July 25, 2013
The federal health-reform law will improve health care and help make Kentuckians healthier, though some will be inconvenienced, officials of Kentucky’s leading hospitals and the Humana Inc. insurance company said Tuesday at the Kentucky Chamber of Commerce’s annual Business Summit.
“We have the ability to move the needle, and we will move the needle,” Kentucky One Health CEO Ruth Brinkley said after citing the state’s dismal health statistics. She was one of four hospital chiefs on a panel that concluded the meeting in Louisville.
Dr. Michael Karpf, head of UK HealthCare, said “More people will be insured, we’ll do things better and we’ll focus on the right things… .You’ve just got to buckle up for the ride.”
Norton Healthcare President and CEO Stephen Williams said Kentucky has some of the best health care in a nation that has the best health care in the world, but the state’s health status is low and the U.S. ranks only in the middle among industrialized nations, though it pays more for health care than any other country. A fundamental reason for the state’s poor health, he said, is lack of access to health care.
At an earlier session, in response to a question about the Patient Protection and Affordable Care Act, Humana President and CEO Michael Broussard said, “Having access and people covered is the right thing to do. When people have the ability to go get health care, they’re going to be healthier.”
Brinkley there are some things in the law that she does not like, but she didn’t name them, and said her organization was “very encouraged” by Gov. Steve Beshear’s expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level. “It will offer an accessible system to the people who need it most,” she said, adding, “None of us will do well if the vulnerable remain vulnerable.”
While no one on the panel or the audience raised the prospect that the law would be repealed, as House Republicans have voted to do dozens of times, there were no suggestions that repeal is a possibility. Broussard said of the law, “It’s here to stay.”
Earlier, he said implementation of the law “will create some disruptions” but also “some really neat changes,” as the country changes to a true “health care” system, from the current “sick care.”
The reform law is making hospitals change their approach from a fee-for-service system, which rewards them for more and longer admissions and procedures, “to something that rewards outcomes,” Karpf said.
“We are paid to do the wrong things,” Williams said. The current system “basically rewards more volume, whether it’s needed or not… .We’re volume-based rather than value-based,” which the new system is supposed to be.
Hospitals have not been at the forefront of helping people be healthier and avoid hospital stays, but need to do more of that, said Steve Hanson, CEO of Baptist Health. “It’s the right thing to do.” He said one his company’s stated missions is to enhance health, “which we don’t talk nearly enough about, and we do even less.”
Brinkley said she worries that there won’t be enough health-care providers to handle the people who are joining the health-care system, but she said the law will decrease use of hospital emergency rooms, and “that will be good for all of us.”
“We have got to keep people out of our emergency departments,” said Hanson, whose company owns or manages 10 Kentucky hospitals. “That’s the most expensive place … and it’s still not the best care.”
Hanson said President Obama’s delay of the employer mandate (actually the requirement for employers to report on their health insurance to the Internal Revenue Service) would not be the last delay in the implementation process, because the law is so complex. Brinkley said she would not be surprised to see other parts delayed.
Among patients, “There will be some disappointments and concerns,” Karpf predicted, noting that some won’t be able to keep their doctor if he or she is not in the network of the health plan they choose, contrary to promises made by the law’s advocates. “Once you sign up for a plan you may not have much of a choice of a doctor.”
Also, Karpf said, the process of buying insurance through the online exchanges may be daunting for people who have never bought a health-insurance policy. For example, he said, they may not realize that they are buying a policy with high deductibles.
And, agreeing with some of the law’s critics, Karpf said many people may lose their employer-provided insurance because their employers will choose to drop coverage for employees and pay the relatively modest penalty for not insuring them.
Broussard said the implementation problems will work themselves out, but “We’ll be talking about this for the next decade.”