Health Care and Community
At the county commission work-study session on Tuesday, July 9, 2013, Holy Cross Hospital (HCH) CEO Peter Hofstetter presented a complex picture of health care issues and how local service is affected by state and federal mandates. For the last few years Holy Cross Hospital has experienced a decrease in revenue due to changes from in-patient to out-patient trends in treatment, federal and state cutbacks of reimbursement, and what Hofstetter called “leakage,” as local patients seek treatment outside the community.
Meanwhile, according to Hofstetter, the hospital continues to cut staff, tighten operating costs, and manage more with less. The CEO said customer service surveys showed improved satisfaction; the hospital had received recognition from its peers in a number of categories, including clean audits. Apparently the hospital has been spending its reserves for a number of years to remain afloat. From what I could tell the Hospital’s reserves have declined from $5 million a few years ago to just over $2 million today, due to the squeeze.
Hofsetter’s mentioned how “rack audits” or audits by accounting firms, paid for by the federal government on commission, seek out “dedicated documentation” and currently force not only Holy Cross Hospital but all hospitals to justify requests for Medicare reimbursement. Indeed, the feds were, as one HCH staffer, said, punishing the hospital for decisions made seven years ago, as the men with green eyeshades delve deeply into the files. A county employee told me in an aside that it sounded like the East German Stasi.
When bankruptcy courts allow trustees to go after investors who may have profited, albeit unknowingly, from fraud, as in recent ponzi schemes by the Bernie Madoffs of the world, they use the term “clawback.” Through no fault of their own, private investors have found themselves coughing up dough from profitable investments in the past.
In addition to the spectre of accountants decked out in green eyeshades and bifocals, who are empowered to debate medical decisions made years ago by doctors or hospital staff, Hofstetter described the advent of the Affordable Care Act and the dispute between state and federal agencies regulating “sole community providers” i.e. local rural hospitals, as a further challenge. In fact the issues are so complicated that HCH is unable to finalize a budget in terms of accurate revenue projections and expenses because nobody understands the system.
Hofstetter mentioned that due to the changes in medical health care insurance and Medicaid that a trend is underway wherein most doctors are switching from private practice to becoming employees of hospitals and other health care units.
The Holy Cross team did not appear at the work-study session to ask for money but to alert the commissioners to the trends. The commission reimburses the hospital for indigent care based on need and provided for by a county GRT tax. So it was an information session that was as interesting as it was confusing, due less to the presentation than the complexities of BUD (Bureaucratic Use Disorder) caused by POD (Politics of the Day) in Washington D.C. and Santa Fe.
In a second presentation, Dr. Harris Silver, a health care consultant and drug policy analyst on the faculty at UNM, who serves as a liaison to the association of counties, discussed Medicaid and substance abuse with commissioners. Basically, he encouraged the county to qualify jail inmates during intake for Medicaid reimbursement. Dr. Silver also discussed the Affordable Care Act and the state’s interaction and how the Martinez administration had vetoed Senate Bill 65, called the “no-brainer” bill, which encouraged enrollment of inmates into Medicaid so they could be treated upon release from detention facilities.
According to Silver, the Governor opposes federal programs that encourage the acceptance of offenders in Medicaid. Silver discussed in detail statistics that show 60 to 70% of inmates suffer from a medical disorder. In turn they abuse alcohol and drugs to self-medicate. For every dollar invested in treatment, Silver said approximately $12 are saved in judicial and health care costs. Silver said you have to treat substance abuse before you can treat the mental disorder associated with it.
Apparently, following nationwide trends, younger Taosenos are becoming addicted to prescription drugs. When the addict runs out of doctors and can’t afford to buy prescription drugs on the street, he or she turns to heroin. Hence, according to Silver there has been a spike in heroin usage, especially by pre-teens, teens and young people in Taos.
The Annie B. Casey Foundation studies found the state of New Mexico to be at No. 50 when it came to its care of children, using studies based on economic, education, and health care conditions et al. Google it on the web and see the survey for yourself. Or Google The National Health Service and see how New Mexico maintains its status as No. 1. in most categories when it comes to substance use disorders (SUD) or the abuse of alcohol and drugs. Although Rio Arriba County maintains its No. 1. status in the nation for death by drug overdoses, Taos County is catching up and was recently rated No. 8 in New Mexico.
Once a black-robed member of the judiciary told me, “we (judges, DAs) aren’t social workers.” But he was wrong. Hilary Clinton probably said one true thing: “It takes a village to raise a child.” In Taos there are lots of attentive folks, do-gooders, non-profits, local, state and federal programs in place. The state, during both the Richardson and Martinez administrations, has thrown a ton of money at education to no avail.
We have to try harder. Si se puede.