From the
PRESIDENT
ROBERT “BOB” H. COUCH, MD, MBA
GLMS President | [email protected]
ONE VOICE
T
he Kentucky Medical Association
Annual Meeting ended August with
a new format and time. Attending
the meeting gave me pause to contemplate
the impact that organizations like GLMS
and KMA have on the practice of medicine.
The heart of what we do as physicians is
being assaulted, or at least altered, on many
fronts. We are seeing the impact of health
care consolidation through the employment
of a majority of physicians. The shrinking
number of health insurance companies,
along with reduced market competition and
patients’ choices, will make these companies
even more powerful.
We simply cannot let hospital systems
and insurance companies become the voice
of medicine. While competing interests are
consolidating power, we must find our own
voice.
We’ve already seen tremendous changes
in health care in Kentucky. Like it or not,
the Affordable Care Act has provided health
insurance coverage to a majority of people
in the Commonwealth. Unfortunately, it
hasn’t brought health care. In my practice,
I’ve seen dramatic increases in patients seeking emergency care – not because of a wave
of disease, but rather a wave of patients with
health insurance without a personal health
care provider.
Health care costs are rising, while payments are in peril.
Our citizens will see a balloon payment
due in 2017 for expanding health care coverage. At the same time, the state is facing
another budget predicament – funding
public pension plans, including those for
state employees and teachers. These two
liabilities don’t bode well for maintaining
funding levels for current programs such
as physician reimbursement for Medicaid
payments. I already pity the next governor.
It’s vital for physicians to have a voice in
Frankfort and Washington as these chang-
es impact our practices. As funding cuts
loom, we need to make sure that our voices
are heard. What I fear is the return of the
provider tax, which was a bad idea the first
time around and even worse now.
In 1993, during the second of three special sessions, Gov. Brereton Jones convened
the General Assembly to consider ways to
offset the higher costs of health care. Their
answer was to force health care providers
to pay a tax to allow them to continue their
practice.
In years past, the provider tax was justified by saying tax would go towards
matching federal dollars that would allow
for increased reimbursement among providers, providing for an effective “refund”
of the tax (but only if you were a Medicaid
provider and saw a significant number of
Medicaid patients). I have no realistic hope
of increased revenues in the near future.
Instead, I see a potential provider tax as
a way to maintain reimbursements with
net healthcare reimbursements suffering
as a result.
Hospitals will certainly feel the brunt of
reimbursement challenges in the coming
years. The Kentucky Hospital Association,
in a white paper earlier this year, predicted
that hospitals would see a $7 billion cut in
revenues by 2024.
As a result of the ACA, over 400,000
Kentuckians who previously did not have
health care were enrolled in some type of
plan. About 75 percent were enrolled in
Medicaid plans, and the remaining 25 percent joined Kynect plans. While the promise
of fewer medically indigent patients was
received favorably, the economic reality is
that hospitals are seeing reimbursements
being reduced on multiple fronts, such as
lower disproportionate share payments for
uninsured care and penalties for 30-day
readmissions and hospital-acquired conditions. Sequestration cuts further reduce
payments.
The net result is that we who work in
medicine are facing a dire financial predicament. We are facing a crisis in health care,
one more serious than we have seen in decades. Many hospitals are barely squeezing
by, keeping their doors open through cuts
in services and layoffs. Rural hospitals are
especially in peril, and a number of them are
predicted to close. Our efforts to increase
health care have certainly had their share
of unintended consequences.
What’s the answer to this looming quagmire? It’s essential that we physicians speak
with a common voice. Our individual specialties have influence, but our best opportunities arise from a cohesive front. We as
individual physicians are certainly opinionated, but a lone voice in the wilderness isn’t
heard by very many. Organized medicine
gives us the chance to speak co