Hoping for a recovery

While public hospitals can expect another challenging year operationally, Dr. Bruce Siegel, president and CEO of the National Association of Public Hospitals and Health Systems, says there might be some good news ahead.

“I think it's a year of economic recovery,” which translates into potentially fewer uninsured patients and fewer patients on Medicaid.

Safety net hospitals rely heavily on the relatively low reimbursement rates of Medicaid, but an improving economy would reduce that reliance.

Moreover, some procedures and elective care that has been put off for financial reasons could get a second look as more people gain jobs with health insurance coverage, giving a boost to volume.

“People have been holding back and I think that may change,” Siegel says.

Some provisions of the Patient Protection and Affordable Care Act that hospitals will need to prepare for in 2013 also are attractive to public hospital executives, such as efforts to get healthcare providers in hospitals, clinics and elsewhere working together on a patient's care.

It's something that vertically integrated public health systems have done for years, Siegel says. “They're already there. They're already used to this” approach, he says. “The days of the hospital that only worries about its own four walls is going to pass.”

Meanwhile, the NAPH and its members are still fighting to avoid a looming 2014 cut to Medicaid disproportionate-share hospital payments tied to the Affordable Care Act.

For critical-access hospitals, 2013 will include a heavy focus on achieving the standards for the meaningful use of electronic health records, says Brock Slabach, senior vice president for member services at the National Rural Health Association, Kansas City, Mo.

The federal government is aiming to get 1,000 of the country's small rural hospitals—including critical-access hospitals—qualified for meaningful use by the end of 2014. The government is awarding up to $30 million to regional extension centers to help up to 1,500 hospitals work toward meaningful use, which would represent about 90% of hospitals that qualify as a small rural hospital by the government's definition.

And like other hospitals, rural facilities are going to be monitoring closely the development of health insurance exchanges among the states, Slabach says. Rural residents may have access to health plans, but a big question is whether or not those plans give them appropriate access.

Coverage isn't worth much if primary care and other essential providers in a rural resident's community are not a part of that coverage, Slabach says. “Are they going to use the local hospital, the local doctors?”