PMC Prepares for ACA in 2014

John Leavitt, President of The Colorado Network, a health care firm representing rural hospitals in western and southern Colorado, presented the Prowers Medical Center board of directors with an overview of the impact the approaching HealthCare reforms will have on rural hospitals.  Leavitt said the emphasis on the new medical directives will center on areas such as chronic disease management for:  diabetes, asthma, chronic heart failure, low back pain, chronic obstructive pulmonary disease and in a close sixth position, oncology for cancer treatments.  He added that the 20% of patients who account for use of a hospital’s 80% of resources and payment of bills will climb to a 10%/90% ratio.  Leavitt added that medical care facilities will see the amount of paperwork steadily climb with additional reporting expected on quality of care.  

“Reimbursement will begin to fall on outcome of treatment instead of the volume of work done in treating patients,” he predicted.  Rural hospitals will have a more difficult time generating percentages of treatment through lack of patients, compared to a metro facility which handles larger patient flows.  He said patient numbers will begin to grow with the level of new Medicaid patients being signed up across the country.  Leavitt said Colorado will see 225,000 new Medicaid registrations and nationwide the number is expected to reach 37 million.  “Fees or taxes or whatever you term them, are being collected now to be able to pay off the added costs of future medical care under the new system,” he said. 

“Insurance claims will see a significant alteration by the start of January 2014,” he told the board members.  Starting with the Medicaid sign-ups and the advent of Health Insurance Exchanges, the means by which persons can purchase medical insurance coverage, more people will have medical coverage.  Pre-existing conditions will no longer eliminate a person from having medical insurance.  “You may have stage 3 cancer and you’re still going to be able to sign up for medical insurance beginning next year,” he explained, adding that the premium payments will reflect your health status at the time.  He said the Exchange should be ready for operation by October of this year. 

Leavitt said statistics indicate about 10-15% of the local population is without insurance.  Next year, under the new health guidelines, businesses with fewer than 50 employees will have an option of either providing health care for their workers, or make payments to them so they can purchase their own coverage.  He said that will grow to groups of 100 employees by 2016.  The Health Insurance Exchanges will allow for online insurance purchases, Leavitt added, stating, “Mostly uninformed insurance shoppers will purchase their coverage based almost solely on the price of premiums.”  Leavitt said he expected that there will be good news along with the bad in the approaching changes, anticipating a leveling of premium costs on a national level.  “The old will pay less for their premiums and the young will pay a little more.  The same will happen with men and women, as studies show woman, as a rule, require more health needs throughout their lifetime,” he added. 

The Prowers Medical Center board approved a resolution to seek a Dola grant to pursue a study of HVAC improvements at the hospital as outlined in earlier meetings by Kevin Taylor and Gary Berngard, representatives of Honeywell Business Solutions.  The hospital site planning committee met with Taylor and Berngard as well as representatives from CPI, who presented a strategic expansion plan for the hospital facilities in 5 stages.  If adopted, the project should extend through May, 2016. 

As PMC continues to update procedures for its accreditation process, six policies were approved for adoption by the board, relating to various medical procedures, holiday pay and paid time off.  Two policies were removed and one was tabled for future discussion. 

Physician recruitment is an on-going process for Prowers Medical Center.  It was announced that Dr. James Smith will begin his employment as a general surgeon at the hospital beginning the end of May.  CEO Craig Loveless said the search is focusing on a family practice doctor as well as a family nurse practitioner. 

Karen Bryant, hospital COO, said an agreement for patient overflow in times of disaster was discussed for the hospital’s emergency preparedness plans.  The Lamar Community Building will serve as the second site for overflow patients and the Wellness Center at Lamar Community College will become the third back-up and would be able to utilize the nursing staff on site from High Plains Community Health Center.  Bryant also reviewed the April Healthy Places survey and interview process that will be held in Lamar the week of April 21.  The community is in line for a $1million grant to provide and upgrade infrastructure in Lamar to help offset growing obesity trends in southeast Colorado. 

Frederick Esgar, longtime Wiley businessman, approached the PMC board, requesting a meeting date so board member and Wiley representatives can meet to discuss the close of the Wiley Health Clinic, set for April 5.

By Russ Baldwin


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