Due to the costs of complying with recent health care reform, health care providers in New Hampshire will face a "rough road" during the next two years, Tina Naimie, vice president of corporate finance at Dartmouth-Hitchcock Medical Center, said during a health panel in the Rockefeller Center's Hinman Forum on Wednesday. The panel sponsored by the 2010 Rockefeller First-Year Fellows also featured New Hampshire Sen. Matthew Houde '91, D-Plainfield, and Alice Peck Day Chair Hospital Michael Harris '72.
While several federal reforms entail changes to health care delivery, most concern hospital finances, Naimie said. Administrators at DHMC, the second largest employer in the state, must rethink the institution's fiscal outlook, she said.
"In this new reality with the state budget, we won't get paid at all," Naimie said regarding Medicaid reimbursements. "We will actually owe the state money at the end of the year."
Collaboration and "increased partnerships" may provide part of the solution to cutting costs and saving money, according to Naimie. In addition, officials will identify hospital services and departments that may be reduced or eliminated in order to reduce the budget deficit.
DHMC received three weeks' notice from the state government that the hospital needed to pay $10 million of a $40-million deficit incurred from net patient service revenue, which represents a "significant" reduction, she said.
Houde presented the effects of both new federal health care policies and the state's legislative actions in health care. The state Department of Health and Human Services, for example, has cut 10 percent of its budget since the beginning of the recession.
"Almost all of [the changes] were geared at saving money or reducing costs," he said. "The budget represents, perhaps more than any other legislation, the priorities of the state."
New Hampshire politicians are also grappling with the issue of Medicaid reimbursements because hospitals lose money by treating patients covered by Medicaid, Houde said.
"Those costs and needs don't go away," he said. "They just get shifted somewhere else."
Houde said that the state must defray some of the Medicaid costs assumed by health care providers, but the state budget lacks sufficient funds.
"That leaves the hospitals in a fairly precarious situation, which is why there might be some challenges to what the state has done with respect to health care reimbursements," Houde said.
Reforms could have distinct effects on small, local hospitals, like Alice Peck Day, Harris said. Administrators at the hospital, located in Lebanon, may cease treating patients receiving Medicaid given a financial imperative for the hospital, Harris said in response to a student's question.
"Essentially, there appears to be a deficit of somewhere between $100 and $150 million for Medicaid reimbursements," Harris said. "[The hospital] stands to lose about 5 percent of its budget from these reimbursements."
The most important question for small hospitals deals with providing "personalized care" in the face of an uncertain economy, according to Harris.
"The challenge for us as a small hospital is how to operate and remain viable and competitive in the face of the state's squeeze on revenues and this federal uncertainty," Harris said.
States like Vermont and Massachusetts are "further along" in establishing a viable statewide health care system in line with federal reforms, according to Harris.
"There will certainly be a demand for more data, more paperwork from hospitals, in a field that's rather notorious for paperwork already," Harris said.
