Preparing for the Affordable Health Care ActPositive change seen by BIHS executive director
Executive director of the Block Island Medical Center, Barbara Baldwin, comes to this position with experience from leading other healthcare agencies (three Planned Parenthood offices around the country) and other healthcare related projects (Rhode Island Healthy Kids Initiative.)
With the national Affordable Health Care Act (ACA) scheduled for implementation in January, 2014, Baldwin felt this was a timely topic for discussion. The Center needs to gear up for change, Baldwin said, and she has some ideas on how that might be accomplished. This interview was conducted earlier this year.
B. I. Times: How will the Affordable Health Care Act benefit people?
Baldwin: Medicaid, which was first created in 1965 as an amendment to the Social Security Act, has been until now the closest thing to public healthcare our country has provided other than Medicare. A joint effort of the federal and state governments, it offers health coverage for a portion of low income people at no charge. It is limited, though, because it is focused only on women with children and does not cover men or single women.
The ACA will extend health coverage to include men and single women. Anybody who earns under 133 percent of the poverty level set by the government will be eligible. (The federal government sets guidelines for poverty levels, depending on how many people in a household. For a single person, the poverty level is set at $11,490. Therefore, 133 percent of the poverty level would be $15,282, which means that a single person earning under $15,282 a year would be covered by the ACA.)
The Massachusetts Health Care Reform Act is similar to the national Affordable Health Care Act, and in Massachusetts, that law extended healthcare coverage to people who had not previously had any. Now 98 percent of the people there have coverage. More people on Block Island might qualify for the program than there have been.
There has been a lot of controversy about the ACA, but from my perspective, it is a big step forward, particularly for the most vulnerable people in our population.
B. I. Times: What is Rhode Island’s role in implementation of the Act?
Baldwin: I have been in contact with the people making these decisions. [R.I.] Lt. Gov. Elizabeth Roberts, who has a background in healthcare policy, laid the groundwork for how the program should be structured in this state, and to do so, Roberts studied the Massachusetts plan and Vermont, as well. The latter state has universally available health insurance with a single administrative system for claims and provider payments.
Subsequently [R.I.] Gov. [Lincoln] Chafee appointed Christine Ferguson as Director of Rhode Island’s Health Care Exchange. Her task is to set up the exchange. She previously oversaw the Department of Public Health and Healthcare Finance and policy in Massachusetts and prior to that ran the Department of Human Services in Rhode Island.
The healthcare exchange might have three components: a plan for people with pre-existing conditions, a plan for small businesses, and plans for individuals who do not qualify for either Medicare or Medicaid. Who the providers will be has not been determined, but there will probably be a cap on insurance costs for the public.
B. I. Times: Will it increase primary care visits and revenues at the B.I. Medical Center?
Baldwin: The dilemma we are in is, it is almost impossible to know how many of the uninsured we see [at the Center] will become insured and increase our revenues.
Although there will be financial penalties if people choose not to carry insurance, they aren’t set yet, and no one knows how many young people will choose the penalty over health insurance. One group that might increase is young people up to age 26 who can be carried on their parents’ plans. We may see the impact of this in summer, when young people work or visit the island and need emergency health care.
With so many unknowns, it is hard to create a realistic budget for the BIHS. I do not foresee staff changes at the center as a result. Staff issues are driven by the number of people we see. We’ll be providing the same services.
B. I. Times: How will the Electronic Medical Records (EMR) requirement impact the medical center?
Baldwin: Paper health records will be obsolete. Healthcare providers will be required to convert to electronic records. The cost of making this switch could be high. However, if the medical center can accomplish it by 2014 it will reap back some financial benefits. Incentives are being offered not only by the federal government, but also by insurers. It will not cost us as much to do it if we can establish meaningful use, that is, demonstrate that we can see a specified number of Medicare and Medicaid patients within a certain time period, then we qualify for these financial incentives.
Counterbalancing the expense of implementing the electronic records are the benefits. They will facilitate transport off the island. The electronic record can arrive before the patient, allowing preparation at the mainland facility. There will be better continuity of care. The record can be summarized and shared easily.
One of the hard parts of the electronic record is people end up focused on the computer, not the patient…we are considering using tablets [rather than desktops]. Tablets are more portable, and can be used like a clipboard with paper. Staff will need to be trained to use them effectively.
B. I. Times: How will the transfer to electronic records be implemented?
Baldwin: The first charts to be transformed will be the health center’s primary care patients. I am in the process of obtaining a report on the number of those people seen in the last two years with a Block Island zip code, as well as their last date of visit.
The Center is working with consultants to come up with an implementation plan. While carrying out the transfer, patients still have to be seen, and their records available, which makes the process tricky. The medical center has found a vendor in North Kingston, Amazing Charts, which is highly rated and one of the more affordable of the available options. Because it is located nearby, staff can be sent there for training.
A system used by the medical center needs to interface with other places the records will go, one set for billing, and one a practice management program that will go to hospitals, specialists, etc. The government, has set up key data elements so there will be similarity between systems.
B. I. Times: How will people be able make a knowledgeable choice among the plans that are offered?
Baldwin: One interesting component of the ACA is that the government has requirements for insurance companies to report what they do in the same manner so that someone can look at five different insurance plans, for example, and compare them.
The website Healthcare.gov explains what benefits will be available to the public.
B. I. Times: So, can you sum up the impact here?
Baldwin: It’s a big unknown for us. I want to think it is a wonderful opportunity for the people on Block Island and the Block Island Medical Center.