Health care: Major changes in '05, likely issues for '06

~ Medicaid reform that reduced coverage not popular with hospital officials. Hurricanes prompt health-care preparedness.

Two Cape Girardeau hospital administrators and a physician who advises the county's medical society say 2005 was a year of significant changes in health care -- some good, some bad -- and it's too soon for a full prognosis of 2006.

In Missouri, the most significant issue of last year was the reduction in Medicaid coverage for 98,000 of the state's elderly, disabled and working adults through legislation passed by the General Assembly, say the two hospital executives, Steven Bjelich, president and CEO at Saint Francis Medical Center, and James Wente, president and CEO at Southeast Missouri Hospital.

Dr. Thomas Sparkman of Cape Family Practice, an adviser to Cape Girardeau County Medical Society, said the most significant change in health care last year was the start of Medicare prescription drug coverage for the elderly.

Wente said 2005 legislative action also calls for the discontinuation of the program, as it is currently structured, by 2008. A Medicaid Reform Commission was established to make recommendations for the program's revision, and it finalized its report in December.

Missouri's Medicaid reform last year is a negative, said Steven Bjelich, president and CEO at Saint Francis Medical Center. "It will stress the entire health-care system," he said. Bjelich said cuts in the number of people covered and reductions in benefits will eventually have an adverse impact on physicians and hospitals alike.

"The [Medicaid reform] committee's report will be the focus of much attention and debate during the 2006 legislative session," said Wente.

Health-care professionals -- especially direct patient caregivers -- see firsthand the effects of Medicaid reductions, said Wente.

"Uninsured individuals frequently wait longer to seek primary care, which results in a compromised medical condition that requires more medical intervention," he said. "In addition, because they don't have access to primary care, uninsured or underinsured patients often seek care in the emergency department where the care is most expensive."

Bjelich said about 15 percent of Saint Francis Medical Center patients are on Medicaid, and it could be a hardship for some health-care providers if Medicaid coverage is not returned to some of the people who had been covered. Those who are uninsured or underinsured might become charity patients, he said.

Wente said other effects of reduced health-insurance coverage include patients who are unable to continue with drug or rehabilitation therapies for chronic conditions.

Another significant health-care issue was related to state and federal responses to hurricane relief efforts.

"We saw how hospitals in many states stepped to the plate to deal with these tragedies," said Bjelich. "Of course, it's what hospitals do every day. We're an integral part of disaster relief. Those two hurricanes put a lot of stress on health-care providers, and it was a learning experience."

These natural disasters, said Wente, have created a renewed sense of urgency for disaster planning and preparedness by health-care providers and state and local governments that will likely continue into 2006 and beyond.

The rising cost of medical malpractice insurance has long been a thorn in the side of physicians.

"In Missouri, comprehensive tort reform legislation was enacted in the 2005 legislative session," said Wente, adding that it's a bit early to fully evaluate the effect of the law. "It appears the improvements will make a significant difference in the availability and affordability of medical professional liability insurance."

Bjelich said legislation signed by Gov. Matt Blunt will help hospitals and medical clinics throughout the state recruit and retain physicians. He cited Illinois as a state that is losing physicians because of high medical malpractice insurance.

Providing adequate health care to rural residents has been challenging for some time, and Bjelich thinks the challenge will continue. He said there are many hospital-affiliated clinics in rural areas but it is not always easy to staff them.

"There's a nationwide nursing shortage, and the demands on the health care systems are being driven more and more by baby boomers," he said. "As they begin to turn 60, dependence on medical services will increase."

Physician-owned medical facilities, or limited service providers, were an issue in 2005 and will likely be contentious in 2006, according to Wente.

"It's an issue over which community hospitals and entrepreneurial physicians disagree," said Wente.

He said hospitals are concerned about the increasing prevalence of these medical facilities that include physician self-referral, the provision of charity care, emergency department on-call coverage, and the continued viability of community hospitals to offer a full range of services.

In 2005, the Missouri hospital community announced its support of an effort by the Citizens for a Healthy Future to raise the state's tobacco tax. The proposed initiative would raise the tax on a pack of cigarettes by 80 cents, and the proceeds would fund smoking prevention and cessation programs as well as treatment programs for patients with tobacco-related diseases. Wente said the issue will be on the November 2006 ballot.

Bjelich said 2005 was a good year for advancements in technology. He said Saint Francis has a new 64-slice CT scanner that is a tremendous diagnostic resource for the emergency department physicians and other staff.

A positive local development for 2006 will be the February opening of Landmark Hospital, a 30-bed, long-term, acute-care facility on Independence near Mount Auburn Road.

Sparkman said that last November the general population of retired people were offered enrollment for prescription drug plans with their coverage starting the first of this year. He said those who qualify for extra help and who have not chosen a plan may enroll during April and May for assistance that would begin June 1.

"The plan started in May with identification of those who would be automatically eligible for extra help with drug costs," he said. "Those who applied for extra help were informed whether they qualified for this help by August 2005."

On the average, said Sparkman, the plans will pay about $1,366 in financial support for each senior with Medicare paying about half of their drug costs.

Sparkman said 2005 "was a year for great effort" in improving safety and quality of American hospitals. He said emphasis was placed on understanding what the problems were and what could be done to remedy them.

"This plan of clinical quality improvement will be a monumental victory for patient safety," he said.