Hospital, clinics grappling with changes to comply with law [The Sun, Yuma, Ariz.]

Sept. 30--Editor's Note: With the next phase of the Affordable Care Act going into effect Tuesday, the Yuma Sun is taking a look at what Yuma County residents need to know.'

The local hospital and clinics have been gearing up for the Affordable Care Act since it was signed into law by President Obama in 2010.

The law has meant big changes for health care providers, with some of those changes set into motion in the last few years.

"The changes it brings to Arizona and our clinics are significant," said Amanda Aguirre, CEO and president of the Regional Center for Border Health, a nonprofit organization. She runs the San Luis Walk-in Clinic.

"There are a lot of things that have been moving since implementation," she said.

Health care providers have already been adjusting for years. For example, since 2010, young adults have been allowed to stay on their parents' plan until they turn 26 years old. The law also calls for free preventive care, such as mammograms.

Aguirre sees those changes as positive. "I believe in preventive medicine and saving money to the taxpayers."

Yuma Regional Medical Center has experienced changes as well.

"At first it was no big deal," Pat Walz, YRMC CEO, said.

But then the hospital had to turn its attention to complying with some of the law's stipulations or risk losing reimbursements. Starting in 2011, health care providers have been required to avoid unnecessary re-admissions by coordinating care for high-risk Medicare beneficiaries after they leave the hospital.

"Medicare will no longer pay for re-admissions within 31 days," Walz explained.

With 55 percent of county residents enrolled in Medicare, this can add up to millions of dollars.

"Our response was to focus on chronic illnesses -- COPD, diabetes -- all those things that won't get cured, they can get better, but they're chronic," Walz said.

To avoid high-risk patients ending up in the hospital again, YRMC established Transitional Care Services to provide care to patients with chronic diseases, such as congestive heart failure and chronic obstructive pulmonary disease.

"We set up a transition outpatient service to monitor patients and make sure they're taking their drugs, getting dietary counseling, pharmaceutical counseling. They're more likely to take their pills if they understand why they're taking them," Walz noted.

The hospital also needs to be vigilant about the potential loss of other reimbursements. For example, Medicare no longer pays for certain things, such as treatment for injuries caused by falls or bedsores that occur while hospitalized.

"All this drives down reimbursements so we had to react by focusing on those things," Walz added.

In 2012, the law established a program linking payment to quality outcomes for Medicare patients.

"They take 2-1/2 percent at the beginning of the fiscal year and we have to earn it back. It's pay for quality," Walz explained.

On the "upside," Walz noted, in 2014 everyone should have health insurance, either through Medicare or the health insurance marketplace, also called the exchange, which opens Oct. 1.

The six-month open enrollment period runs through March 31. Coverage begins as early as Jan. 1. Arizona consumers will be able to choose from an average of 106 health plans.

"In theory everyone who comes to the hospital will have insurance. So we'll be able to afford the lower reimbursements. We'll have to figure how to live with that," Walz said.

The San Luis Walk-In Clinic has also been striving to comply with the changes that affect the way it delivers primary care.

"Some have been very tough. It takes capital to comply. It's very difficult," Aguirre said.

One of the clinic's biggest investments has been a changeover to electronic medical records, something YRMC did more than a year ago.

This change has been a challenge, especially in rural areas where technology might not be as updated. And while younger physicians might be more tech-savvy, it's hard for older providers to adjust, Aguirre noted.

However, she is optimistic about the changes. "It's a win-win, but it takes work. I think in the end it will be OK."

She noted that Yuma County has one of the highest uninsured populations in the nation.

"We have one of the highest levels of poverty. The number of children living in poverty is 29 percent in Yuma County. It's 22 percent nationwide," Aguirre said. "We had the third highest percentage of children impacted by foreclosures in 2007. People who filed bankruptcy, the No. 1 reason is debt and medical bills. That tells you the catastrophic effect on a family when someone doesn't have insurance.

"Many ended up in the ER, and we only have one hospital that is taking all the hit," she added.

RCFBH and the San Luis Walk-in Clinic are part of Cover Arizona, a coalition of nonprofit organizations conducting outreach and enrollment assistance for Medicaid and the Marketplace.

Aguirre invites residents to reach out to RCFBH for assistance or information.

Walz suggests people fully investigate the law before forming an opinion. He recognized that some people -- in particular, business owners --don't like it "for justifiable reasons. They're being told how to run their business and what to provide to their employees."

However, he added, "they should make sure to get all information before deciding whether they like it or not."

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