Missouri Hospital Association president Herb Kuhn was a guest speaker at the monthly meeting of the Texas County Memorial Hospital board of trustees last week.
Kuhn, who was last at TCMH in 2013 after the hospital opened the new construction, focused his overview of the current state of healthcare in Missouri on the changing demographics of potential patients in the U.S. According to Kuhn, the “silver tsunami” of people joining the Medicare rolls is about 10,000 new enrollees daily.
“Today there are 50 million people on Medicare, and there will be 80 million on Medicare by 2030,” Kuhn said.
Kuhn explained that when the Medicare program began there were 4.6 people working per Medicare recipient. Today there are 3.2 workers per Medicare recipient, and in 2030 there will only be 2.3 workers per Medicare recipient.
“Missouri hospitals are being asked to do more with less and to find new and innovative ways to deliver care,” Kuhn said.
Kuhn pointed out that with longer life expectancies, more and more people are over age 85. Those over the age of 85 have the greatest utilization of healthcare services.
Missouri’s current population stands at about 6 million people with one million of those residents on the Medicare rolls. By 2030, 1.5 million people in Missouri will utilize Medicare.
“This is especially important to not in rural communities because most of these people want to age in place,” Kuhn said.
Kuhn noted the healthcare provider recruiting and retention continues to be a “huge driver” in all hospitals. Telemedicine is becoming an important way to connect with specialized services. Connecting smaller hospitals with a larger tertiary care center is also a key strategy for hospitals in rural Missouri.
Kuhn stressed the importance of rural healthcare facilities to the communities they serve.
A 2014 MHA study of the primary care physician workforce in Missouri shows that 40 percent of the physicians practicing in the state are 55 or older, and the percentage is even higher for physicians practicing in rural Missouri.
“Many hospitals are doing ‘grow your own’ programs where they reach out to area schools to educate students about healthcare professions,” Kuhn said.
TCMH serves as a training site for physicians in residency, medical students and other ancillary students such as physical therapy nursing and radiology. The Youth Ambassador volunteer program also targets area youth that have an interest in healthcare.
TCMH also participates in the 340b pharmaceutical program that offers prescriptions at a discount for patients seeing a TCMH-based healthcare provider, which Kuhn also discussed.
“The 340b program was designed as a way for Congress to send funds to rural and inner city areas,” Kuhn said. “The program is not popular with pharmaceutical companies, so there will be ongoing challenges for the program.”
Kuhn also discussed the movement in healthcare from a “volume-based to value-based” system. Until recent years, healthcare reimbursement has been based on piecework, i.e., the more a healthcare provider did, the more he or she was paid.
Today, healthcare facilities are receiving “bundled payments” or set amounts for certain types of healthcare services. Kuhn called the bundle payments “a whole new level of risk.”
Physicians are also facing changes to their payment models.
“There are no new dollars out there available for healthcare,” Kuhn said. “Will there be enough incentive for physicians to consider practicing in rural areas?”
Kuhn stressed that rural hospitals must ask themselves, “What are we going to do different? How are we going to do it better?”
The need to insure more Missourians was discussed by Kuhn and the board members. Kuhn noted that over 10 percent of the state’s residents were uninsured, calling the numbers “real troubling.”
According to the MHA, uncompensated care in Missouri hospitals was more than $1.3 billion in 2014.
“Someone, somewhere, every minute of every day is presenting themselves in a emergency department, and they don’t have a way to pay for their healthcare,” Kuhn said.
MHA has worked for Medicaid expansion and reform in the state for the past few years, but state lawmakers seem unwilling to budge on the issue.
“Medicaid expansion would bring $2 billion in healthcare dollars back into the state each year,” Kuhn said.
Kuhn explained that 50,000 veterans and their family members would qualify and benefit. Local law enforcement would also benefit from an increased availability of mental health services to those without healthcare coverage.
“There is an opportunity cost here, too,” Kuhn said. “Businesses in the community end up paying for the uncompensated care.”
Kuhn said 75 percent of the Missouri hospitals that are “stressed” are rural hospitals.
“We have lost three hospitals in the state,” Kuhn said. “Once that infrastructure is gone, it’s not coming back.”
MHA continues to build a network of supporters for increased healthcare coverage in the state.
Wes Murray, chief executive officer at TCMH, noted that since 1980 there are 30 million more people in the U.S. and 20 percent fewer hospitals.
ADMINISTRATIVE REPORT
Murray, and Amanda Turpin, quality management director at TCMH, discussed emergency department wait times.
“The emergency room is the front door of our hospital, and like most hospital ERs, it’s the most criticized department,” Murray said.
Turpin shared a website –– https://projects.propublica.org/emergency/state/MO — that shows ER wait times for hospitals across the nation. The site breaks down state averages by hospital, and TCMH is included.
The average ER wait to see a physician in Missouri is 23 minutes. TCMH has an average of 24 minutes to see a physician in the ER, which is also the national average.
“We stack up very well to other hospitals in the area and across the state,” Murray said.
CAFETERIA RENOVATION
Murray reported the hospital cafeteria is undergoing a renovation. The renovation work is taking place in the evening and includes new paint, countertops and cabinets.
“The work is being done at night to create minimal disruption for the flow of the dietary staff as well as patients, employees and visitors that use the cafeteria,” Murray said.
FINANCIAL REPORT
TCMH began fiscal year 2016 with a positive bottom line of $59,675, according to the January financial report.
Linda Pamperien, TCMH chief financial officer, reported that volumes for January were down and expenses were up with some large annual dues and payments in January.
“Our contractual adjustment was low,” Pamperien said, “Our medical staff did a great job managing the length of stay for our patients.”
Present at the meeting were Kuhn; Murray; Turpin; Pamperien; Doretta Todd-Willis, chief nursing officer; Joleen Senter Durham, public relations director; and board members Dr. Jim Perry, OD, Omanez Fockler and Janet Wiseman. Board members Mark Hampton and Russell Gaither were absent.