New health care law pressures hospitals, doctors

By Nick Tabor, New Era Senior Staff Writer

Changes in insurance reimbursements are putting serious pressure on hospitals and doctors alike — but different kinds for each, said Eric Lee, president of Jennie Stuart Medical Center, in a presentation Thursday evening.

For Jennie Stuart, much of the pressure is competitive.

At one time it only competed with other nearby hospitals, like those in Madisonville and Clarksville, for patients. But on account of the Patient Protection and Affordable Care Act, it now competes with all the nation’s hospitals in quality measurements. If it ranks highly enough, its Medicare reimbursements don’t get docked, Lee said.

Private insurers like Anthem and Humana may eventually use a similar system for doling out reimbursements, Lee said.

Meanwhile, insurance changes and other complications may drive doctors to work for hospital corporations instead of maintaining independent businesses, Lee said. They want to free themselves from financial burdens and legal complications.

This explains Jennie Stuart’s impetus for creating the Fairview Physicians Network, its wholly owned subsidiary. The network already has several practices, and it will add three to five more doctors by the year’s end, Lee said.

It gives doctors a space to enter the company.

Lee was speaking to a small crowd at a Jennie Stuart conference room. The Christian County League of Women Voters recruited him and Dr. Thornton Bryan Jr., a retired Trigg County doctor, to give presentations on the Affordable Care Act.

It only drew a crowd of about 10. Bonnie Lynch, one of the organizers, suggested the cold temperature and reports of an oncoming storm may have kept people at home.

Bryan opened with an overview of the problems with health care in the U.S. and the changes the health care law effects.

In short, this country’s health care is dropping in quality and getting more expensive, Bryan said. It’s tilting toward profit-generating for insurance companies. By one estimate, 45,000 people die in the U.S. every year because they lack access to health care.

Nevertheless, this country’s spending on health care tops every other high-income country. It spends 18 percent of its gross domestic product on health care, an average of $8,900 a person every year, compared to $4,300 a person in the next highest country, which has universal coverage, according to a study Bryan cited.

There’s no consensus on whether the new law will successfully drive down costs. But Bryan explained some of its methods, such as forcing insurance companies to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement.

Afterward, Lee spoke briefly about how the law is affecting Jennie Stuart, then he took questions.

He focused on Kentucky’s Medicaid problems. In November 2011, the state contracted with three companies to handle Medicaid payouts to hospitals and doctors. The companies have received money from the state, but they’ve been slow to pay providers in turn, and other problems have followed.

Soon some local doctors may have to choose between retiring, leaving the state or joining hospital corporations, Lee said.

The League of Women Voters will soon meet with legislators, and Carolyn Self, a member, asked whether Lee had any advocacy requests. Lee said he wants to see the state take control of Medicaid reimbursement again.