| Medicaid
roundtable
Administrators at hospitals
around Virginia were asked: How does Medicaid funding
affect access to care in your area?
Virginia Business
May 2005
Access to Medicaid is vital
to the poorest and most underserved in our society.
Medicaid needs to pay
its fair share to the physicians, hospitals and other
health-care providers who care for these patients.
To cut the Medicaid budget quickly gets very personal;
it reduces access to health care for thousands of individuals.
Cuts often result in patients having no choice
but to repeatedly show up in hospital emergency rooms
when they could be more effectively treated in physicians’ offices.
— Michael
J Halseth,
President and CEO of Valley Health System,
Winchester
Children’s hospitals such as Inova Fairfax
Hospital for Children provide important health-care
services to low-income and privately insured children
alike. Here at Inova Fairfax Hospital for Children,
25 percent of our inpatient volume and 40 percent of
our outpatient volume is Medicaid. If the Medicaid
budget continues to be cut, children’s hospitals
will be forced to reduce critical services necessary
to care for pediatric patients.
— Toni
Ardabell,
Vice president, Inova Health System, and COO, Inova Fairfax Hospital and Inova
Fairfax Hospital for Children
At Children’s Hospital of The King’s
Daughters, children covered by Medicaid account for
about 47 percent of our overall care. More pointedly,
in our neonatal intensive care unit, more than 50 percent
of our tiny, fragile newborns rely on the Medicaid
program. Fortunately, our substantial commitment
to providing the highest level and quality of pediatric
care to all children within our community has been
recognized by the Virginia legislature, providing our
hospital some relief for the shortfall we inevitably
face between our cost to provide care and the reimbursement
we receive through Medicaid. That disparity is right
at about 30 cents on the dollar; in other words, for
every dollar it costs to provide care to our patients,
Medicaid pays us 70 cents. At the physician-practice
level, the deficit is even greater. Daily, we hear
of more primary-care and specialty practices weighing
their sense of moral obligation to provide care to
all children in need against the reality of meeting
their employee payroll and operational expenses. It’s
clear that something needs to be done. From our perspective,
that something is keeping our Medicaid funding whole
on the federal level and rejecting cuts to this very
important program that provides health care for our
nation’s most vulnerable citizens.
— Jim
Dahling,
President and CEO,
Children’s Hospital of The King’s Daughters, Norfolk
As the chairman of the Virginia
Hospital and Healthcare Association, it is my responsibility
to help advocate
for fair and adequate reimbursements from all payors — including
Medicaid — to all providers. Specifically regarding
Medicaid funding, positive signs include the U.S. Senate’s
elimination of the $15 billion Medicaid cut in its
version of the budget resolution. We hope the Senate
can persuade the House to adopt this version. We are
grateful that Gov. Warner and the Virginia General
Assembly have raised Medicaid inpatient reimbursement
to 76 percent from less than 72 percent of allowable
costs, effective July 1. Virginia still ranks 48th
of the 50 states on Medicaid spending, but these steps
are in the right direction.
Lower reimbursements for physicians paired with rising
medical malpractice insurance premiums force doctors
to limit the number of new Medicaid patients they can
accept. In Hampton Roads, this has meant that new Medicaid
patients often turn to hospital emergency departments
for primary care. Hospitals cannot recover their costs
of rendering primary care in this expensive care setting,
which puts further pressure on our resources. Consequently,
it is increasingly difficult to fund important programs
and services for the overall community. At Bon Secours
Hampton Roads Health, we continuously assess our ability
to acquire new medical technologies and add new services
that will benefit our patients. At the same time, we
are focused on keeping our costs in check by working
as efficiently as possible.
— Richard
A. Hanson,
CEO, Bon Secours Hampton Roads Health System, Suffolk
Inadequate funding from Medicaid
resulted in the discontinued operation of a mobile
health and wellness
service we offered. Continued inadequate funding
threatens many of the health related community service
programs that we offer in Southside Virginia and makes
providing core health care services extremely difficult.
— W.
Scott Burnette,
CEO/President, Community Memorial Healthcenter, South Hill
My lofty vision of what Medicaid reimbursement should look like in Virginia
would be for 100 percent of the cost of care to be covered. Current payments
to hospitals are at 76 percent of cost. What results is a hidden “sick
tax” embedded in the cost of health care to cover the shortfall. This
tax is passed on to the business community in several ways. In a rural county
that experienced 12 percent growth in Medicaid patients last year alone,
small hospitals like ours face a huge burden.
— Lee
Kirk,
CEO, Culpeper Regional Hospital
At Clinch Valley Medical Center,
we see the immense impact that each Medicaid dollar
has on our patients
and on our ability to care for them. In many cases
Medicaid payments cover less than 75 percent of what
it costs to provide essential health care. This puts
an enormous strain on our ability to provide safety-net
services to a population that depends on us. Each year
we struggle to stretch these dollars further, while
always making strides to advance the quality of care
we provide. When Medicaid funding is cut, the impact
ripples across the community. The end results could
mean an increase in our uninsured population, which
further taxes our already strained health-care system
and potentially impacts the business community and
private insurance markets. As state and federal policymakers
continue to grapple with the challenge of funding state
Medicaid programs, we must not lose sight of the fact
that for many of our fellow Virginians, it’s
not a financial issue at all; it’s an issue of
life!
— Tim
Tobin,
President and CEO, Clinch Valley Medical Center, Richlands
Virginia’s underfunding
of Medicaid puts negative pressure on providers (hospitals
and physicians) in
the commonwealth. If Virginia would increase Medicaid
spending, it could get matching funds from the federal
government.
With regard to Medicaid spending
for nursing-home care (which is the vast majority
of Medicaid spending),
we should look to a true catastrophic or means-tested
system whereby people with the ability to pay should
pay for their long-term care (LTC). This approach has
been tried in other states, and it works. Additionally,
the need for more home-based LTC should be an emphasis
of the government and providers.
— William
B. Downey,
Executive vice president and COO,
Riverside Health System, Newport News
We take care of all patients, including Medicaid patients, regardless of their
ability to pay. Though access is not affected, the failure of Medicaid to
keep up with the rising cost of providing care affects all our patients.
Ultimately, the Medicaid “deficit” has to be paid, and the result
can be a “hidden tax” of transfer costs that affects the entire
community.
— Dr.
Edward G. Murphy,
President and CEO, Carilion Health System, Roanoke
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