Uninsured will cause strain for health-care providers

Cost-containment pressure will continue to be a driving force in the medical industry in the new year, hospital-industry officials say.

“Health care is going to continue to be challenged from a whole lot of different perspectives,” Colorado Hospital Association president Larry Wall predicted. “It’s a very tumultuous time for health care.”

On the federal level, two related issues will affect health-care delivery, Wall said. First, Congress has given itself only five years to balance the federal budget. Health care being the largest portion of the budget, it will naturally come in for significant cuts.

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Second, concern about the solvency of the Medicare Trust Fund has grown over recent years. Congress appears, Wall said, to be determined to extend the fund’s solvency over 10 years. How or whether they do that will have a significant impact on payments to providers.

“Especially in rural areas,” Wall said, “where the bulk of patients – 60 to 80 percent – are Medicaid or Medicare recipients, anything that results in reduced payments will have an impact on the financial viability of medical facilities.”

Another strain on public health care will come from a growing population without health-care insurance, Wall predicted. Employers, he said, continue to reduce their work forces, resulting in the loss of health-care coverage to ex-employees.

Moreover, even employed people tend to have less coverage. Employers are discontinuing coverage of employees’ dependents, and they are increasingly hiring part-time rather than full-time workers, avoiding altogether the necessity of paying health benefits.

“Couple that with managed care,” Wall said, “and the bottom line is, hospitals É are going to be challenged to find ways to pay for health care for those people who are uninsured.”

How hospitals try to meet that challenge will vary, of course, but North Colorado Medical Center may be one model.

Increasing standardization of diagnosis and treatment is one way NCMC has tried to control costs.

Studies have found, said Wayne Potter, care coordinator for NCMC, that increased standardization generally yields better results in the patients’ health. Hospital staff at NCMC develop standardized “care paths,” from admittance through diagnosis and treatment to aftercare.

Because patients do better, their stays are shorter and they have fewer unneeded tests and medications, Potter said. This helps keep costs down.

A second cost-containment strategy is to plan for the patient’s discharge and aftercare from the time he or she is admitted.

Wall foresees the beginnings of a consumer reaction to managed care coming in 1997.

“Those consumers who’ve experienced managed care are beginning to say they would like more options,” Wall said.

In response to consumer requests, managed-care organizations have begun to offer more “point-of-service” plans, which allow health-care consumers a greater choice of providers.

“Point-of-service is growing and will continue to grow,” Wall said.