Hospitals to work with marketplace

Source: The Bismarck Tribune, N.迷你倉D.Sept. 23--With the Affordable Care Act health insurance marketplace opening Oct. 1, local health care providers are taking a "wait and see" approach.St. Alexius Medical Center and Sanford Health in Bismarck say that while they are preparing, the full impact won't be known for at least a couple of years.North Dakota is one of 34 states that chose to let the federal government operate the marketplace. The Legislature voted earlier this year to expand Medicaid in the state, in anticipation of that.Anyone whose income is 138 percent of the federal poverty guidelines or below qualifies for Medicaid, a government-run health care program for low-income individuals and families.In 2011, 9 percent of North Dakotans were enrolled in Medicaid, according to the Kaiser Family Foundation, a nonpartisan group that analyzes health care policy.According to the U.S. Census Bureau, 11.6 percent of North Dakotans were uninsured that same year.The Medicaid expansion could add 20,500 to 32,000 members, according to separate estimates by the state Department of Human Services and Kaiser Family Foundation.Those who don't qualify for Medicaid will be able to shop for plans in the marketplace. Tax credits of varying sizes to help pay for insurance are available to anyone at 400 percent above federal poverty guidelines or below.Blue Cross Blue Shield of North Dakota, Sanford Health Plan and Medica will be the three providers available on the marketplace, with a variety of plans and coverage options."This is uncharted territory," said Michael Fierberg, a public affairs official at the Centers for Medicaid and Medicare Services in Denver, the regional agency that covers North Dakota.That sentiment was echoed by area health care providers. Craig Lambrecht, the CEO of Sanford in Bismarck, said there is "global uncertainty" on how it will all work."The impact of the health insurance exchange is unknown," Susan Sick, the vice president of accounting and finance at St. Alexius, said in a statement.A lot of the changes for health care providers come not from the insurance marketplace but from other aspects of the 2010 health care reform law.St. Alexius did not want to comment on any specifics, but Marnie Walth, Sanford's innovation officer, said there would be no major system changes due to the marketplace.The major difference likely will be the number of uninsured patients treated. The hope is for those numbers to go down with the opening of the marketplace, but it is difficult to anticipate whether that will happen.For fiscal year 2012, St. Alexius reports 4.78 percent of patient encounters -- a term that refers to anyone coming into the hospital -- were uninsured, wh文件倉ch is more than 6,000 encounters.Sanford calculated that 6.8 percent of its inpatient encounters were self-pay, usually meaning uninsured, although this doesn't include outpatients, like same day surgery or observation patients.North Dakota hospitals are actually in a better position than those in states that did not vote to expand Medicaid, Fierberg said.When the marketplace was designed, it was not anticipated that states would be able to opt out of the Medicaid expansion, Fierberg said. As a result, in those states, hospitals will be paying for a similar caseload of uninsured patients, but with lower reimbursements because of the expected rise in the insured."If there are more insured patients, for a business model, that's a good thing," Lambrecht said. "But do we know that's going to happen?"Marketplace modelThe marketplace is aimed at those who are uninsured and those who are paying for their own insurance plans that are likely very expensive, Fierberg said."The marketplace is not intended for -- and probably should not be used by -- people who already have quality insurance," he said.Included in that category would be people who have health insurance from an employer and those who are already enrolled in Medicaid or Medicare.The federal government has been providing grants to states to train health care "navigators," who are trained to assist consumers and small business in evaluating their options in coverage.Organizations also can train certified application counselors who will help with consumer education and outreach with the marketplace.Melissa Hauer, a corporate counsel at Sanford, said Sanford is planning that some of its staff will become certified so that they can help patients through the process of finding insurance.It will take a two or three years before the effects of health care reform will be more measurable, Lambrecht said. That fact can be frustrating for health care providers."At the end of the day, we just want to know what's coming at us," he said.However, Lambrecht said, it also is an opportunity to start encouraging more patients into preventive care that could keep them out of hospitals.Lambrecht said Sanford will take the changes and challenges as they come."We are, quite frankly, very good at what we do," he said.Specific plans and prices will be available at .healthcare.gov starting Oct. 1. A health care hotline has been set up for anyone who wants more information or who has questions on coverage at 800-318-2596. It's staffed 24 hours a day, seven days a week.Copyright: ___ (c)2013 The Bismarck Tribune (Bismarck, N.D.) Visit The Bismarck Tribune (Bismarck, N.D.) at .bismarcktribune.com Distributed by MCT Information Services存倉