Health care providors watch election closely

By Ken Little

Health care professionals across North Carolina are keeping close tabs on the candidates this election season.

Spokespeople for groups representing North Carolina physicians and hospitals said that regardless of who voters choose for national and statewide office on Nov. 4, solutions must be found to long-standing problems.

“We’ll see who ends up in office and work with them. The most important thing is dialogue and to work these things through,” said Dr. Charles Schleupner, president of the New Hanover-Pender County Medical Society.

Providing affordable health insurance, Medicare reform, medical malpractice liability reform, revamping the state’s Medicaid reimbursement formula and the ongoing shortage of health care specialists are foremost on the agendas of providers.

The public also needs to do its part, said Denise Mihal, president of Novant Health’s Brunswick Community Hospital.

“I have the utmost faith in our community and our country. We are going to hold our politicians responsible,” Mihal said.

The health care topics being debated on the national stage and by candidates for state office are familiar ones.

“These are issues that have been around. They are not new and they need to be addressed,” said Mike Edwards, spokesman for the North Carolina Medical Society, which represents the interests of more than 11,000 doctors throughout the state.
“They want to be part of the debate,” Edwards said.

The economy and the uninsured
The wild card looming in the minds of policy makers everywhere is the economy, said Hugh Tilson, senior vice president of the North Carolina Hospital Association.

“We are re-evaluating all of the issues in light of the substantially changed economic conditions in the U.S.,” Tilson said. “Part of what we’re trying to figure out is given all the economic changes, how that factors in.”

Those without health insurance grow in number every day, as layoffs and business closings continue.

The American Medical Association urges lawmakers to implement a system of tax credits to enable individuals to buy health insurance. In North Carolina, about 1.5 million people are uninsured. Nationwide, the figure exceeds 47 million.

Doctors across North Carolina strongly favor Medicare reform, “in particular, the formula used to calculate the reimbursement fees given to physicians for the services they render,” Edwards said. Under current law, Medicare will make cuts in payments to doctors every year until 2015.

One frustration among private physicians is the lack of standardization in reimbursement methods. Policies vary by insurance provider, Schleupner said.

“It’s like driving your car and the switches are different in each car,” he said. “There is always quibbling over billing, so the whole billing issue is a problem.”

Schleupner said more uninsured patients seeking doctor care puts a strain on many private medical practices.

“In this area, it’s a major issue,” he said. “It’s a very difficult thing to try to address in this community. Most physicians do see people who are uninsured, but it’s difficult to put them into the practice.”

In the past, Schleupner said, doctors could “cost-shift” and compensate for uninsured clients because the majority were insured. But if cuts are made in federal programs like Medicare, the margin for accommodating uninsured patents decreases.

The equation for doctors is complicated by the rising cost of pharmaceuticals, medical equipment and liability concerns.

“There are so many issues that go into the cost of medical care and physician costs go into the whole thing, but it’s a complex thing.

There is no simple answer,” Schleupner said. “Am I saying there should be a national health care plan? I don’t know what there should be. Our country has the highest standard of living on the globe and I think we’re down in the mid-30s compared with other developed countries in terms of our health care delivery.”

Medicaid reimbursement changes needed
The state Medicaid reimbursement formula needs re-evaluation and can’t be trimmed further as some lawmakers advocate, Edwards said.

“If they reduce the scope of the program it will affect people and their health,” he said.
“There are a lot of doctors giving away these services now at or below cost. They may have to cap the amount of patients they see or opt out of the program altogether.”

Meanwhile, Schleupner said some uninsured people with medical conditions go untreated and end up suffering serious health problems as a result, which ultimately ends up costing the system more. He cited patients diagnosed with hypertension who suffer strokes.

Continued reductions in Medicaid funding will make it “very difficult for patients with Medicaid to get health care. (Physicians) can’t afford the cost of office space and nurses present,” Schleupner said. “Literally, physicians can’t afford to see Medicaid patients if Medicaid gets cut.”

Mihal said policies being proposed by candidates to address issues like health insurance must have real substance.

“They need to provide a plan for the insurance and a plan individuals can find affordable. I want to know how it’s going to be done and how it’s going to be funded. They just can’t scratch the surface on that,” Mihal said.

A viable plan needs to be implemented, Edwards said.

“Something needs to be done from the standpoint of making sure that the uninsured have access to care, and the number is growing and with the state of the economy it will continue to grow. The candidates have offered different plans,” Edwards said.

“The question is, will they be effective? Will there be a return on the tax dollar? That’s the issue.”