Here comes Obamacare

Like it or not, Obamacare is here, and our healthcare leaders say they are doing their best to deal with that.

“It’s the law of the land,” said Jon Ness, CEO of Kootenai Health. “This is a federal law that has been upheld by the Supreme Court of the United States, and if we don’t participate, there will be penalties.”

And devastating penalties at that, he added.

So what does that mean for Kootenai County residents who have relied on the Kootenai Hospital District since it was formed in 1956 to care for their medical needs?

Everything is going to change. Everything.

And with change there is always uncertainty, said Kootenai Hospital District Board Chairman Paul Anderson, adding the district is well prepared to meet those challenges.

“I am probably not the biggest fan of all things Obamacare,” said Anderson, a retired Avista executive who has served on the hospital board for the past 16 years.

“But one positive thing it has done is shine a light on all of the extra costs and services that healthcare providers have been providing under the old system,” he said. “Some of those services didn’t need to be provided.”

The Affordable Care Act, which has been politically branded and commonly referred to as Obamacare, was established in law three years ago and is designed to be implemented in stages over a 10-year period.

What most people don’t realize is that the healthcare industry nationwide has quietly spent the last three years wrestling with the complexities of how to seamlessly continue delivering quality healthcare services while navigating through more than 400 rules this new law requires.

Essentially, whether they like it or not, Ness and Anderson have the untenable task of leading our regional healthcare system through a transition from its traditional pay-for-service business model into a pay-for-performance system that is more affordable and accountable to the patients they serve.

That means change — a whole lot of change — and as a matter of course, change involves political fall out. Kootenai Health has had its fair share of that recently.

Just this year, the hospital district has come under fire for allegedly causing a mass exodus of oncology doctors from its cancer center.

It’s been criticized for buying out a number of healthcare businesses in the region and taking them off the tax roles.

And, most recently, the hospital board — and even Ness himself — has been accused by conservative political groups of using taxpayer dollars to advocate for Obamacare and the new state-run insurance exchange that was passed by Idaho’s legislature last month.

One political group, the Reagan Republicans, came out this week targeting two seats on the hospital board that come up for election on May 21st.

The accusations, both Ness and Anderson said, can be explained.

The Politics

Jeff Ward, of the Reagan Republicans, came out last week and accused Ness and the board of trustees of advocating for a state-run insurance exchange and he claims Ness has vocally supported certain elements of the new Obamacare law.

Ward explained his position in a recent online post.

“Why are Reagan Republicans concerned about Kootenai Hospital Board of Trustees?” Ward wrote. “Consider this: Kootenai Health. a public hospital, has been a huge proponent of the implementation of Obamacare in Idaho. The current and former CEOs have been vocal proponents of Obamacare. This public hospital is an active paid member (using public funds) of the Idaho Hospital Association, the most active lobbying organization for implementation of Obamacare in Idaho”

Ness said Kootenai Health, along with every other hospital in Idaho, is a member of the Idaho Hospital Association for number of reasons, the least of which is for political reasons.

“Personally,” Ness said. “I have never advocated for Obamacare or the insurance exchange and to my knowledge no one on the board has either.”

In fact, he said, he has made a conscious effort to remain completely neutral when it comes the politics of healthcare.

Anderson agreed, saying the hospital board has to do the same thing in order to stay focused on the transition they are going through.

“When it comes right down to it,” Ness said. “It really makes no difference what our opinion is on these things. These are federal laws, and we have to implement them.

“And, quite frankly, the hospital would go broke if we didn’t do it.”

As for the election challenge, Anderson said he hopes the Reagan Republican candidates aren’t going to come in thinking they are going to micro-manage the hospital’s administration.

“The board has never done that,” he said, “We don’t set administrative policy, we set corporate strategic policy.”

While CEO does answer to the board, Anderson said the board’s direction to Ness can be summed up quite simply.

“Don’t put us in a position that would damage the (hospital),” he said.

Monopoly, or ... ?

“The notion that a hospital is just a hospital is simply not true anymore,” Ness said. “Under the new laws, it’s a comprehensive healthcare system.”

That can help explain why Kootenai Health appears to be aggressively buying out private practices all over the county. Ness said that is also why they are building a new Family Home Medicine Residency program across the street from the hospital.

Kootenai Health has also entered into a partnership with Earnest Health to build a new 30-bed inpatient rehabilitation hospital in Post Falls. And they have stepped in to stabilize private practices that provide specialized medical services that would otherwise no longer be available to the citizens of Kootenai County.

They have added specialized cardiology equipment and hired 3 physiologists and 22 cardiologists, so people won’t have to travel anymore to get healthcare for their heart problems.

“For decades people have been going to Spokane for those services,” he added. “They won’t have to do that anymore.”

It’s all part of a strategic plan to create an accountable care organization by expanding its palate of healthcare services, so patients no longer have to travel for their healthcare needs. Ness said that will be important under the new pay-for-performance rules.

Under Obamacare, the hospital is transforming its healthcare delivery system. Gone will be the days of going to hospital with pneumonia, and leaving with a handful of prescriptions. When the transformation is complete, that same pneumonia patient will come to the hospital and be assigned to a “team” of healthcare professionals who will be responsible for that patient until they are better.

“That means we can no longer send you home with a prescription and leave it at that,” Ness said. “Now we will be required to follow up with that patient to make sure they are taking their medication properly until they get well.”

If the healthcare team fails to do everything it can to ensure a patient’s wellness, under the new rules that patient will have the right to come back to the hospital and get treated again — free of charge — until he or she is well.

“We are on the hook for that. We have a financial incentive to make sure they get well,” Ness said. “If we don’t keep them well, we have to take care of them at no cost.”

That is why Kootenai Health is hiring doctors on staff, and building a new residency program to train doctors locally, Ness explained, adding that many doctors are seeking to become employees of Kootenai Health rather than going into traditional private practices.

“One of the things I keep hearing is why are we out there recruiting doctors and making them employees,” he said. “That is simply not the case. We have never gone out knocking on doors to recruit doctors. They want to become hospitalists.”

Hospitalist, he said, is the new term to describe the doctors who will be employed by the hospital.

As for the exodus of cancer doctors, Ness and Anderson can’t say much about that for legal purposes, but they hope the community will soon understand that it is all of part of this plan to strengthen our regional healthcare system in a way to deal with the new laws.

“I will say this,” Anderson explained. “About a year ago, the board sat down with Jon and said, we can do better than this, and that is exactly what we are doing. People will see that soon enough.”

What’s next?

Ness and Anderson said people may notice a new collaboration between the five community hospitals in North Idaho. The CEOs from hospitals in Bonners Ferry, Sandpoint, Kellogg, St. Maries and Coeur d’Alene have been meeting monthly to discuss how they can help each other.

Anderson said under the new rules it makes sense to form these collaborations.

“The one thing we have in common is that it is in our collective best interests to add services and keep patients closer to their homes,” he said.

According to Ness industry experts expect about one-third of the nation’s hospitals to fail under the new healthcare system. Most of those will be small community hospitals, he explained.

“What would happen if that occurred in Kootenai County? It’s unimaginable,” he said. “But in some communities it’s not unimaginable.”

Ness said he is gearing up the hospital to become a level two trauma center that will work primarily with the four smaller hospitals.

Anderson said in the past the hospitals competed for patients, but under the new laws, the hospitals will work together to ensure every patient is placed in the facility that is best suited to treat their ailments.

“If a patient is going to be able to get the care they need in one of these outlying hospitals, then that is where we want them to stay,” he said, adding that if the smaller hospitals cannot provide adequate services, Kootenai Health wants to be prepared to help.

“That is unprecedented,” Ness said. “You would never have seen anything like this collaboration before.”

Both Ness and Anderson said there some positive things that will come out of the new laws, and there are some controversial things that will be implemented along the way. (See related story)

“The important thing to understand is there is no way to opt out of this. Every hospital in the nation has to do this, and some hospitals will close,” Ness said. “We are fortunate to have a board with enough wisdom to get us through this.”

Anderson added it is also important to understand that things will be changing and that his board is focused on ensuring a smooth transition.

“This is a work in progress,” he said. “We are not there yet, but we are getting there.”