executive officer of RGH, said they, too, already have systems in place to provide health care to any patient seeking their services.

"Rural communities with locally owned hospitals are a great example of how accountable care should be provided," Leaming said. "If a patient presents to the emergency room, our staff provides emergency care. When a patient sees one of our providers in the clinic, there are sliding fee schedules that can discount our fees based on financial need."

Approximately 27 percent of patients seeking care at RGH are covered by some form of commercial health insurance, according to James Ybarra, RGH business office director. This does not include Medicaid and Medicare.

Now that the law calls for expansion of eligibility for Medicaid, RGH officials aren't sure how the expansion will affect their facilities.

"Medicaid represents about 20 percent of our business here at RGH; as to how the expansion will influence the number of actual Medicaid recipients is hard to say," stated Ybarra. "I believe it will first depend on if the state of New Mexico relaxes the guidelines to qualify for Medicaid. The uninsured population county-wide would be the number to keep an eye on since this would be the population that would be potential Medicaid recipients."

Overall, Leaming sees the provisions in Obama's health care bill as helpful.

"Any program that increases health insurance coverage for people without coverage without increasing the cost of regulatory compliance would be a benefit to the hospital," Leaming said.

La Casa Family Health Center CEO Seferino Montano praises Obama's efforts to improve America's health care system. Montano says the bill will particularly help the uninsured in rural areas of New Mexico.

"We know for a fact that we have a dire shortage of primary care physicians, so the bill also enhances funding for physicians," Montano said. "We will be able to hire more physicians in rural areas, that's a plus because we need physicians desperately."

Montano added that the bill would allow La Casa to provide access to their clients at an early stage before health complications grow.

"If you provide early access you'll be able to keep people healthy and reduce the local health care costs," Montano said. "(The Affordable Care Act) is a blessing. We look forward to implementing the law to help all Americans."