Freas says uncompensated care at Southwest General is 4% of net revenue, but she's unclear how the Supreme Court's ruling will affect her organization's Medicaid payments and payer mix. For forecasting purposes, though, Freas is assuming that Ohio will participate in the expanded Medicaid program, which will cause her organization's uncompensated care levels to decline while Medicaid numbers will increase.
"If they don't participate, my downside isn't as bad as it may be at other hospitals because we don't get [Medicaid] DSH," she says. For now Freas says she'll watch to see how Ohio responds to establishing the insurance exchanges—a process which hasn't started yet.
"At the end of the day, we are focusing on finding ways to reduce the cost of delivering care regardless of whether there's PPACA or something else [in effect]," she says. "There's always been uncertainty [in healthcare], now there's just another layer of it. Dealing with [change] is just part of what CFOs do."
Freas, Freed, and Fifer all agree that moving ahead with the transition from volume reimbursements to value is essential, regardless of what happens to PPACA and Medicaid.
"[CFOs] can't wait around and engage in debate endlessly while the government tries to think up a solution," Freed says. "We think the solution will come out of us and the community."