Facing a challenge: Hospitals in northwest Oklahoma struggle with old, new problems
By Jessica Miller, Enid News & Eagle, Okla. | |
McClatchy-Tribune Information Services |
"There's quite a struggle going on right now, and some of it's old and some of it's new,"
Physician and patient shortages
Patient volumes in
"The decline started in 2008, when we had the economic downturn," he said. "It's maintained down. I'm not sure what it is, but it's a nationwide trend that inpatient is down."
In
"It becomes another concern, and I think that's probably part of the federal government's thought process, when you look at hospitals like
A patient perception that metropolitan areas provide higher level care is probably the biggest challenge for
"You have the
One study indicated approximately 40 percent of people in rural communities will go to a metropolitan area for surgery, Herrman said.
"Which is, for us here in
Another struggle "plaguing rural America" is a physician shortage, Knak said.
"That is also becoming another crisis, (with a) change in the physician demographic as requirements in rural
"The biggest challenge that these rural hospitals face, and we're included in this, is physician recruitment," he said. "And I think everybody's having trouble recruiting physicians, particularly primary care, but specialists are the same way. It can take years to recruit a specialist into your facility and they tend to migrate to the urban areas because of quality-of-life issues, where they don't have to take calls as often.
"You look at these rural hospitals and the doctors are leaving them right and left."
Herrman agrees there is not enough primary care in northwestern
"For us, we don't really just worry about
There are some specialties that are more difficult to hire, and those usually follow national trends, Herrman noted. Gastrointestinal specialists are difficult to find, with approximately 120 graduated across the nation each year.
"That's just a difficult recruit, period. Outside of that, I would say we've been very fortunate because we have the OSU Family Practice Residency here, and that's had a tremendous impact for northwest
Waiting on promises
"With the passage of the Affordable Care Act, there were certain promises made to hospitals, including that everyone would be insured," Knak said. "In return, there was a reduction in reimbursement rates that was set up and was approved, thinking, 'well, if everyone is insured we won't have to worry about the uncompensated care.'"
Due to the rollback of the employer mandate to provide coverage, the "very rocky rollout" of the Affordable Care websites for the purchase of insurance and the failure of roughly one-half of the states to expand
"We still have, running roughly at nine percent uncompensated or bad debt," Knak said. "So if you take a look at gross revenues and write nine percent of it off the top as uncompensated care, then that was a challenge that was supposed to have been met with the rollout of the Affordable Care Act, the rollout of the expansion of
A high underinsured rate remains, he said.
"With the Affordable Care Act, a lot of the people that have accepted the exchange plans are taking high deductible plans, which are basically catastrophic illness plans. So they still have a significant out of pocket," Knak said.
There also are a lot of companies that cannot or will not provide insurance for employees, he noted.
A recent study indicated that 21 percent of
"So the Affordable Care Act really did nothing to provide increased number of insured population in our area," he said.
Herrman said probably 80 percent of those signed up for insurance provided through the Affordable Care Act were forced to go to the market due to their previous insurance policy type.
"It (has) not really had much of an impact here on our uninsured. And a lot of our uninsured here would have qualified for the
Funding cuts and other struggles
A 2 percent sequestration went into effect in 2010, Knak said.
"That has been extended," he said. "As a critical access hospital, we're set up to be paid at 101 percent of cost. So then you add the sequestration to it, which is a 2 percent reduction in the
He said the sequestration affected all
"What we see now is
Cuts to
"We're typically much higher
Some rural hospitals have even higher numbers of
"It's not uncommon for a rural hospital to be 75 percent
Six to seven percent of St. Mary's business comes from
The effect the Affordable Care Act has had on
"Not accepting the federal funds, then cutting actual
"But with them not excluding physicians, even on the last cut, here in
Herrman said there will probably be providers who will start limiting the amount of
"Because, we're basically going to get paid eight percent less to do the same work that we did the whole entire year, last year," he said.
"In the critical-access world, it's the
Rural hospitals are facing another issue with the Affordable Care Act requirement for an Electronic Health Record.
"They actually will incur penalties if they don't have it in the near future, and that can be very expensive, to acquire that technology," Tatum said.
There were decreased efficiencies in
When it was first installed, productivity was cut in half, he said.
A year and a half later, productivity is still down, and there is the added cost of the EHR and the decreased volume in patients, Knak said.
"There are benefits to the EHR, but on a patient volume and revenue side, it's not necessarily a benefit," he said.
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