Affordable Health Care Act
Reform will mark shift for local health system
by W. Winston Skinner
While many of the details of how the federal Affordable Care Act will impact local health care remain unclear, it is certain that health care reform is leading to a focus on keeping people healthy — as opposed to simply taking care of them when they are ill.
Officials with Piedmont Healthcare also say the first year will be a time of transition as the hospital, doctors and others in the medical field move from current medical paradigms to a different delivery method. Holly Lang, director of external affairs for Piedmont, emphasized that the “how” is changing — not the “what.”
Lang spoke of “the urgency and the immediacy of what we do every day — the business of saving lives and making lives better.” She said that will remain Piedmont Newnan’s central focus — with the changes coming from ACA impacting how those services are delivered.
“We want people to stay healthy, rather than winding up in the most expensive place to get care — the hospital emergency room,” said Diana Lewis, senior director of public relations for Piedmont Healthcare.
More urgent care clinics and more support for services for low income patients may be needed. Education about alternatives to the emergency room for non-emergency health issues may also be required.
“We are understanding that it’s a different model of care,” Lewis said.
“We’re a mission-driven organization,” Lang said. “Our core mission and why we exist will always remain.”
As ACA begins, Piedmont Newnan and other hospitals will be serving patients using the current health care insurance system while implementing the new model.
“Everybody’s very nervous about the first year,” Lewis said, adding that after a year everyone should have a clearer picture of how the entire process will work.
“That’s the hard part in that we’ve got this gap. We’ve got one foot in this kind of care and another foot in another kind of care,” Lewis said.
Lang pledged Piedmont Newnan will work to make the transition as invisible to patients as possible. “We’ll be able juggle these things and manage these changes in the background,” she said.
Part of the reform movement centers on “population health” — which Lang described as “helping people stay well, rather than get well.”
Piedmont, Wellstar and other large medical care providers in the Atlanta area have been working together for a while to see what health reform might encompass. “We have for at least three years — Piedmont and Wellstar and Emory to some degree — have been working toward health care reform,” Lewis said.
“We’ve done a lot of pilots,” she said.
Some physician practices are now using coaches who make follow-up calls to patients. The coaches make sure patients understood instructions and got prescriptions — and that the prescriptions are helping.
Too often, “people don’t even know what we’re talking about and don’t have the tools to take care of themselves,” Lang said. Giving patients information — “everything they need to stay well” — is a major goal, she stated.
The question being asked, Lewis said, is: “How can we help people stay out of the hospital?”
“We have had a lot of really great opportunities to more thoughtfully address the more vulnerable populations,” Lang said. That includes people with complex chronic conditions and patients who have cancer, heart issues, diabetes or other other diseases or conditions.
“Creating community-based initiatives” is another facet of the health reform process, Lang said. Rather than just the hospital looking at its own functions, there is a “bringing in the whole community” aspect, Lang said. “It is a community effort and not just a hospital system,” Lang said.
“We’re going to have to have a team approach to taking care of the patient,” Lewis said. In pilot programs, “we’ve seen amazing results,” she said.
Lewis said changes in the medical delivery approach will lead to shifts in where people work, but the hospital — though with fewer patients and fewer emergency room visitors — will remain. “People are still going to get sick — especially with the aging population,” she said.
While there is much that is still unknown, Piedmont Healthcare, which owns the local Piedmont Newnan Hospital, and other area medical systems have a good idea of how much of the ACA — also commonly called Obamacare — will work. “There are those things that we know. We have time frames for some of the big parts,” Lang said.
The ACA is a complicated law with many different facets — and with programs that roll out at different times. Also, some aspects of the original law have been modified or delayed. “Because of the way it’s going through, there is not a day a switch is flipped,” Lang said.
Changes will be gradual. The new law “will have an overall effect on the system,” Lang said.
Hospital organizations generally have supported health care reform in recent years. People without medical insurance often seek care at hospital emergency rooms. Many of those people have little income, and bills remain unpaid — a financial challenge for the provider.
In addition, the uninsured often go to the emergency room for health issues that can be treated at much lower cost in a doctor’s office or clinic.
The issue of uninsured patients was a motivator for hospitals and industry groups to support reform, but the ACA is not going to be a total cure. “In the best case scenario, it will partially answer that,” Lang said.
People may still choose to be uninsured — although they would face a fine. Someone could also show up at the hospital with a catastrophic care policy that might not cover an ER visit.
The U.S. Supreme Court ruled states could not be required to expand Medicaid as outlined in the ACA. Because of that, people in certain income brackets may still have difficulty getting coverage.
“As politics shift and the environment shifts, that may change,” Lang said.
How many Cowetans who are currently uninsured will enroll in one of the health exchange policies is uncertain. “We have some projections, but we don’t for sure know how that is going to unfold,” Lang said.
“That’s the part we really don’t know,” Lewis concurred.
Looking at the entire Affordable Care Act, there are “things that have not been finalized,” Lang said. She said the impact of ACA will be felt “for years to come.”