As the Affordable Care Act takes effect this year, Delta County Memorial Hospital Administrator Jason Cleckler is navigating uncertain terrain.
Already about half of the hospital’s patients are insured through Medicare, and the first wave of baby-boomers is just becoming eligible.
And, new guidelines for Medicaid will likely increase that percentage by as much as 20%. That means about 70% of the hospital's clientele will likely be covered by government insurance plans.
What's more, over a third of Delta County’s physicians have left in the past two years, and that's setting off alarms for local healthcare professionals.
Jason Cleckler began his medical career as a psychiatric nurse. He progressed to teaching at CU, coordinated a trauma center, and only recently became Delta County Memorial’s CEO. As someone who knows both the clinical and the business side of healthcare, he says the Affordable Care Act is presenting a big challenge.
“The concern from a rural healthcare standpoint is that the reimbursement for Medicare and Medicaid is low,” he says, “and now Congress is looking at the serious potential of cutting reimbursement again for Medicare and Medicaid.”
Cleckler says because of those cuts, more people will be now be on both forms of coverage, but he says many private practices have had to close their doors to Medicare and Medicaid since the reimbursements are so low.
“So it really puts up a barrier to one of the two key pieces of affordable care - affordability and access,” he says.
Still, Cleckler believes there were good reasons to reform healthcare.
“I do believe the basic premise was a good one,” he says. “We had a rapidly growing population of uninsured in this country, we had healthcare costs skyrocketing, and it was quickly becoming evident that there was not any more money to take care of these people, and a large majority of people did not have access to healthcare.”
The concerns of rural nonprofit hospitals were not considered in the reform legislation, says Cleckler, while insurance companies and pharmaceuticals lobbied heavily for their interests.
“I have concerns that in the next couple of years they say insurance companies will quadruple their profits due to healthcare reform,” he says. “I have concerns that pharmaceuticals are posting record profits, and hospitals are having their reimbursement cut.”
Compounding the problems, the Affordable Care Act mandates costly procedures, among them implementation of Electronic Records Management. Cleckler says while the idea is that those electronic records will improve efficiency and give hospitals more access to patients’ data, rural hospitals haven’t necessarily seen those benefits.
“About $3 million has been spent on a computer system,” he says, “and now we have to continually purchase interfaces, we have maintenance fees on those programs.”
But Cleckler is encouraged that a consortium of local medical facilities and services have recently come together to create a plan for a rural health network.
It would allow for shared costs and cooperative arrangements. Against the odds, he’s optimistic about the future of healthcare in Delta County.
“There’s more challenges coming,” he says, “and certainly there will be some positive things as well, but it makes it a whole lot easier when you have people from different groups coming together for the common good of improving health care and access to health care.”