Obama healthcare plan a plus for hospitals, Moody's says

While I agree a funding/financing solution to the uninsured/uncompensated care problem for many hospitals could be a positive... however, at what cost? Are we jumping from the frying pan into the fire?

Some real world issues to consider.

(1) How will states reallocate funds currently supporting hospitals with large uninsured patient care loads through the Medicaid funded monies associated with bad debt charity care and disproportionate share dollars... especially when Medicaid typically pays hospitals only 75% of actual care delivery costs at present?

(2) Will states and/or the federal government also add assessment fees on top line hospital revenues to help pay for these new programs, creating an effective care giver tax? The complexity of the healthcare system usually means that new healthcare entitlement programs are generally more expensive than originally anticipated.

(3) How will the large managed care plans react with respect to their hospital reimbursement when they have known for years that the reimbursement that hospitals seek from them in excess of actual cost are in part, intended to offset underpayments from government payers and bad debt from the uninsured?

(4) With respect to Medicare reimbursement... how will bad debt charity care and disproportionate share as well as graduate medical education dollars be reallocated?

(5) Government... be it federal or state... has a long history of reimbursing providers below the actual costs vs. allowable costs, of delivering health care services. As such, how will the Obama healthcare plan reconcile that history with current budget crises at both the federal and state level?

(6) How will the Obama plan address the high cost/complex care needs of chronic care and major acute care patients whom as a group might represent 5% or 6% of the population, but consume over 60% of the claim dollars? Might there be more funds available for care if we can improve quality and outcomes as well as improve early diagnosis and perhaps avoid costly down the road events?

(7) The cost of IT solutions and creating IT solutions with interoperability are incredibly expensive and take years to implement and integrate. Where will the money come for this initiative when nearly half of the nation's hospitals are on the verge of bankruptcy?

(8) Finally, let us not forget physicians whom increasingly worry about how they will maintain their compensation levels in an increasingly complex and difficult business environment. Relationships and incentive alignment between hospitals and physicians have greatly weakened over the last decade with many hospitals increasingly competing with their own medical staff. How will the Obama health plan align incentives between these two parties and encourage collaboration vs. competition?

Cautiously Optimistic but Concerned Healthcare Finance Professional