By Mike Shields
KHI News Service
DENVER, Colo. — There likely will be fewer rural medical practices five years from now because of the various sweeping changes under way in the U.S. health care system, according to panelists at a conference held here this week.
“I really do believe that rural health systems aren’t going to exist in the same number they do today … and our job is to be the last one standing,” said Chrysanne Grund, who works for Greeley County Health Services out of Sharon Springs in western Kansas.
Grund was one of three featured speakers during a panel discussion on rural health issues that was part of the annual conference of the Association of Health Care Journalists, a four-day event held at a downtown Denver hotel. The other panelists with her were primary care doctors from remote areas of eastern Colorado and south-central Wyoming. The discussion was moderated by Bryan Thompson, a longtime health reporter for Kansas Public Radio.
The rural medical providers described a broad range of issues facing them, including the sweeping changes in federal health law and the more mundane but key problem of coping with the planned switch – likely as soon as Oct. 1, unless Congress decides otherwise – to a new coding system for medical billing called ICD-10.
Dr. Dean Bartholomew of Platte Valley Medical Clinic in Syracuse, Wyo., described the coding changes as “the coming tsunami” that could cost small practices up to $226,000 each to implement. The coding is used for billing and reimbursement by government health programs and private health insurance companies.
Bartholomew compared the changes to forcing a group of English speakers to switch to German more or less overnight.
There also will be the cost in lost time dealing with the new system, he said, that will make his practice “10 percent less efficient.”
He said that is critical in a practice that operates on narrow margins and where there are no competitors to fill the needs of the community in the event his operation closes.
“All the burden will fall on the provider,” he said. “This is a major, major issue.”
Bartholomew also said people newly insured through health plans purchased through the Affordable Care Act’s marketplace likely won’t be able to pay the relatively high deductibles, leaving doctors, particularly those providing primary care, to eat the cost.
He predicted the “self-pay burden” would become the “Achilles’ heel of the Affordable Care Act.”
He also said many of the patients coming in with the new health plans have long lists of health problems they had put off dealing with when they didn’t have coverage.
“I have some patients who have waited way too long,” he said, “and it’s going to be expensive to treat them.”
The providers talked about the rewards of helping family, friends and neighbors, but the close relationships that exist in small communities also can make the work difficult at times.
One problem is complying with HIPAA, the federal patient privacy law, when working in a place where everyone pretty much knows all there is to know about one another because of close-knit families or just routine proximity. It’s hard to keep secrets for long in a town of 700 people, he said.
Dr. Jack Westfall, who practices on the High Plains of eastern Colorado, described the anger of the Lutheran minister when a nurse told him she couldn’t acknowledge or confirm the condition or whereabouts of a member of the pastor’s congregation so he could do his ministering.
“He almost got in a fight with the nurse,” Westfall said, recalling when the law first became effective.
The closeness to patients can be gratifying but also can “take an emotional toll we don’t like to talk about,” Bartholomew said.
The day he had to tell his mother-in-law that she had cancer with a low survival rate “was the most difficult day of my life,” he said.
Each said they were moving forward with new technologies, such as electronic health record systems for patients, and using telemedicine in various ways to help link patients with specialists in distant cities.
“In a rural community, people want to sit down across the table (from a doctor) and look them in the eye and shake their hand and see these people feel they are important enough to show up for,” he said. “Telemedicine works well after meeting the specialist first.”
Westfall has been involved with community-designed health promotion campaigns. He said getting 700 or 800 people involved in an awareness campaign using locally inspired materials is far more effective than pamphlets designed by someone with little or no experience with rural living.
He also is working with Colorado Health-OP, a nonprofit health plan put together by a member cooperative that designed it to put “patients before profits.