Hospital CEO weighs in on health care changes

Repealing Medicaid expansion without increasing reimbursements to hospitals could cause 'economic chaos,' says hospital CEO

Leigh Black Irvin,
Jeff Bourgeois, president and CEO of San Juan Regional Medical Center, discusses the ramifications of proposed changes to the Affordable Care Act during an interview Jan. 31 at his office in the Farmington hospital.

Editor's note: The Daily Times is publishing a two-part series about the changing landscape of health care in our country. We asked leaders in San Juan County's health care industry to weigh in on what changes to the Affordable Care Act could mean for the county's residents and health care facilities.

Below is a Q&A with Jeff Bourgeois, president and CEO of the San Juan Regional Medical Center in Farmington. A story with reaction from more local health care officials will publish Monday. 

The ACA and Medicaid

Q: Much of the discussion concerning adjustments to the Affordable Care Act involves repealing Medicaid expansion. That expansion allowed some states, including New Mexico, to extend Medicaid coverage for all residents below a certain income level. What's your view of the current health care situation under the ACA and Medicaid expansion?

A: It is very apparent to me that the (ACA) in its current form — from a federal perspective and even here at the state level —  is no longer affordable in the long-term. However, the expansion in Medicaid in our state has been very beneficial and has been very effective in reducing the number of our state's citizens who don't have insurance. Ultimately, I believe that's good for patients, in that they now have access to primary care and are not waiting until they are so sick that they need the ER, which is the most expensive care within the health care industry. Patients can be treated with much more appropriate low-level care before they get catastrophically ill.

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Jeff Bourgeois, president and CEO of the San Juan Regional Medical Center in Farmington, says the Affordable Care Act in its current form is not affordable long-term.

Q: What are changes you foresee the Trump administration making to the health care law?  

A: It's not an easy problem to solve, and I don't know what President Trump will do. I don't think he would do something like eradicate Medicaid, but I believe he would take an approach to drastically reduce the amount of Medicaid programs that are offered. I think he may consider the privatizing of Medicaid to make it more of a free market capitalism-type of program, rather than one administered by the government. One possibility is that a block grant program might be implemented, in which states would be responsible for administering their own Medicaid program. That way, states would be required to handle their own individual realities. Our challenge is that almost half of our state's citizens are on Medicaid — 43 percent, according to the American Hospital Association.

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I think it's important to note that while it's great to have patients on some level of funding now, the amount of funding we get from Medicaid doesn't cover the cost of the care. So we're still providing care at a loss, and that's where the commercial insurers, or those who get the bill, are making up the difference.

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Impact on Four Corners area

Q: What would a reduction in reimbursements mean for the hospital and for our county?

A: It's important to realize that when you look at where our hospital is located in San Juan County — and the fact that it's the second largest trauma provider in the state of New Mexico — a drastic reduction in reimbursements will impact the lives not only of San Juan County citizens, but also the lives of people throughout the Four Corners area. With our AirCare service, we provide emergency transportation for patients from accident scenes and other hospitals to the entire Four Corners area, which encompasses about 300,000 people living in relatively isolated areas. If we didn't have the trauma services here, lives would be lost in the time it takes to get patients to the next trauma center. We truly are a health care safety net provider for the entire Four Corners region.

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Q: What are you doing to prepare for the shifting health care environment?

A: We have an aggressive financial stewardship focus right now. We're looking at improving our revenue cycle to ensure we code, bill and collect everything we can just to make sure we are as efficient and high-performing as possible. 

On the cost or expense side, we are looking at every single opportunity to manage our expenses better. This industry has always gone through some pretty significant changes. In the midst of all that, our purpose remains unchanged, and that's to provide the very best health care we can for the communities we serve. We have a focus on high quality care, and we have never taken our eyes off of that.

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The health care industry, through our state level hospital association and our American Hospital Association, are offering to be a part of the decision-making process in order to create a system that will be financially sustainable for the federal and state-level governments, and also to provide fair reimbursements for the hospital.

Something has to change, but what? I don't have the answer to that. I would like to urge our federal legislators, as they consider options to repeal and/or replace the ACA, to keep in mind that they need to restore Medicare payments to hospitals that largely funded the ACA. If they don't, it will create a lot of economic chaos and hardship on the nation's hospitals, causing them to try to figure out how to provide care to a growing number of uninsured patients. 

Leigh Black Irvin is the business editor for The Daily Times. She can be reached at 505-564-4621.