Healthcare Reform and Hospitals

The discussion on whether the Affordable Care Act is a success or not will most likely continue for years, but authorities at St. Rose Hospital in Hayward say, because of the ACA and other state and government cuts, it might not be around to see the accidental complication of healthcare change. St. Rose Hospital has had cash problems for years. In fact, it has almost closed a few times before. Its sufferers are mostly without insurance or under-insured. The new control group is making progress to keep a hospital open, but the discount rates in state and government cash might mean those gates close for good.

For sufferers like Ginny Almond, St. Rose Hospital’s place in Hayward is everything. She was recently rushed there for emergency surgery. She says a few years ago, St. Rose physicians saved her life after she almost passed away in a fire. “Very thankful that they were there and so close to where I stay,” Almond says. The personal, non-profit hospital admits almost 35,000 E.R. sufferers a year. With Kaiser Hayward closing, St. Rose will be the only service getting 911 sufferers in the Bay Area’s fifth biggest town.

Now, because of cash problems, St. Rose might have to shut down. “It’d be terrible for myself and for the group,” according to Almond. St. Rose’s Chief Financial Officer, Mark Krissman, points out, “If St. Rose no longer exists, that means lives are at stake because emergency vehicles have to journey a little bit further to another service.” He says, as a safety net hospital, St. Rose admits a huge number of without insurance and under-insured sufferers.

The charges those sufferers can’t pay have been sponsored by state and government programs, such as, Medicare and MediCal. The Affordable Care Act will decrease Medicare financial assistance by $22 billion dollars over the next five years. The idea is that more people will be covered and able to manage medical care. But Krissman claims his hospital still needs that cash, because St. Rose serves a poor community, many of whom might not sign up for insurance. “We will get $3.6 million less in compensation for the next 12 months,” according to Krissman. Add that to the $10,000 shortage Krissman says St. Rose shelves up every day, in part because MediCal doesn’t cover full service expenses.

Hospital Executives and the Affordable Care Act

Of hospital executives surveyed, 65% indicated that by 2020, they believe the wellness care program as a whole will be somewhat or significantly better than it is today. And when they were asked about their own organizations, the positive outlook was even more impressive. Fully 93% expected that the quality of care provided by their own wellness program would improve. This is probably related to initiatives to reduce hospital obtained conditions, medicine mistakes and needless re-admissions, as motivated by financial penalties in the Affordable Care Act (ACA).

On price control, there was similar optimism: 91% expected developments on analysis of price within their own wellness program by 2020. A large proportion, 85%, expected their company to have decreased it’s per individual working expenses by the end of the decade. Overall, the common working reduction expected was 11.7%, with a range from 0% to 30%. Most professionals believe they could save an even higher amount if Congress introduced regulation to speed up the move away from fee-for-service payment toward models like included payments. In such a case, the hospital executives estimated regular yearly benefits of 16.0%, which, if used across the wellness care program, would amount to benefits of nearly $100 billion dollars per year.

How can such benefits be achieved? Hospital executives anticipate three strategies rising to the top: decreasing the number of hospitalizations (54%), decreasing the number of re-admissions (49%) and decreasing the number of E.R. trips (39%). Other likely resources included decreasing expenses for medical devices (36%) and medicine (27%), along with enhancing back-office performance (23%). These leaders believe that benefits can be found through a mixture of better management performance, price discount rates and decreased dependency on hospital services.