Wednesday, August 15, 2012
Safety-net providers will be among the most significantly affected--for better or for worse--by what happens to Medicaid over the next several years. Perhaps prescient about the Supreme Court's ACA decision, Health Affairs has devoted its August edition to challenges facing safety net providers. The issue begins with Timothy Jost's discussion of the Court's holding concerning Medicaid and the states and the editor's observation that we may be facing a two-state system: states that do expand Medicaid and states that do not (or that even cut back). (Here's the issue: Health Affairs Aug 2012)
The issue is particularly useful for the empirical work it presents about the current state of safety net providers and their patients. Not surprisingly, nearly a third of providers are unwilling to accept new Medicaid patients at current reimbursement rates, percentages that were higher in smaller practices and in metropolitan areas. Perhaps more surprisingly, safety net hospitals directly governed by elected officials have done reasonably well financially--in part because of subsidies from state and local governments and disproportionate share payments, payments that may erode over the next several years. These hospitals have faced challenges in implementing new technologies such as electronic health records and may find themselves struggling competitively over the next few years. Efforts to introduce integrated delivery systems, medical homes, and accountable care organizations have met with some success, but the evidence suggests that as funding incentives wane these gains have diminished.
I commend this rich issue to readers of this blog. The overall conclusion I draw is that if safety net providers are to continue to function for patients, we will need to pay attention not only to which states expand Medicaid or to Medicaid reimbursement rates, but also to support for the infrastructure of safety net providers themselves.