Special Report Day 5 | The Affordable Care Act: Doctors and hospital officials don’t know how much pent-up demand for medical services will be unleashed by the Affordable Care Act in January and beyond, but they say newly insured patients shouldn’t have to deal with long lines. And officials say health care locally is changing so these patients and others will receive more efficient services.
This is the final day of a five-day series where GateHouse Media Illinois heath care reporter Dean Olsen examines the Affordable Care Act and its expected impact. This series is posted in its entirety at http://bit.ly/ACAseries. If you have questions about the ACA, email them to firstname.lastname@example.org. Olsen will round up the best questions and publish the answers in the newspaper and online in the coming days.
* Summary of the Affordable Care Act
* Online calculator to estimate premium subsidies offered through the ACA
* Enroll America
* Receive email and/or text message updates on the ACA
* County-by-county look at number of uninsured residents in Illinois (pdf)
* A look at the number of uninsured Illinois residents eligible for the ACA (pdf)
Doctors and hospital officials in the Springfield area don’t know how much pent-up demand for medical services will be unleashed by the Affordable Care Act in January and beyond, but they say newly insured patients shouldn’t have to deal with long lines.
And officials say health care locally is changing so these patients and others will receive more efficient services.
“We’re going to treat more people, but in the right setting, at the right time and at the right price — that’s the future of health care,” said Ed Curtis, president and chief executive officer of Memorial Health System.
Memorial, which operates Springfield’s Memorial Medical Center, Taylorville Memorial Hospital and Abraham Lincoln Memorial Hospital in Lincoln, is “embracing that change,” Curtis said. “We’re not fighting it. America’s health care is too expensive. It’s choking our economy.”
A planned expansion of Medicaid eligibility for Illinoisans as part of the ACA, also known as Obamacare, could provide publicly funded coverage to as many as 8,000 uninsured people in Sangamon County alone, according to Dr. Jerry Kruse, chief executive officer of SIU HealthCare.
The Illinois health-insurance exchange that is scheduled to begin enrolling people Oct. 1 could provide coverage, often with federal assistance to reduce premium costs and other out-of-pocket expenses, to another 6,000 to 10,000 county residents, Kruse said. The coverage will begin Jan. 1.
SIU HealthCare, the group practice of veteran doctors at Springfield’s Southern Illinois University School of Medicine, has been working with other health-care providers in the area to make sure this new population can be served well if and when people seek health care they may have put off for years, he said.
There may be a bump up in the overall number of visits to local doctors’ offices because of the ACA, Kruse said, but patients shouldn’t expect long waits.
“The mood in the community is one of cooperation,” he said.
Greater Medicaid acceptance?
Statewide, there will be enough family doctors to assist Illinoisans who gain coverage through the ACA over the next few years, according to the Illinois Academy of Family Physicians.
Doctor shortages will be more of a challenge later, the academy says, though critics of the ACA point out expanded insurance coverage doesn’t necessarily lead to more access to health care.
A study published in Health Affairs in August 2012 said almost one-third of office-based doctors in the United States, and 35 percent of doctors in Illinois, were unwilling to accept new Medicaid patients, largely because Medicaid payment rates tend to be lower than other forms of insurance.
The study also says, “Prior evidence suggests that physicians’ acceptance of Medicaid patients will increase as Medicaid payment rates increase.”
As part of the ACA, many primary-care doctors will qualify this year and next for Medicaid payments at Medicare levels. It’s unclear whether that temporary increase in payments will have the hoped-for result of more doctors willing to serve Medicaid patients, according to Mark Kuhn, chief administrative officer of Springfield Clinic.
“Certainly, there is a financial incentive that wasn’t there previously,” he said.
Officials from the community’s major health-care providers — including Springfield Clinic, SIU, Memorial and St. John’s Hospital — said they haven’t been hiring additional doctors, nurses and other professionals specifically to meet any expected new demand.
But they said their hiring of primary-care doctors and specialists in recent years to better serve the region and deal with the aging of the baby boom population will help with any initial surge of new patients.
“I don’t think it will be a landslide of new demand for services,” Kuhn said.
Time to boost staffing
Hospital officials said inpatient care probably won’t increase much because of the ACA.
Hospitals already are serving uninsured people who need surgery and emergency care, though the uninsured may have avoided the doctor in the past and, as a result, made their way to the hospital with more advanced diseases, officials said.
Office visits and outpatient settings are likely to experience more of an increase, they said, and patients may be better off in the long run.
Brian Reardon, spokesman for Springfield-based Hospital Sisters Health System, said the system’s network of primary-care and specialty doctors has capacity to handle an influx of patients.
Tim Eckles, vice president of community benefit, public policy and advocacy at HSHS, said there will be time — several years, probably — to boost staffing to care for patients insured through the ACA.
“They’re unlikely to all sign up in the first year, so it will take awhile for it to ramp up,” he said.
The SIU Center for Family Medicine, 520 N. Fourth St., Springfield, was certified last year as a federally qualified health center, giving it federal funding to expand its services to the uninsured and other low-income patients.
People without insurance pay a sliding fee based on income; most pay $20 per visit.
The center has room for another 3,000 to 4,000 patients, said Dr. Janet Albers, an SIU family medicine physician and chief executive of the center. The center currently serves 6,600 Medicaid recipients.
“We anticipate this to grow significantly, especially with Medicaid expansion in January 2014,” Albers said. “We will see anyone, regardless of insurance or ability to pay.”
At Springfield’s other federally qualified health center, Central Counties Health Centers, 2239 E. Cook St., CEO Craig Glover said a 12-room addition that will be built this year and next, costing $4 million to $6 million, should help to handle any additional patients.
Central Counties’ 13 doctors, two advanced-practice nurses and three dentists currently use 27 exam rooms and a $7.5 million annual budget to serve 17,000 patients each year.
Glover said it’s uncertain how the ACA will affect the organization or demand for its services.
In theory, many of the organization’s uninsured patients might qualify for Medicaid or private insurance through the Illinois Health Insurance Marketplace, he said, but they would continue to be served by Central Counties regardless.
Referrals to specialists elsewhere in the community could be easier if Central Counties patients have public or private insurance, he said. The organization currently teams up with the Sangamon County Medical Society to send uninsured patients to specialists in their offices for free visits through the CATCH program (Coordinated Access to Community Health).
Central Counties is trying to let more people know about its services, and more demand could prompt the center to expand its hours at night and on weekends, Glover said.
Central Counties also is trying to educate its patients, and be available by phone during off-hours, to help patients stay healthy and avoid unnecessary trips to the emergency room, medical director Dr. Dora Ramos said.
To ensure that people who qualify for Medicaid under the ACA’s expanded eligibility standards will be able to find a doctor, Memorial Health System in January 2013 changed the way its employed doctors are paid so doctors aren’t financially penalized for seeing more Medicaid patients.
“They’re blind to the payer status,” Curtis said. “We thought that was a way to expand access to every patient in the community. It’s consistent with our charitable mission.”
For years, the doctors employed by HSHS have been paid in a way that doesn’t reflect whether their patients are privately insured, covered by Medicaid or uninsured, Reardon said.
Officials from Memorial and St. John’s say they are involved in projects to make care both more efficient and better in response to trends in the health-care industry and “pay-for-performance” initiatives in the health-care law.
These efforts will be even more important as more patients seek care, and payments to hospitals for that care — both from Medicare and private insurance — are ratcheted down, officials said.
“We’re going to treat a lot more people, we’re going to do it while being paid substantially less, but we have to do it while delivering a higher level of quality,” Curtis said. “Reimbursement’s at an all-time high. It’s only going to keep coming down.”
Kuhn agreed, saying cost-containment efforts are being forced by insurance companies and employers.
“There’s a lot of effort being paid to appropriateness of care and utilization management,” he said.
One way the ACA is being paid for is through reductions in scheduled increases in Medicare rates.
For Memorial Medical Center, the changes will mean an estimated loss of $181.2 million in Medicare funding over a 10-year period. For St. Johns’, the estimated reduction is more than $131 million.
Whether Memorial Health System will make more money overall because of the ACA is an open question, according to Scott Kiriakos, vice president for clinical integration.
With more people insured, the system may need to spend less on charity care, he said. But the system may be paid less from Medicaid through managed-care initiatives. And other per-patient reimbursements are going down.
“There are a lot of tradeoffs,” Kiriakos said. “We don’t know where it’s going to end up on balance.”
The major health-care players in Springfield all say their services will be offered through private insurance plans in the Illinois Health Insurance Marketplace, but they worry how smoothly the insurance exchange will operate.
Insurance rates through the exchange could be more of a bargain because of the intense competition for customers, Eckles said.
Kuhn said patients and doctors may have to endure administrative headaches, at least initially.
“It’s uncharted water,” he said, “and it’s going to be bumpy.”
Dean Olsen can be reached at (217) 788-1543. Follow him at twitter.com/DeanOlsenSJR.
Affordable Care Act — early impact in Illinois
* More than 125,000 young adults in Illinois have retained or gained insurance coverage by being included on their parents’ coverage until age 26.
* The act gradually is closing the gap known as the “doughnut hole” in Medicare Part D prescription-drug coverage. About 134,000 people saved more than $95.9 million, or an average of $716 per beneficiary, in 2012 because of the law, and Medicare beneficiaries in Illinois have saved more than $235 million on prescription drugs since the law’s enactment.
* The ACA already requires many insurance plans, including self-funded plans, to provide coverage without cost sharing to enrollees for a variety of preventive services, such as screening for colon cancer, Pap smears and mammograms for women, well-child visits and flu shots.
* The law already bans insurance companies from imposing lifetime dollar limits on “essential health benefits.” The law bans annual limits beginning in 2014.
* More information is available at http://bit.ly/IllinoisACA.
Source: U.S. Department of Health and Human Services