Skip to main content

Community Hospitals Become Default Advisors on HIX

 |  By John Commins  
   September 25, 2013

Hospital associations and the feds are encouraging community and rural health providers to step up for health insurance exchanges. But for many, it's just one more mandate.

As the six-month open enrollment period for the new health insurance exchanges created under the Patient Protection and Affordable Care Act begins on October 1, community and rural hospitals will be the default advisors for patients and consumers trying to find the right coverage.

The nation's three largest hospital associations—American Hospital Association, the Catholic Health Association, and the Federation of American Hospitals—embraced that idea at a joint webcast last week and encouraged the hospitals they represent to play an active role in signing up their patients for coverage through the exchanges.

"People will only enroll if they know that this coverage is available and if they understand how to access these new coverage options," AHA President & CEO Rich Umbdenstock said at the event. "That is where we can help. It is critical that community stakeholders—certainly hospitals, faith groups, civic organizations and others—come together to help make the enrollment process straight forward and widely available."

Meanwhile, the Department of Health and Human Services said this week it would divvy up $2.5 million and give $25,000 each to 52 hospitals and other rural providers to "educate and enroll uninsured individuals and families living in rural America in new health coverage options."

"Soon millions of Americans in rural communities will have new opportunities for quality, affordable health coverage through the Health Insurance Marketplace," HHS Secretary Kathleen Sebelius said in prepared remarks. "Through these awards, trusted community providers will help people understand their coverage options, including whether they can get a discount on costs."

(It's not clear if that money will be nearly enough for the task at hand, but undoubtedly the thousands of tiny rural hospitals out there whose critical access designation is under threat will take comfort in knowing that they are still "trusted community providers.")-

Of course it makes sense that hospital associations would actively press their members to push HIX and that these member hospitals would embrace the challenge as well, if only for the bottom line and regardless of how they feel about the larger reforms under the PPACA. The more insured patients, the more reimbursements, the less charity care, etc.

Lori Real, COO of Bi-State Primary Care Association in Vermont, says the nonprofit is using its $25,000 grant to support outreach and enrollment in select parts of that almost entirely rural state.

"We are working with the Open Door Clinic to provide education and assistance to uninsured residents planning to enroll in Vermont Health Connect beginning October 1," Real told HealthLeaders Media. "Navigators are trained and already providing information through libraries, famers markets, and direct outreach to farmers and farm families in Addison County."

For other providers, the rollout is proving to be more difficult.

"We don't have anyone trained as of yet, but when it comes to it community hospitals in a lot of smaller communities are the main healthcare resource. if not the only one," says Tim Putnam, CEO at Margaret Mary Community Hospital in Batesville, IN.

"There is no other resource that can do it so we have to be there for patients by default. Unfortunately we are not well versed on it yet. There are a lot of variables, and each state and each region in the state have a lot of different options available. We are going to have to get up to speed on this quickly," he says.

While all providers will benefit from serving more insured patients, it seems a little late in the game to be dropping this responsibility into the laps of small hospitals that are already struggling with a host of challenges related to lower admissions and reimbursements and a numbing number of new and complex mandates, ranging from meaningful use Stage 2 to ICD-10.

"It's been one trim or one mandate after another. It is so difficult to keep track of them," Putnam says. "It's just another thing we are going to have to provide, but a big part of our mission is community access to healthcare, so we will figure out a way to do it."

In fact, Putnam sees HIX and other reform challenges as a test of his hospital's mettle, and other community healthcare providers like his.

"We were here before Medicare existed. We've been through a lot," he says. "We are not talking about organizations that sway with the wind. We act like an umbrella. We still serve the patients regardless of which direction the wind and rain are coming from. We have a lot of history behind us that we have to adapt our organization to fit whatever the rules are and still be able to provide good care for our patients. Everybody who has been in healthcare for a long time realizes that. We walk down the hallways of this organization and have the pictures of the people in the 1930s and 1940s who delivered care and faced their own challenges. This is our time."

Pages

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Tagged Under:


Get the latest on healthcare leadership in your inbox.