ESCANABA - While employers and employees struggle with the ins and outs of health care reform, doctors and other healthcare providers have struggles of their own. Congressman Dan Benishek was in Escanaba Wednesday to hear their concerns as part of a listening tour of hospitals in Michigan's 1st Congressional District.
Benishek's visit Wednesday brought the congressman to OSF St. Francis Hospital and Bellin Health in Escanaba, where he asked staff about the affects of the Affordable Care Act and other regulations on their operations.
"I'm just trying to go (on tour) now because now (ACA is) being further implemented. I'm quite concerned about the effect it's going to have on local healthcare," Benishek told OSF staff.
One concern that was raised was that lower reimbursements from Medicare, costs associated with mandates, and strict regulations could force smaller community hospitals to join networks out of necessity. While OSF St. Francis has been a part of the OSF system for 130 years, other Upper Peninsula hospitals are following suit, including Marquette General which recently became part of Duke LifePoint Healthcare, a for-profit hospital network.
Benishek also expressed concern this trend would affect more than hospitals, but also individual physicians.
"A lot of physicians are leaving private practice to become affiliated with somebody because they can't afford all of the mandates and paperwork and all that," he said.
While OSF hospital and its physicians may be better positioned than some other healthcare providers due to its long-standing network system, the hospital is far from immune to the financial burdens that plague medical facilities.
"This hospital was built 1986 against the advice of the consultants, (which) said 'you're going to have a hard time recouping your costs from building this facility.' We still maintain the original debt from building this facility. So we struggle as well," explained OSF St. Francis Hospital CEO and President Dave Lord.
To become a more sustainable model, OSF in Escanaba was reclassified as a critical access hospital in June 2012. The designation allows the hospital and medical group to receive greater Medicare reimbursements but puts greater restrictions on available beds and stay lengths.
To qualify for the designation a hospital must have no more than 25 inpatient beds, maintain an average stay for no more than 96 hours for acute inpatient care, offer emergency care, and be located in a rural area at least 35 miles from any other hospital.
OSF staff raised concerns over two rules: the "96 hour rule," which is the limit on average inpatient stays, and the "two midnights rule," which switches patients from observation status inpatient if they are in the hospital for two consecutive midnights.
"Bureaucrats in Washington trying to dictate rules to local hospitals don't have a clue what's going on in Escanaba. So if somebody ... needs to get their colon re-sectioned for a tumor of the colon, you're capable of doing that here, but you certainly can't guarantee that person's going to be home in four days," said Benishek.
Besides shortening the 96 hour window of an ideal average stay, the two midnight rule reduces the number of already limited available beds.
Staff also mentioned that the questions they were required to ask patients at each visit were cumbersome and frequently annoying to patients - and their physicians.
"We have to check for learning disabilities with all these patients. We have to ask if they're depressed even if they come in with an ear to ear grin. We have to do all these things that don't make a lot of sense that we have to do to everybody, but we have to do it to everybody," said Dr. Mark Povich, family physician and director of the primary care medical group.
Staff noted if the regulations produced better care through incentives they would not object to them, but felt that the regulations did nothing but create hoops to jump through for incentives and create penalties.
"My goal is to save a system of healthcare that is really the best in the world but it costs too much, and the president's plan hasn't brought down costs at all," said Benishek. "From what I'm hearing it's making it more expensive for the patient and making it more difficult for hospitals to continue to provide care."