About this series
The Affordable Care Act requires all Americans to have health care coverage. Beginning Oct. 1, they can shop on health care exchanges for insurance plans. The Times takes a look at what that change means for the average Northeast Georgia resident.
Previous stories from this series:
In all the talk about health care reform, much of the focus seems to be on insurance — questions about how Americans will pay for coverage and whether they can take advantage of tax credits to offset those costs.
But how about health care itself, the actual delivery of services from doctors and hospitals to patients?
Questions still abound for Dr. Jeff C. Reinhardt of The Longstreet Clinic’s Center for Women’s Health, including whether widening access to health care means opening a new stream of patients into health care.
“Is that going to be a significant volume? If so, where (are) all the providers coming from?” said Reinhardt, president of The Longstreet Clinic. “We already have a physician shortage.”
Other providers have questions, too, and have for months — if not longer — considered the ramifications of the Patient Protection and Affordable Care Act, which, unless Congress votes to block it, rolls out Jan. 1. The first major lead-in to the overhaul is open enrollment starting Oct. 1 at government-operated health care “marketplaces,” where Americans can shop for insurance.
Gainesville-based Northeast Georgia Health System considered coming changes as part of its strategic planning work with Kaufman, Hall & Associates Inc., an Illinois-based adviser to hospitals and health systems.
The company conducted a “new era readiness assessment,” which looks at how well prepared providers are in certain areas, such as financial strength, information systems and “cost structure management.”
“Health care providers are on the cusp of a new era, heading toward a value-driven environment in which success is achieved through successful patient outcomes related to quality and cost management across the continuum of care,” states Kaufman Hall’s website.
“We really wanted to find out where we were on the scale and how we needed to begin (addressing) goals, strategies and objectives to move us on those continuums,” said Carol Burrell, NGHS president and CEO.
“We found it to be extremely helpful. As a result of this particular tool, we’ve been able to share this with all of our constituencies: our medical staff, our directors, our board.”
Patrick Allen, senior vice president at Kaufman Hall, added, “It is just a tool. It’s a way for organizations to identify their strengths and shortcomings, and to layer on those key competencies that we think are going to be required to be successful across the changes (to come).”
The “switch from volume-based to value-based reimbursement is one of the most critical components that we see hospitals, health care providers and physicians having to grapple with. It’s a new dynamic,” Allen said.
“The new dynamic is they’re going to be paid to keep people healthy and ... if you’re keeping people healthy, that means they’re not coming to your hospitals or to the doctors as often. The revenue growth is not going to be as strong because the reimbursements are going down.”
Steve McNeilly, director of NGHS’ Health Partners Network, spoke to that issue during a Greater Hall Chamber of Commerce forum on health care reform last week at the Brenau Downtown Center.
“We’re in an environment called fee-for-service, which means if a physician or hospital bills for a service, they expect to be paid for that service,” he said.
“It doesn’t really matter if it’s an appropriate service or whether we have had three of the same services done in the same week, we get paid. And that’s flawed. There’s a lot of waste and duplication in our health care system today.”
Burrell said that “having access to consistent information is going to be vital in the future, and that’s not going to happen overnight. We’ve got some strategies in place, so we feel like we’re well positioned in (that) regard. But there’s still a lot of work.
“Overall, we’re staying focused on the basics of being as efficient as we possibly can be in this changing world.”
Mimi Collins, CEO of The Longstreet Clinic, said one major challenge ahead is grasping the full extent of the Georgia health exchange and “how do we identify individuals who have an exchange product.”
The insurance companies participating in Georgia’s exchange are Alliant Health Plan, Kaiser Foundation Health Plan, Peach State, Humana and Blue Cross and Blue Shield of Georgia.
The exchange is open for any Georgian to browse through, but the plans are designed for those outside of employer-based insurance, Medicare or Medicaid.
Tax credits are available for anyone whose income is between 1 and 4 times the federal poverty level and if the amount of the insurance premium exceeds 9.5 percent of their income. Insurance policy amounts vary according to various factors, including age and size of household.
“As far as our organization preparing for this,” Collins said, “we’ve really been looking at ... ways we can provide care in a more efficient manner, that we can focus around those preventive activities that people need.”
Dr. David Westfall, District 2 public health director, said that when health care reform is viewed through the lens of public health, “anything that improves access to basic, affordable quality health care for more people will translate into better health for the public.
“To the extent that the law is able to accomplish some of that ... it should improve the health of the public,” he said.
“One of the things that the law does is it focuses more on prevention and more on increasing resources for the broader public health discipline across the country.”
As a state employee, he added, he can’t take any position on “any of the warring political agendas that (the law) is being held hostage to.”
Funding for the Affordable Care Act is being debated as part of a federal budget bill in Congress, with the fiscal year starting Oct. 1.
The Republican-led House passed a bill last week that provides funding but strips the health care reform law. The bill moves to the Senate, where Democrats are the majority.