Executives at Forum, HMHP:Time has come for change

By Don Shilling

Covering the insured doesn’t necessarily mean hospitals will receive more revenue.

Leaders of the Mahoning Valley hospital systems support national health-care reform but are waiting to see whether politicians can find the right prescription.

The ailments are clear, said Bob Shroder and Walter “Buzz” Pishkur. Having more than 45 million Americans without insurance is unacceptable, as are the large expenditures that hospitals must make in providing charity care, the hospital executives said.

“It’s a broken system. It does need to be fixed,” said Shroder, chief executive of Humility of Mary Health Partners.

The big questions are how to provide care for the uninsured and who will pay for it, said Pishkur, president and chief executive of Forum Health.

Those questions will be explored Monday at a town-hall meeting sponsored by The Vindicator and WFMJ-TV Channel 21. A Conversation on Health Care will be broadcast live from 6:30 to 8 p.m. on WFMJ.

Five invited guests, including Shroder and Pishkur, and 100 area residents will discuss health-care reform with U.S. Rep. Tim Ryan of Niles, D-17th.

Both of the local hospital systems spend tens of millions of dollars a year on providing care for people without insurance and who can’t afford to pay. President Barack Obama campaigned on providing health-care insurance for all Americans, and Congress is now debating his legislation.

Shroder and Pishkur said the uninsured should be on an insurance plan, not only to cut the charity care of hospitals but also to help people. The uninsured often wait too long to receive treatment for diseases, which makes recovery more difficult and drives up the cost of care, they said.

The executives noted, however, that covering the newly insured doesn’t necessarily mean hospitals would receive more revenue.

Under the current system, hospitals provide charity care, but they also lose money on providing care for people on Medicare and Medicaid because of low reimbursement rates, they said. Those shortfalls are covered through negotiated rates with the insurance companies that cover the rest of the patients, they said.

Pishkur said he is concerned reform will lead to fewer people being in the group covered by insurance companies. If that happens, the drop in charity care would be offset by a loss of revenue from insurance companies, he said.

Debate in Washington has included offering other options to people besides insurance companies, such as insurance exchanges or a government-run plan. Some are concerned that insurance companies would not be able to compete with the prices offered by those options and would be forced out of business.

Shroder and Pishkur said they don’t have recommendations on what system would work best, but they think the financial concerns of hospitals need to be considered.

Shroder said any solution should allow health-care providers to negotiate with insurance entities so providers can cover their costs.

He added, however, that he thinks it is unrealistic to think health care for the uninsured can be paid for by cutting back on waste in the system. Either extra costs are going to have to be built into premiums for those that can pay, or taxes must be raised, he said.

“I know that’s a bad word for any politician, but they have to get realistic,” he said.

Shroder said reform should include an overhaul of how providers receive reimbursement. Fees are now based on standards of care from the 1980s, and much has changed since then, he said.

For example, for-profit surgery centers have opened because they have identified certain procedures that are profitable, he said. Some surgeries now require brief hospital stays, but reimbursement guidelines were set when stays were lengthy, he said.

Shroder said HMHP, as a Catholic institution, does not want new legislation to force it to provide certain procedures such as abortion.

Though concerns about revenues and other issues are important, much good can come from the current debate, Shroder and Pishkur said.

Pishkur said the overall health of the nation could be improved if people had incentives to participate in wellness programs.

Shroder said this is an opportunity to eliminate measures that lead to a denial of coverage, such as pre-existing conditions and exceeding lifetime maximums on expenses. It also is a chance to allow individuals and small businesses to join pools so they can be part of a larger insurance group, he said.

“This is a hopeful time,” he said.

shilling@vindy.com