Wednesday, November 12, 2014YOUNGSTOWN, Ohio -- Hospitals in the region report that the Affordable Care Act is having a healthy effect on the community. Health-care professionals cite the rising number of patients with private insurance or expanded benefits under federal programs such as Medicaid.
“Overall, I think the Affordable Care Act has been positive to the community,” says Matthew Love, senior vice president and chief financial officer at Mercy Health, formerly Humility of Mary Health Partners.
Since the act took effect last year, the number of those insured through an expanded Medicaid program has increased and the hospital system’s charitable care expenses are down, he explains.
“For us specifically, we’re seeing good changes in payer mix,” Love says. “Charity care is down a little bit, but that’s offset in part by some of the losses on Medicaid,” he adds.
Medicaid doesn’t completely cover the cost of medical care and, under the new law, penalties are assessed for readmissions within 30 days, Love notes. That means if a patient is treated at a hospital and readmitted for any reason within 30 days, that hospital is penalized.
However, the ACA hasn’t affected the primary objective of HMHP, he emphasizes. “The good news is it really doesn’t impact of our overall mission – that hasn’t changed.”
Federal law sets the maximum readmissions penalty at 3%, and Mercy’s three area hospitals -- St. Elizabeth Health Center in Youngstown, St. Elizabeth Boardman Health Center, and St. Joseph Health Center in Warren -- could expect penalties during fiscal 2015.
Penalties are based on readmissions during the previous fiscal year.
According to federal Medicaid reimbursement records, St. Elizabeth’s Youngstown campus would be assessed a 0.61% penalty in fiscal 2015, St. Elizabeth Boardman 0.57%, and St. Joseph 0.26%.
Northside Medical Center, Youngstown, and Trumbull Memorial Hospital, Warren, operated by ValleyCare Health System of Ohio, saw assessments of 1.72% and 1.33% respectively. Salem Regional Medical Center will incur no penalties in fiscal 2015, according to records.
Love says Mercy's area hospitals have seen an increase in the number of insured patients and a rise in clinic volumes in its emergency departments. “Our ED [emergency department] volumes are up overall about 5%, so we’re going to hit over 200,000 visits by the end of this year.”
It’s more difficult to ascertain just how many patients today are receiving preventive treatment before they reach the point where they are admitted into emergency care, he says.
“What we’ve tried to do as an organization is to provide access through clinics and other access averse to the ED,” Love says, which is the most expensive place to provide care. “We’ve seen increases in all of those services, through clinics, outpatient visits as well as folks showing up in the ED.”
Most health-care systems in Ohio, including Mercy, have supported the ACA and in the last year also have seen improvements. “When we look across the state, most health-care organizations view the ACA as having a positive impact,” Love says.
As such, hospital systems in the region are actively hosting educational programs that boost enrollment through the health insurance marketplace.
Sharon Regional Health System, for example, announced Nov. 6 that it plans to conduct informational sessions to help those uninsured or underinsured find insurance.
“As a primary health provider in the Shenango Valley, we want to help residents in an easy-to-understand way,” says Amy C. Smith, interim CEO of Sharon Regional. “During the next few months, we’ll be helping to educate consumers, hosting in-hospital events, and meeting one-on-one to help these individuals find affordable coverage.”
Similarly, ValleyCare Halth System of Ohio, like Sharon Regional a unit of Community Health Systems of Tennessee, also will conduct informational sessions through the November.
George Morris, president of Morris Financial Inc., Salem, says that generally two subsets of the population benefit from the ACA: those who couldn’t get insurance before because of a pre-existing condition, and low-income individuals and families who qualify for subsidies.
“For individuals, it helps those who didn’t have coverage before,” Morris notes. “That’s one of the successes of the ACA.”
But the law fails for most Americans, Morris emphasizes, because contrary to what the Obama Administration says, the law hasn’t reduced costs at all. “There is no savings,” Morris posits.
Group-plan rates have skyrocketed, Morris reports, citing figures that compare group plans’ latest increases to ACA premiums.
One client, he says, saw its current plan rise just 5%. Under the ACA, that plan would have soared 34%.
“At this point, most people should see that this is not working,” Morris says. “The ACA is not going away, but it needs to be fixed.”
Under the ACA, most U.S. citizens were required to purchase health insurance beginning this year or face tax penalties ranging from $162 per child to $325 per adult.
Ten million uninsured individuals across the country have enrolled in a marketplace plan, but another 30 million remain uninsured. The next open enrollment period begins Nov. 15 and closes Feb. 15, 2015.
Other organizations such as Access Health Mahoning Valley have developed outreach efforts with area hospitals to help consumers navigate the sea of plans, determine the one that suits them best and enroll, says Bill Adams, Access director.
“We’re looking at three events with HMHP,” he says. The enrollment events – scheduled for Nov. 15 at St. Joseph in Warren, Nov. 19 at St. Elizabeth in Youngstown, and Nov. 22 at St. Elizabeth in Boardman – are designed to help those without insurance understand the law.
During the last open enrollment period – Nov. 15 2013, to March 31 – Access Health Mahoning Valley directly signed 1,000 people who lacked insurance on the exchange. “We tried to educate people, and between our two staff members, we enrolled about 1,000 onto the exchange,” Adams says.
More than half are low-income, he notes, but the organization was instrumental in helping those with a mid-level income enroll as well.
According to Enroll America, a national organization that helps educate individuals about the ACA and tracks its progress, the number of uninsured in Mahoning County dropped to 11% from 18%, a 7% difference. In Trumbull County, the number fell to 10% from 17%, also a 7% drop.
“That’s substantial in one year,” Adams says. “In both cases, we were above the statewide average.”
Adams estimates that 20,000 residents of the Mahoning Valley region have signed up for health insurance under the ACA.
Those without insurance and who earn more than the state threshold for Medicaid might qualify for federal government subsidies on the health-plan exchanges, depending on their incomes, Adams says.
This year, Access Health Mahoning Valley is considering opening offices in Columbiana County and has added an additional enrollment specialist.
Throughout the year, Access has received feedback from many individuals who have lost their jobs and their insurance but obtained coverage through the exchange.
“Some hadn’t had insurance for a year, or several years,” Adams relates. “When they found out that they could afford this on their own, they were very happy about that.”
Copyright 2014 The Business Journal, Youngstown, Ohio.
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