Facing challenges never seen before

Posted 11/24/15

“I personally think that right now is some of the biggest and largest amount of change to happen in health care at one time,” said Eric Boley, executive director of the Wyoming Hospital Association.

Boley recently explained several federal …

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Facing challenges never seen before

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By its nature, the world of medicine is a complicated one. Now, because of government involvement, red tape has made providing health care far more complicated than ever before.

“I personally think that right now is some of the biggest and largest amount of change to happen in health care at one time,” said Eric Boley, executive director of the Wyoming Hospital Association.

Boley recently explained several federal requirements and their effects on hospitals in the state. Those include electronic medical records requirements and health information exchanges; new, more complicated medical diagnosis codes; additional changes under the Affordable Care Act; and all the effects those changes have on the health care system.

“It’s easy to sit back and think, ‘Well, they’re just boo-hooing,’” Boley said. “But I think once people realize what’s being thrown out there, they’ll realize the challenges and the difficulty that our health care providers are up against.”

Electronic medical records

Several years ago, the federal government began requiring doctors and hospitals to convert from paper records to electronic medical records, also known as health information systems. 

“Each physician is required to use that system,” Boley said. “The physician’s office electronic health record is supposed to ‘talk’ to the hospital record. On top of that, those are supposed to talk to every other health record. If you leave Powell Valley, Salt Lake should be able to look at your records.”

While that is a worthy goal, reality is proving more challenging, Boley said.

Different health information companies produce different electronic medical systems, and those systems often don’t communicate well.

“Hospitals are spending millions and millions of dollars, and so are physicians, trying to get systems to talk to each other,” he said. “There aren’t interfaces, and that’s a huge problem.”

To help solve that problem, each state is supposed to have a Health Information Exchange, a big information system that houses records for the entire state. Then that health information exchange should talk to health information exchanges in other states, he said.

Again, that sounds good, but reality is quite different: Wyoming, along with several other states, including Montana, South Dakota and Idaho, don’t have Health Information Exchanges.

“(Wyoming) is working on one,” he said. “They have done studies, and consultants have made recommendations. (But) sustainability is a real problem for our state; the expense is almost unaffordable.”

Meaningful use

In addition to imposing the electronic medical records mandate, the government also established a timeline for compliance, with specified requirements for different stages of “meaningful use.” Health providers that meet those requirements by the specified deadlines receive a one-time bonus; those that don’t, eventually face a lower rate of reimbursement for medicare charges.

“I think just about everyone is being able to meet stage 1,” Boley said, but many are struggling to comply with stage 2 requirements.

“We’re halfway through the time when you can prove stage 2 meaningful use, but now the feds are fighting with each other to figure out what the rules should be. They realized the rules (already in place) were too strict. On top of that, they already have proposed rules for stage 3,” but some say those should be delayed, he said.

“Meaningful use came through the High Tech Act and has nothing to do with the Affordable Care Act,” Boley said. “On top of that, you have the ACA, also a huge moving target. (It’s) almost impossible to keep track of everything you’re supposed to do as providers of health care.”

New diagnosis codes

In addition to those challenges, the diagnosis codes used by healthcare providers changed in October to a new, 10-digit format. The new format, required for all medical bills sent to Medicare, is much more detailed and includes exponentially more diagnosis codes. “That’s a huge issue,” Boley said last month. At that point, he said, no one knew what impact it would have on doctors or hospitals.

“It could seriously hurt our hospitals if they haven’t prepared, or if they are not able to submit claims the way the feds want paperwork submitted. They will have claims helped and won’t be able to be paid, and that would create a cashflow problem. ... I think there are a lot of people on pins and needles now waiting to see how that’s all going to go.”

ACA increasing costs

Under the Affordable Care Act, companies that offer health insurance have had to come up with similar plans, Boley said.

“Those plans that are offered on the insurance exchange all have to be competitive,” he said. “All commercial carriers are adjusting so they’re offering similar plans ... and they have much higher deductibles.”

When people’s deductibles are higher, “either they don’t go to get preventative care, or they’re waiting until they’re really, really sick. Their episode of care is longer and more difficult.”

While some of the provisions under the ACA are good — such as allowing people with pre-existing conditions to purchase insurance and providing coverage for college students under their parents’ plans — they also increase the cost of insurance and the cost of coverage.  Some insurance co-ops, including WINhealth, Wyoming’s second-largest insurance company, have announced they will shut down. WINhealth was one of two health insurance providers in Wyoming that participated in the federal health care exchange program.

The health care industry is feeling impacts from both sides — in addition to pressures the act places on providers, it places financial pressures on hospitals in the form of higher insurance costs for their employees.

“There are so many negative parts that weren’t really thought out and vetted before it went into effect,” he said. “I think we’re just going to be seeing more and more problems as we get further down the road. ... It’s tough. A lot of people are really struggling to figure out how we’re supposed to do all this, how we’re supposed to meet all the regulations, how we’re supposed to deliver the care when it’s so difficult.

“There’s a lot of concern,” he added. “We’ve seen hospitals in the country that have already closed, and a lot has to do with their inability to survive with all the pressures and changes. We haven’t seen any in Wyoming yet, but I worry.”

But Boley, a former administrator for the hospital in Kemmerer, said that worry is offset somewhat by the strength and ingenuity of Wyoming’s hospitals and their leaders, and the challenges he’s seen them survive.

“I’m always impressed with how we’ve been able to adapt and our hospitals are able to stay solvent,” he said. “It’s going to take a lot of work ... a lot of good choices. But I have confidence in them.

“They’ll find ways through it, I hope. I am worried, but we’ve got some great people in our state.”

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