Herb Kuhn, president of the Missouri Hospital Association, left.

The president of the Missouri Hospital Association discussed the health status of the state during a visit last week with the board of trustees at Texas County Memorial Hospital.

Herb Kuhn likened service on a hospital board in today’s healthcare environment to trying to listen to an analog radio. “The signal is not very clear,” he said, “but we do know where we are going.”

Kuhn presented data showing Missouri ranking eighth from the bottom in overall rankings of the health of all 50 states and Texas County ranking 101st out of 115 counties.

“We have a lot of health issues in our state,” Kuhn said as he listed obesity, heart disease, high blood pressure, diabetes, poverty and smoking as some. “This is not a problem. It’s an opportunity.”

Kuhn last visited TCMH in 2011 to honor TCMH employees for their donation to the MHA’s HERO Fund that was created to assist the healthcare providers involved in the natural disasters in the state. It was also Kuhn’s first visit to the hospital since the new construction was opened for patient care.

“What a great community asset you have here,” Kuhn said, calling the new construction “impressive.”

Kuhn has an extensive background in healthcare policy, formerly serving as director for the Center for Medicare Services (CMS) and currently serving as a commissioner on the Medicare Payment Advisory Commission. Kuhn and the staff at the Missouri Hospital Association are also actively involved in healthcare legislation as it relates to Missouri hospitals on a state and a federal level.

Kuhn noted that more than 850,000 residents of Missouri are not insured, and Medicaid recipients in the state have the highest utilization of the emergency departments in the state.

“Five percent of Medicaid recipients use 52 percent of the Medicaid funding in the state,” Kuhn said.

Healthcare and legislative policy makers are looking for solutions, according to Kuhn. He explained that Missouri hospitals are “in a world of hurt,” trying to shoulder the cuts made as part of the Affordable Care Act and the lack of Medicaid expansion in Missouri.

Kuhn ticked off notable losses to healthcare in the state — Heartland Hospital in St. Joseph stopped running the local ambulance service; Liberty Hospital cut many positions at their facility; the University of Missouri Hospital and Barnes Jewish Hospital currently have a hiring freeze.

“With Medicaid expansion and the health insurance exchanges, we may be able to get the number of uninsured in the state down to 6 or 7 percent,” Kuhn said.

Kuhn explained that many hospitals, members of law enforcement, state business leaders, community chambers of commerce as well as the state chamber of commerce supported the expansion of Medicaid in Missouri, but the state legislators are still determining the course of action to take regarding the expansion on Medicaid.

Kuhn also discussed the “new healthcare marketplace” — healthcare exchanges — that will open up on Oct. 1, allowing the uninsured or self-insured to shop and compare value of various health insurance products. Missouri’s health insurance exchange will be set up by the federal government since Missourians opted out of creating their own exchange program.

“The real issue is enrollment,” Kuhn said. “Hospitals like TCMH will have to help uninsured folks determine if something is available to help patients with their insurance needs.”

There are approximately 3,800 uninsured patients in Texas County, according to Kuhn. He also noted that the “very poor” will still be left out of the process, and those individuals will continue to need healthcare that hospitals like TCMH will have to provide regardless of the individual’s ability to pay for services.

“There has been a big shift in healthcare,” Kuhn said, calling healthcare services “a piecework system” — payment is made for services when they are completed.

“The piecework system is highly inflationary, and it will be as long as we continue to treat each sickness,” Kuhn said.

Kuhn explained that the current system traditionally treats people when they are sick rather than trying to help people manage their health so they don’t become sick.

“We need to get out of the sickness model,” Kuhn said. “How do we straddle the current payment system and change the way people think about their healthcare going forward?”

Wes Murray, chief executive officer at TCMH, thanked Kuhn for taking the time to visit TCMH and complimented him on doing a tremendous job at the MHA.

“We tend to live in our own bubble,” Murray said, “And it’s important to know that at TCMH we’re facing the same issues being faced by hospitals across the state.”

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