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Health Care: Providers balance care, expansion with more uninsured

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Health care is one of the brighter lights in the economy, though the sector is far from immune to market pressures.

Locally, demand for services is largely undiminished, and health systems continue to invest in new medical technology and facility improvements.

Providers report the number of uninsured patients is rising along with Medicaid enrollment, stretching uncompensated care and government reimbursement dollars to the breaking point.

Health systems in the Ozarks and nationwide face both an unpredictable economy and a potential regulatory storm in health care reform.

“As Wall Street goes up and down, that affects their day’s cash on hand, it affects their investment portfolio, so in order to make plans for the future, we need a stable market and we need a stable economy,” said Eddie Marmouget, a partner in the health care practice of BKD LLP.

Reform-related talk of cutting Medicare has particularly alarmed local providers.

“For us here in Springfield, Medicare is the largest payer of insurance benefits of any segment of our population,” said Mike Peters, vice president of public affairs for St. John’s Health System. “Any time you talk about a half-a-trillion-dollar cutback in Medicare compensation over the next 10 years, it could mean a significant hit for our bottom line and our ability to provide those services. That is true in all parts of the country.”

Growing demand
Local providers report the number of uninsured patients has practically doubled in the last year, climbing with the unemployment rate which approached the 10 percent mark.

“We will average probably 700 to 800 new patients to our program each month,” said Brooks Miller, CEO of Jordan Valley Community Health Center, which serves the uninsured and those covered by public and private insurance.

Of those, about 375 will apply for Jordan Valley’s income-based sliding fee scale because they do not have private insurance, do not qualify for Medicaid and earn less than 200 percent of the federal poverty level.

“Previously, we’d bring in about 180,” Miller said. He expects the number of uninsured patients to continue to grow, along with the number of children participating in Missouri HealthNet, the state Medicaid program.

He said the center’s ability to serve sliding-fee patients is tied to seeing patients with some type of coverage, because payments from Medicaid and insurance subsidize the sliding fees. Still there are fears among the health community that Medicare and Medicaid reimbursements will decline as more people enroll in those programs.

Jobs and hiring
While health care continues to provide thousands of jobs, the hiring bonanza of recent years is over – at least for now.

“This past year we’ve been very careful in the number of jobs that we’ve added,” said Bob Bezanson, president and CEO of CoxHealth, which has 8,968 employees, according to Springfield Business Journal research.

Job scarcity in other fields has decreased turnover in health care, Bezanson said.

Peters said the situation is similar at St. John’s, which has 9,300 employees and a historically low nurse vacancy rate of about 2 percent.  

Women are playing a growing role in the health care work force.

“As the husbands lost their jobs over the last year, the female medical providers returned to work, increased their hours from part time to full time, and remained employed,” Bezanson said.

Peters noted that despite the present economic picture, health care is poised for job growth, because as baby boomers hit retirement age, providers will have to be ready to care for them.

Health care reform
The biggest impact of national health care reform so far is that it’s adding uncertainty to adversity as businesspeople wait to see whether reform will pass, said BKD’s Marmouget. If privately insured groups migrate to governmental plans, health care organizations could see their reimbursement diminish. On the other hand, if reform results in more people being covered by insurance, reimbursement could increase.

But for some businesspeople, reform talks have taken on too narrow a focus.

“The sad thing is, the whole process started talking about health care reform, and then it narrowed to the evil villain of insurance companies,” said Gordon Kinne, president of Med-Pay Inc., an independent third-party administrator. “I’m not saying (insurance is) not part of the problem, but the cost of care is what drives an insurance premium, and that’s not even in the debate right now.”

Ted Andrews, vice president of corporate health for PJC Insurance, agrees. With health insurance rates rising by double digits and deductibles climbing into the stratosphere, the chief cause of rising costs – the cost of medical care – is not being addressed in reform, he said.

What would really bring costs in line, Andrews said, is true competition.

That begins with transparency, allowing apples-to-apples comparisons of costs and outcomes for specific services.

“When you shine the public light on facts, things start changing,” he said.

In expansion mode
While the health community waits to see how reform will change the landscape, local systems are evolving and expanding to meet existing need. Jordan Valley Community Health Center moved this summer to 70,000 square feet in the L.E. Cox Building, and CoxHealth finished construction of its $21.8 million Walnut Lawn surgery center and launched a retail-based service model with megaretailer Wal-Mart Stores.

Also this summer, St. John’s opened its Jane Pitt Pediatric Cancer Center, and construction is under way for a Ronald McDonald House within the hospital walls.[[In-content Ad]]Data from the Missouri Economic Research and Information Center’s 2006–2016 Employment Projections for the Ozarks region shows expected hikes in multiple categories of health care jobs by 2016.

Ambulatory Health Care Services
2006 - 8,556
2016 - 9,857, up 15.2 percent

Nursing and Residential Care Facilities
2006 - 5,257
2016 - 6,056, up 15.2%

Social Assistance    
2006 - 2,524
2016 - 2,907, up 15.2%

Hospital Employment (private, state, local)
2006 - 15,015
2016 - 16,966, up 13%

Source: Missouri Economic Research and Information Center, Missouri Department of Economic Development


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