That’s the word Noble Hospital President George Koller chose to describe the latest in a series of financial hits that the state’s hospitals have been forced to absorb.
He was referring specifically to a letter from the state Division of Health Care Finance and Policy (DHCFP), which was alerting hospital administrators to what is expected to be a larger-than-anticipated deficit in the state’s uncompensated care pool. The DHCFP was telling administrators that when 50,000 people go off the Medicaid rolls next spring, the only recourse for many in that category will be the emergency room and other services that hospitals simply won’t be reimbursed for.
The irony here is that the state is dropping people from the Medicaid rolls in an effort to mitigate what has certainly become a budget buster for the Commonwealth. But this effort to balance the budget will come on the backs of hospitals, more than half of which have been losing money for years.
Indeed, at a time when hospitals have been begging the state for Medicaid relief, they not only fail to get that relief, but they get an additional burden instead.
That’s why Koller chose the word he did. It summed up the frustration that he and other hospital administrators have been feeling for several years now as they try to deliver quality care in an environment that makes that task incredibly difficult. “If this keeps up, no hospital will survive,” said Koller, who was certainly exaggerating, but nonetheless got his point across.
No one can say with any certainty yet what the impact will be on individual hospitals from this latest fiscal maneuver. But even if the losses are slight, they still add up to backward movement at a time when the state needs to take steps forward in efforts to fix an ailing health care system.
This latest turn of events serves up yet another reminder of why the next governor of the Commonwealth, be it Shannon O’Brien or Mitt Romney, needs to make health care one of the state’s top priorities. Clearly, at this point, it isn’t. It couldn’t be if the Medicaid reimbursement rate still hovers around 70 cents per dollar of care provided, one of the worst rates in the country.
Health care can’t be a top priority if the state continues to pull back on reimbursements for behavioral health programs, forcing many providers to simply eliminate such services because they can’t pay for themselves. And one can’t say health care is a priority if the state — to help ease a budget crunch — eliminates Medicaid services for tens of thousands of people and, in the process, throws another fiscal challenge at already beleaguered hospitals and other providers.
Elected officials — and those who want to be elected — talk about health care being an important issue, but actions speak louder than words, and the actions to date contradict the words.
The next governor of Massachusetts will have a lot of work to do when he or she takes over the Corner Office. The state’s economy is at a critical juncture, and there must be some imaginative steps taken to create not only more jobs, but high-wage jobs. Meanwhile, the budget deficit is projected to be about $1 billion, and no amount of waste-cutting and trimming of our bureaucracy will make up that shortfall. There will be some hard choices to make about steps to either raise more revenue (yes, taxes) or making cuts.
But health care must also be a priority. The state has been very fortunate thus far. The cutbacks and falling reimbursement rates have certainly hurt, but they have not had a serious impact on quality of care — not yet, anyway.
If steps are not taken to reverse current trends, quality of care will almost certainly be impacted. That’s why one of the next governor’s top priorities — and biggest challenges — will be to stop the insanity.