Hospital Issues

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With the New Year, Arizona hospitals are facing new issues, such as the Affordable Care Act and hospital price transparency, which requires hospitals to list prices. Greg Vigdor, the CEO and president of the Arizona Hospital and Healthcare Association, will discuss new issues hospitals are facing in our state.

Ted Simons: Arizona Hospital Association. Talk to us about the group.

Greg Vigdor: We're the trade association fort hospitals across the state and other health systems. We're trying to provide leadership on the many health issues we face as a state.

Ted Simons: Among the issues I'm sure you're looking at now is the affordable care act, better known as Obamacare, and the health exchanges therein. Talk to us about the early impact on hotels.

Greg Vigdor: We don't have a lot of real data because of the obvious problems with the rollout of the website. It's moving slowly in terms of enrolling people. For hospitals when people need care is when they are going to come, so it's not automatic that they enroll and then come to us. We're not seeing much more than anecdotes. We are seeing the beginning of enrollment,we're seeing people come in for care but it's early and relatively slow so far.

Ted Simons: What about the Medicaid expansion here?

Greg Vigdor: A little bit faster, in Medicaid there's correlation of people needing health care and efforts to enroll people. We have a much greater capacity than the federal government did to do it right. We're a bit more optimistic. The impacts on the hospitals remain to be seen. Our hope is it's going to help with the uncompensated care problem in both cases, but we don't have any data yet.

Ted Simons: Uncompensated care was the big factor as far as hospitals were concerned it seems to me. No indication as yet? Any hints that what you are concerned about is actually being addressed?

Greg Vigdor: We did our modeling before the bill this. Was the numeric reason we got involved in it. We know when we go back to when enrollment moved backwards after the great recession that hospital and compensated care doubled by roughly $400 million. We do expect we'll see some benefits from that, but it's only part of the reason we did this. It's also a better way to deliver care to people.

Ted Simons: What about federal reimbursement as far as Medicaid patients?

Kevin Rogers: That's also a problem for us. The hospital field across the nation agreed to over $100 billion in cuts and $3.7 billion were in Arizona. We have been dealing with realty we have to cope with. The problem is every time Congress or the administration comes up with something new they say let's funds it with more cuts. We're now staring in the faces of another 1.3 billion. That's difficult for us. We're saying enough is enough.

Ted Simons: Like 70% now? Is that the level as far as how much a hospital has to pay?

Greg Vigdor: That's in terms of Medicaid payments a rough number. Medicare is higher. Over all it gets back to the uncompensated care number.

Ted Simons: Another concern I would think would be higher deductibles. A lot of what goes on with the affordable care act is the opportunity to take whatever deductible you want. Once they get into a rough situation and they can't pay the bills, concern for you.

Greg Vigdor: Right. These are some of the real questions with the affordable care act. It's what happens after people mayor their selections. Do they know they are choosing a plan where they are responsible for the payments? Do they understand who is in the provider networks? These the emerging issues in the state. We're seeing troubling signs but our job is to manage them, take care of people, figure out how to make it work.

Ted Simons: Troubling signs unexpected?

Greg Vigdor: I don't think so, not to those of us in the business and saw what was happening.

Ted Simons: What about the idea, again, affordable care act means more people with insurance means more people getting health care means more doctors are needed? Concern?

Greg Vigdor: It is. Especially in primary care. Not exclusively there. We have a shortage in Arizona. I think other parts of the country they may talk about this as a problem. Here it's much more acute. We are going to have to look at the capacity question pretty seriously. I think we'll have to do some policy and other solutions to try to make what we expect to happen work.

Ted Simons: I think the worry is if you can't find a doctor, not enough doctors, boom, back in the emergency room for a cold.

Greg Vigdor: Exactly.

Ted Simons: All right, there's a new hospital price transparency law. Talk to us about this. What it does and how it can best serve folks without confusing the heck out of them.

Greg Vigdor: People are confused with good reason. There's no justifying the way we have set up our pricing systems. It's an artifact of how policy is developed in this country, no policy, really this. Is an effort of the legislature to find a way to give people information they can use. Our members are working to try to work through how we can comply with the law. We hope it works, but I think it will be incomplete for folks because we don't control their insurance contracts. I think they really care about what they have to pay and if they have a deductible plan we don't have that information. We have to try to make that work but find other solutions and fix our payment system.

Ted Simons: Is there a website up and operational now that compares with hospitals of a certain size compares basic procedures?

Greg Vigdor: It's not a website in our state's case. We have an obligation under law to basically provide the public posting. It can be through a website for the hospital or other means. In our state in terms of this bill we don't have that type of solution.

Ted Simons: DHS does has a website?

Greg Vigdor: There are some solutions where that's being developed. We try a voluntary effort in our association to do that.

Ted Simons: It shows the charge for the procedure and what that procedure costs the hospital?

Greg Vigdor: For the most common procedures, the prices charged.

Ted Simons: But it doesn't include doctors' fees, right?

Greg Vigdor: Right.

Ted Simons: It doesn't include the insurance negotiations that go on.

Greg Vigdor: Right.

Ted Simons: So how do you know what's going on?

Greg Vigdor: We have to figure out a way to help people understand what's going on. We believe in transparency. We have to fix this. That's clear. This may do some good. That's why we're going along with it but we have to find better answers, not just in Arizona. This is a national problem. To get this back where it needs to be we have to find a national solution.

Ted Simons: Are you okay with the idea of a best average and below category ranking for hospitals?

Greg Vigdor: If done right we're ready to stand by accountability measures but ones that are fair and allow for improvement and again, more than anything, are transparent enough so people can understand them. Many of the sites are so complex and complicated people get more confused.

Ted Simons: As far as quality of care, out comes, patient experiences, these are categories listed on the DHS. You're okay with that as far as metrics are concerned?

Greg Vigdor: Yes, improving upon metrics and upon our performance. We're committed to that in this association.

Ted Simons: I know the hospital association was not all that excited about this transparency law when it was being debated. The first was vetoed by the governor. The second goes through but there were concerns.

Greg Vigdor: We thought it would be a waste of time. The bill is much better I think again it's incomplete solution.

Ted Simons: As far as regulatory oversight for this transparency bill for this kind of transparency, what do you think?

Greg Vigdor: If it helps I think we're willing to talk about it, but again, if it's a regulatory oversight of something not being productive for the citizens of the state that's a different matter.

Ted Simons: Before you go, again, the impact of federal cuts to Medicare. We talked about Medicaid. Talk to us about where that stands. What you're concerned about.

Greg Vigdor: The $1.3 billion we're staring at as far as future cuts. Enough is enough. We have to make sure the things we're doing in this country are not coming out of the hides of hospitals. We have to pass it on or have even greater uncertainty in the healthcare system. We already have enough going on in this state with the other things.

Ted Simons: Are you optimistic when it comes to transparency, when it comes to ACA, Medicare reimbursement, are things move in a positive direction to you think?

Greg Vigdor: I'm confident the leadership of our hospitals and their commitment to try to make it work. These are not all our preferred solutions but the obligation for us to take care of people and patients. Why complain about them? Let's just make it work.

Ted Simons: Good to have you here.

Greg Vigdor: Good to be here.

Greg Vigdor:CEO and President, Arizona Hospital and Healthcare Association;

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