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Tommy Hobbs (right) and Robert Chaffin, chief executive officers for Illinois Valley Community Hospital and OSF St. Elizabeth Medical Center, respectively, speak about upcoming health care changes. Hospital executives agree that Affordable Care Act poses big changes in the U.S. health care system but emphasized the changes will happen gradually and won’t shake the world the moment the program takes effect Jan. 1, 2014.
Photo for the NewsTribune/Genna Ord
Yes, you can still sue
If your surgery is covered by an insurance plan purchased on an exchange and things go awry on the operating table, can you still sue? The answer is “yes.” Anthony Raccuglia, a medical malpractice lawyer in Peru, said he’s studied the Patient Protection and Affordable Care Act and didn’t see anything that precludes or limits a patient’s right to recover damages in a court of law. “There are no limits on damages. There are no changes in the rules that require you to do certain things to get into the (legal) system. Everything we have today in Illinois is the same as it was before Obamacare,” he said. But Raccuglia said he does see a change coming to the courts once the ACA is implemented: More lawsuits. As doctors and hospitals have anticipated and responded to the ACA, more facilities are entrusting routine medical procedures to nurses and, especially, physician’s assistants. While these ancillary professionals can provide routine medical services, there is a chance that they might fail to diagnose a problem that a fully-trained physician might catch. Raccuglia is representing a family that was bereaved because of such a situation. A woman with a blood condition was scheduled for surgery, and a physician’s assistant made the decision to pull her off an anti-clotting drug prior to surgery. The patient died from a blood clot. Whether that was the right or wrong call is for a jury to decide; but Raccuglia holds out the proposition it should have been the doctor, and not the physician’s assistant, who made the call. He said he anticipates more such cases in the future. “The trend has been that hospitals have been buying doctor’s practices,” Raccuglia said. “Now, instead of your family doctor coming to see you, the hospitalists are coming in and deciding your care. I think what’s going to happen is there’s going to be less specialized care for the patient, which could result in inadequate treatment, and a consequence of that could be medical negligence. “I’m not in any way attempting to demean physician’s assistants,” he emphasized, “but they’re not doctors.”
Remember Y2K? In the months leading up to Jan. 1, 2000, the mass media warned of widespread computer failure and predicted disaster. Nuclear missiles would launch. Banks would fail. Jets would disappear from radar screens. Yet, nothing happened. And to hear hospital executives tell it, nothing much will happen at the stroke of midnight on Jan. 1, 2014, when the Patient Protection and Affordable Care Act takes effect. The Affordable Care Act makes bold promises: Health care for the needy, lower prices through a government-regulated market and improved quality. But as the new law slowly trickles into existence, many are only now discovering its impact. Plenty of changes are coming, but nearly all will happen gradually. The number of first-time insured patients will not, for example, jump overnight; hospital officials expect newcomers to trickle in — and likely in numbers smaller than predicted. Rex Conger, president and chief executive officer of Perry Memorial Hospital in Princeton, said Americans are likely in for a slow awakening as to how the ACA is going to work, thanks to poor communication of “a very complicated product” that is bound to surprise and disappoint those who enroll. “I believe Jan. 1 will come and go and not much will change,” Conger said. “It is my perception that it will take another year, at least, before individuals begin to understand what is required, what is available, and what it might mean to them personally.” Local hospital executives also say the ACA is, at one level, just another regulatory hurdle to which they must adapt. Since the arrival of Medicare in the 1960s, the U.S. healthcare industry has been inching toward universal health coverage. Healthcare providers aren’t sure whether Obamacare will work; but its arrival didn’t catch anybody napping. “We’ve always known this was coming,” said Bob Chaffin, chief executive officer for OSF Saint Elizabeth Medical Center in Ottawa. “We’ve been preparing for health care reform before there was health care reform,” agreed Tommy Hobbs, chief executive officer for Illinois Valley Community Hospital in Peru. “I don’t know that I could have projected the ACA the way it is,” he said, “but from the standpoint of knowing that we needed to get more efficient and couldn’t continue just the way it is? We’ve known that for years.” And once a few rules and numbers are firmly in hand, local health care providers will have a better idea of how it’s going to work for the minority of Americans who have no insurance. For the majority who enjoy coverage now, the ACA will have little or no direct impact — at least in the initial months. Healthcare providers are waiting for Washington to hammer out policies governing the implementation of the ACA. Hospitals also are awaiting the arrival of online registries for the healthcare exchanges through which the uninsured will acquire coverage or face penalties. The other burning question is how many uninsured there are in North Central Illinois. Though Illinois has anywhere from 1 million to 1.7 million uninsured, the local number of uninsured has proven to be elusive. “I’ve been looking for (that figure) for six months and I really haven’t been able to identify what we should expect,” Hobbs said. “We anticipate additional people coming to see primary care providers, but estimating how many? I can’t do it at this point.” Here’s what healthcare executives think may occur:
The ACA might not attract the number of uninsured the Obama administration will have hoped for On paper, the ACA should attract plenty of young, uninsured people who are in good health — and their care will offset the higher costs of treating the underprivileged with chronic health problems. In reality, however, there is a concern that young, uninsured persons are less likely to enroll in an exchange, preferring to pay the penalty, forgo insurance and roll the dice. If they don’t enroll in sufficient numbers, cost projections go out the window and the program will be harder to fund. “All the pricing is predicated on a cross-section of the population joining these health exchanges,” Chaffin said. “If you only get the sick ones coming in, then you’re talking about a lot higher costs per capita.”
Doctors will spend more time with the chronically ill Youth participation in healthcare exchanges might be low; but older patients with chronic health problems will participate and keep doctors offices filled. “Most of the people coming on are likely going to be those who haven’t seen a physician in several years and who have multiple issues going on,” Hobbs said. “Those people will be extremely sick and it will take a long time for doctors to get their history. “Their treatments will require a significant amount of face time with physicians, which is a good thing,” he said, “but nevertheless, it will slow the ability to see other patients.”
Illinois’ fiscal woes will complicate implementation of the ACA Conger said about half the nation’s uninsured can enroll in the exchanges while the other half will be eligible for expanded Medicaid coverage. Illinois, however, has a poor track record not only with Medicaid reimbursement — Perry gets back just 16 cents on the dollar — but also with ferreting out recipients who shouldn’t have been enrolled in the first place. One study showed half of recipients weren’t eligible. “That means that the money spent on Medicaid in the past was wrongly inflated and has been a waste of the state’s money, which the state did not have,” Conger said. “Combine Illinois’ problems with the problems being created at the national level and this mess is going to take years to fix.” And Illinois is markedly worse off than some Midwestern states. Conger noted that Wisconsin once was in similarly dire straits, but was able to achieve a surplus and right its fiscal ship. “So, yes, our neighbors are in much better shape to implement the ACA,” Conger said.
Businesses may let employees enroll in exchanges rather than extend private coverage Ideally, employees with employer-sponsored health coverage will keep it and only those currently uninsured with gravitate to the exchanges. In practice, however, many small businesses will find it cheaper to pay the penalty rather than to extend private coverage. Employer mandates don’t kick in until 2015, meaning there will be no onslaught of workers suddenly dumped from private insurance rosters by their employers in the coming months. Tim Muntz, president and chief executive officer of St. Margaret’s Hospital in Spring Valley, said 2014 is shaping up to be a wait-and-see period in which employers will monitor how ACA is implemented before deciding how to manage their employee’s insurance needs. “We’ll have this ‘trying on’ period when we’ll see how it’s going to work,” Muntz said. Nevertheless, the possibility of privately-insured people transferring to the exchanges has hospital officials watching with some concern. “We probably will see some small employers who’d rather pay the fine and stop providing insurance and let their folks go to the exchange because the fine is not nearly as expensive as health insurance costs,” Chaffin said.
Enrollment could be low and slow, with many Americans missing the window in 2014 Open enrollment starts Oct. 1 and coverage starts as early as Jan. 1, 2014. There also is a warning that the open enrollment ends March 31, 2014. “I believe that the ‘open enrollment’ period has been very poorly communicated,” Conger said. “Folks who are waiting for their tax refund to seek coverage for themselves will be very irritated to find out that they have to wait for the next open enrollment.”
Hospitals will add payroll, but not necessarily to hire more caregivers More regulation means more paperwork, and some executives anticipate having to bring on clerical workers and legal professionals to deal with the red tape sure to come. More jobs sounds good, but the added payroll could mean less money available to hire doctors, nurses and technicians to treat the increasing volume of patients.
The patient experience will not change, at least not in the short term Muntz said any concerns that patients will be treated differently in the ACA era are completely misplaced. Hospitals will continue to extend care to whoever needs it, irrespective of who is underwriting their medical care. “We’re here to take care of whoever arrives,” Muntz said. Hospital executives shook their heads when asked about reports that patients can brace for invasive, government-mandated questions from care providers such as the number of their sexual partners. Though all had heard news reports suggesting radical changes in registration data, none of the hospitals has been instructed to so alter its data-collection protocols. But Muntz said he wouldn’t dismiss the possibility that reporting protocols might someday change. The medical industry has been moving toward transferring patient records from paper to electronic formats and the emerging technology would allow for the collection of new, unprecedented data. The paper-to-digital transition was happening, anyway; the convergence of this transition with the arrival of the ACA means changes could happen.
The ACA could compound a shortage of available doctors Conger said western Bureau County is among the areas with a limited number of physicians who can reasonably absorb additional patients. Now, the ACA will pump 800,000 new Medicaid patients into doctors’ offices — and this at a time when falling Medicaid reimbursements have spurred physicians into closing or consolidating their practices. “In this part of the state, I see the issue as one where a previously uninsured, new patient may now have Medicaid where before they had nothing,” Conger said, “but this still will not help them get an appointment in a physician’s office. Those patients will be in the same position they were in before: Being seen in the emergency departments.” *** Despite these concerns, executives say many variables remain in play, and predictions of how the ACA will play out are premature. The media are full of alternatively alarmist and rosy portrayals of the ACA — and both scenarios likely are wrong. Chaffin noted the ACA eliminates rules that once kept patients with pre-existing conditions from getting coverage — a welcome reversal for patients and healthcare providers alike. And while the ACA adds more regulatory burdens and financial pressure, the healthcare industry is hardly unaccustomed to either. Hospitals have wrestled for years with rising mandates and declining reimbursements while the federal sequestration and Illinois’ well-documented fiscal woes have limited cash flow. “The reality is everybody wants the right to health care,” Chaffin said. “Is that a bad thing? I don’t think it is. But at the same time, it has to be paid for one way or another and there are a lot of hard choices out there that remain to be made.” Tomorrow: Senior citizen impact
Posted: Tuesday, September 24, 2013
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I have a question that I would like to hear an answer to. There are parts of this law, and make no mistake, it is the law that are in effect right now. This law has been sued six ways from Sunday and has gone to the highest courts in the land and has been deemed to be legal. That being said a few things have happened in the last three years. Health care premiums have gone up and the increase has been largely blamed on ACA. Co have cut hrs. and personnel. These acts, too have been blamed on ACA. Older doctors have left practice or have cut back on hrs. MANY SEN. have blamed ACA and shout that Obama said you can keep your doctor and he lied to you. Well people get older and get sick and cut back to enjoy some things they never got to do. Some sen.. are crying peoples ins. plans have changed when we were promised that we could keep the plans we had. Well, com. shop for best prices so as to get the most bang for their buck. I am an old man and it has always been so , companies come and go . New doctor are made and some retire and some, well , they die. So all this being said, if, Obama care is done away with, written out of law. Gone. If that happens, will premiums go back to 2007 costs? Will all people get their jobs back? Will all workers get their hrs. back? Will doctors come out of retirement and take patients back? Will companies who went out of buss. come back and hire workers back? Will all these things come to pass with the repeal of Obama care? Some one out there in la la land please answer these questions for me, please. Oh, and those of you who have gotten a health service under the ACA in the past three years, will you now have to reimburse the cost of that service? Some have you know? These are some of the things I wonder about. One more question if you please, Why now, less than a week before the main body of this bill begins to take effect, why now after parts of this bill have been going into effect over the last three years, why now does a reporter think that after the train has boarded ind is pulling out of the station that this would be a good time to disturb the hornets nest stir things up so to speak. Where were you for the last three years. Why were you not reporting on the good things that have been taking place because of this bill, like no pre existing cond. adult children can remain on your plan for a few more years, free to you, same costs for the girls in your fam. And the bad, like the long waits you now have getting to see your doctor, if you can get to see him or her. Oh wait, that has not happened for me, for you? At any rate, why now?
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