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Affordable Care Act bringing changes to health care in state

Apr 23, 2013 - By Alejandra Silva, Staff Writer

Former Riverton Memorial Hospital CEO Chris Smolik said that with a reformed Affordable Care Act, providers will be paid less for certain services, and they'll be expected to provide better care while patients will be paying more for health insurance and receive fewer benefits.

"We're already seeing it in the hospital here," Smolik said.

An estimated 19.6 million people in the United States are expected to have Medicaid starting in 2014. According to the Wyoming Department of Health, roughly 28,000 Wyoming residents will be new Medicaid recipients by 2016 under the ACA. As the numbers grow, many health care professionals have suggested limiting the number of Medicaid patients they already see or stop servicing those patients altogether because they're not getting reimbursed a reasonable amount of money.

Smolick said that although several providers around the United States are steering that way, providers from Riverton Memorial Hospital couldn't afford to do that because not helping people with Medicaid or Medicare would mean not helping a majority of patients.

Many doctors are moving to larger practices to dodge reimbursement changes. A survey by The Doctor's Company, a medical malpractice insurance company, reported that out of the 5,105 surveys collected from doctors nationwide, 20 percent of them are shifting to larger practices.

More for seniors

The U.S. Department of Health and Human Services said seniors have saved hundreds on their prescription drugs and will continue to save more under the ACA.

In 2012, the U.S. Department of Health and Human Services reported 2,772 people in Wyoming were enrolled in Medicare, and the ACA saved them each about $630 on prescription drugs.

The department said nearly 40,000 Medicare patients also received at least one free preventive service in Wyoming from January to October in 2012.

Preventive services provide recipients with free annual checkups and screenings for cancer, diabetes and other chronic diseases.

The U.S. Department of Health and Human Services also plans to close what has been called the "donut hole." Under the current plan, Medicare patients go through a rollercoaster of partial payments for prescription drugs after meeting their yearly deductibles under Medicare Part D.

With the new plan, those recipients are expected to pay only 25 percent of the cost of their drugs once their yearly, out-of-pocket spending limit is reached. In 2010, they paid 100 percent of their drug costs after they reached the spending limit.

A positive outlook

The results of a survey conducted by The Doctor's Company reported 22 percent of doctors feel optimistic about the changes in the ACA because those with pre-existing conditions will still get help, there will be better preventive care services, especially for the poor, and many more Americans, including the elderly, will have health coverage.

For instance, a change in ACA states if parents have health insurance plans that cover children, the children can be covered until they're 26 years old. Even if they're married, not living with the parents, or are still attending school, children can join or remain on the family insurance plan.

Teton Therapy -- a physical, occupational and hand therapy clinic with locations in Riverton, Lander and Dubois -- has made it a goal to inform patients of how the changes in ACA affect therapy caps and costs.

Teton Therapy CEO Jeff McMenamy said that with the combination of Medicare coverage, out of pocket costs and supplemental insurances, patients are unaware and many times confused with what services are covered and if they've hit their annual therapy caps provided by Medicare.

"We have resources for patients to walk them through steps to maximize those benefits each step of the way," he said, adding that it gets trickier as the types of services within the cap differ when it comes to hospital stays, home health care services, and nursing home and outpatient services.

"We stay on top of things so we know exactly what to push the envelope to," McMenamy said.

The centers use "patient representatives" who learn about each patient's insurance coverage and consult with them on costs and what's important to know before going further with services.

"People are just going to have to be more educated and really understand what their health system can do for them," he said. "We still have an obligation to get patients 100 percent better even if we have less time to do it or less money."

On the positive side, McMenamy said with ACA changes, services in the health care industry are now judged by the results after care instead of what the treatments are. Less complaining and a different mindset is what the focus of his centers has shifted to, he said.

"If we're in the business of getting people better, we have to embrace it, not fight or complain about it," he said. "We're taking a very positive proactive role."

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