Louisville Medicine Volume 63, Issue 5 | Page 7

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