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FARMINGTON — Several months after enrollment in the health insurance marketplace portion of the Affordable Care Act was implemented, health care officials are seeing the effects of the new law on facilities, patients and the industry.
Despite anticipating continued challenges posed by health care reform, San Juan Regional Medical Center CEO Rick Wallace remains optimistic that the Farmington hospital will continue to provide the same level of patient care under the act, which is often called Obamacare.
"We've been working very hard to prepare for this," he said. "I think our community will be able to benefit from the ACA simply because we do have so many uninsured and underinsured."
Wallace said 21 percent of New Mexicans -- or about 417,000 people -- are currently uninsured. Now, many of these people will be eligible for Medicaid under the expanded health care program, or they will be eligible to obtain insurance through the health insurance exchange website.
"It's a good thing for our community, as it gives everyone an opportunity to have insurance," Wallace said.
Wallace said the hospital is already seeing an increase in patients, and he doesn't expect that to decrease in the near future.
"A lot of people already use the (emergency room) for their medical home," he said. "We can only assume that once they do become qualified for the health exchange and sign up, they will continue to use the ER because that's what they've used historically."
Educating the community about the importance of reserving use of the ER for true emergencies will be key to changing this practice, he said.
"The whole purpose of the Affordable Care Act is to reduce the cost of health care, and if we continue to use the ER for basic health care needs, we're not meeting the goal of the act," he said. "When dealing with a non-emergency, people need to find the appropriate level of care, whether that be a physician, Indian Health Service, Presbyterian Medical Service, etc."
Wallace said he has also noticed a significant reduction in the hospital's reimbursements, which last year saw a reduction of about $2.1 million in Medicare reimbursements and a $1.1 million reduction so far this fiscal year.
"There will be a significant impact over this next year and in future years in how they redesign reimbursement," he said.
The real challenge, Wallace said, will be finding ways to take care of the growing number of patients with less money coming into the hospital. Added to this mix, he said, is the government's requirement for better medical outcomes, which means medical personnel and facilities are now expected to do better with fewer resources.
Wallace maintains, however, that the hospital will not cut back on services. Rather, there will be a greater effort to reduce overhead costs, he said.
Another strategy to meet these challenges is adopting more standardized "care paths," which are expected to improve quality and safety, reduce costs and maintain consistency of care for patients.
"It doesn't mean the doctor will be doing a cookbook-type of practice, but it's like a checklist on an aircraft. When an aircraft lands, there are standard procedures you go through," he said. "It's the same here. The care paths will make sure the care is consistent throughout the hospital."
Private physicians are also closely watching how reimbursements under the new health care system will affect them.
Casey Crotty, CEO for the San Juan Independent Practice Association, said he is also hearing of problems with physician reimbursements, such as when doctors' offices don't make sure patients are up-to-date with paying their premiums and end up not getting reimbursed.
"There's a three-month gap where a patient can fail to pay for their premium before the insurance company drops them, and then the physician gets stuck with the bill," he said. "That's where a lot of the losses come from -- not because the insurance company didn't pay the bill, but because the patient didn't. Realistically, the physician should be collecting the money up front during that three-month time."
As for the huge influx of new patients many are predicting will result from the health care law, Crotty thinks that won't happen until later.
"I would be very surprised if we see this," he said, citing the example of Massachusetts when it adopted its own health care insurance reform law, or "Romneycare," in 2006. "All of a sudden people got insured and primary care physicians couldn't take the influx. But as physicians' offices adjusted to the volume and use of the ER decreased, physician care increased."
Like Wallace, Crotty believes that after getting through the initial growing pains associated with the law's launch, the result will be an improvement in overall health care.
"I think we're going to see people getting in to see primary care physicians, and that's good news," he said. "We have a tremendous amount of diabetes and hypertension in this community, and I hope in the long run we'll see an improvement in care. I really see in the next three to five years a shift in the health of this population."