Georgia Hospitals Face Fiscal Crisis
Since 2013, five rural medical centers in Georgia have closed, and countless others are struggling to stay afloat financially. From restructuring to cutting services, many hospitals are changing in whatever means necessary to survive.
This financial crisis was unintentionally brought on by the Affordable Care Act (ACA) and related legislation that followed it.
Before the ACA, many hospitals in Georgia relied on federal funds from the Disproportionate Share Hospital (DSH) federal payment/reimbursement program to offset the costs of treating patients without insurance. When the ACA was implemented, plans were made to phase out the DSH. It was assumed that all patients would have healthcare under the ACA.
However, things became more complicated when the Supreme Court ruled against a provision in the ACA requiring states to expand Medicaid. Governor Nathan Deal, like many Republican governors, rejected expanding Medicaid due to the costs of such a program.
DSH payments are set to end on January 1, 2018. More than 400,000 Georgians remain uninsured today.
Hometown Health CEO Jimmy Lewis states that in the Healthcare system’s current state, the end of DSH will especially hurt rural healthcare locations, making healthcare less accessible to residents in small communities. Large hospitals that are required to provide care for the uninsured will also find themselves in a bind.
In a recent Atlanta Magazine interview, Deputy Director of Policy for the Georgia Budget and Policy Institute Tom Sweeny stated that Georgia must expand Medicare (as originally planned) to solve the dilemma:
“It addresses the coverage issue and it brings $3 billion into state’s healthcare system. If hospitals weren’t getting paid to deliver care, this would pay them. In the long term, it’s delivering care in lower cost settings than hospitals.”
The Georgia Chamber has hired two previous Deal staffers, former spokesperson Brian Robinson and former health policy adviser Blake Fulenwider, come up with a solution. Though Robinson advocated against Obamacare previously, he now has a different perspective. The effects of the current dilemma will be felt by many—both in healthcare and in the economy:
“This affects businesses and individuals,”…“If a hospital closes and it’s a lot farther to get treated for a stroke, it’s significantly harder to attract major economic developments for those regions. Employees don’t want to go where they can’t get health care.”
The Georgia Chamber plans to release officially recommended plans to expand Medicare by the end of the year, with the intention of gaining supporters to bring such plans to the table during next year’s session.
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Shelley Brooks
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I think that you have mistakenly used “Medicaid” and “Medicare” interchangeably. “Medicaid” is a need based program while “Medicare” benefits are based on age. The closing of rural hospitals is attributed to the failure to expand Medicaid benefits.
When we demand the public to pump money into a bottomless pit we have to examine if we are creating an eternal unchanging, non adapting government bureaucracy or genuinely helping society.
Health delivery is one of the fastest morphing industries and the high technology is extraordinarily expensive and/or held in tight control. Stroke care mentioned is one of them. You can get help but the most advanced stoke care is at just a few hospitals. Wellstar (Kennestone & Atlanta Med) and Grady have a neurointerventional program that can go not the small vessels of the brain.
Many of the rural or small hospitals might better replaced by advanced clinics and depending on the situation patients transported to those hospitals that have the volume to utilize the best technology available and the docs most familiar with the problem.
This is an era of disruptive progress and keeping tradition running on the backs of abuse ridden public money is something to visit carefully.
While I favor everyone mandated to have coverage and private insurance for all (even if publically subsidized) in lieu of a mismanagd, corrupt and fixed government industry. My worry is the “utility” approach as companies merge and my GOP fellows taking either deceptions in participating or the crony beer distributor approach to the market.
Edit ? …..go into the small vessels…. Exceptions not deceptions…..
Georgia is a very large state especially as you head south. If you live in south Georgia and need major surgery you usually have to go to Savannah, Valdosta or Macon. That is a huge area to cover.
Being one of the communities affected by this I’ll throw in my two cents. I’ve spent hours meeting with parties on all sides of this issue trying to come up with the best possible outcome. Our city and county governments have spent several hundred thousand dollars over the last few years trying to keep our county hospital open. The ACA did not cause the issues with rural hospitals, although it doesn’t seem to be helping either. The biggest issue with them is that, in most cases, they tend to get the lower income patients that can’t pay or do not have insurance, while those with insurance go to the bigger hospitals for perceived better health care. This means rural hospitals are stuck with a disproportionate amount of patients that can’t, or won’t, pay their bills.
I’ll just spell out a few of the issues we’ve had and are facing in rambling stream of consciousness fashion.
1) Jobs. The hospital is the third biggest employer in the county. If the hospital closes, we lose hundreds of jobs, mostly good paying jobs, which will only do more damage to our already weak local economy.
2) Emergency services. Our next closest hospital would be 35-55 miles away in Athens depending on what part of the county you are in. Closing our hospital would much longer travel times, which in an emergency, could mean life or death. It also means the county would have to add more ambulances and staff as they will be tied up for longer times on each call. It would also mean life expectancy of an ambulance will be cut as they will have to travel farther distances. Those patients that are not able to pay for their care and have no insurance will no that flood the ER for simple care will now call an ambulance adding to the amount of patients they see. Then the county and Athens Regional are stuck with these costs.
3)Economic development. We are kind of stuck in a “chicken or the egg” scenario here. It is hard to draw new development with no medical services. However, it is also hard to keep the medical services going when you are losing population and tax base.
For consideration not rejection of your points:
1. Creating jobs is not an objective of public health care, that’s bureaucracy. The public needs good health care, trained people and technology.
2. Emergency services: most could be performed at clinics, even hospitals recognizing issues above their capabilities transfer patients. Mandated insurance is needed, even if subsidized.
3. No medical services or a hospital with less respect that a first class clinic hurts economic development. When the cow kicks you, you want to get to good health care and moved on if the situation fits, not be in the hands of folks that might try to handle something best left to another.
Salty,
1) I’m not in public health care. I’m in local government so my perspective is based on what not having a hospital would do to the community. So, yes I agree it is not about job creation, but it can’t be overlooked what closing a hospital would do to the community as a whole.
2) Clinics can only do so much. There are rules and regulations on where you can take patients via ambulance.
3) Not having emergency nearby is a big factor when it comes to attracting industry. If there is a workplace incident, companies want assurances their employees can receive immediate care.
That’s my point: The rules need modernizing for a “disruptive” competitive industry that best addresses their customers, people in strange places.
And then more folks will escape to the good country life.?
It is a complex problem with many sides. It needs to be resolved somehow.
Correct. Doubt that public funding sending more indigents into a budget and systemic stressed provider meets the objective of good health care. Hard to focus on patients with just ok equipment, cutting costs, finding billings, trying to collect from government and patients and employees generally being pissed off to just know they have a job.
The process/business model must change. Something both parties will fight.
Sorry for all this, I am very concerned too.