Low Medicare
and Medicaid reimbursement rates, increased uncompensated care to residents,
and rising medical costs are factors contributing to the decreased sustainability
of community hospitals. Some hospitals
had previously invoked protections as federally designated critical access facilities, under the Balanced
Budget Act of 1997, which provides increased Medicare reimbursement rates;
however, many hospitals
in disadvantaged geographic areas of the Commonwealth are vulnerable to
financial crisis. That is due in part to
lower patient volume, less medical expertise in specialized procedures, limited
access to state-of-the-art technology, fewer patients with private
insurance and an increase in patients with public coverage, underinsurance, or
the uninsured. Moreover, the Affordable
Care Act (ACA)
subjects hospitals to rate reimbursement decreases, while encouraging hospitals
to integrate systems, control costs, and improve patient care. Small hospital financial considerations, therefore, may include
hospital closure, reduction in or elimination of less profitable services, or merger and affiliation with greater
market-sharing facilities.
To
communities, the loss of a local hospital can devastate public safety and economic
survival -- e.g., the recent North Adams Regional Hospital medical crisis. While
the ACA mandates residents to obtain and maintain healthcare
insurance, it also compels providers to evaluate programs and to reduce healthcare expenditures while improving the quality of services rendered. Moreover, the ACA’s accountable care organizations and the Commonwealth’s Chapter
224 of the Acts of 2012 galvanize medical providers to improve the quality of healthcare
services while minimizing cost. To rural hospitals, the solutions are more frequently becoming mergers or affiliations with larger hospitals that have improved access to
physicians, specialty services, updated technology and equipment, and reduced
administrative outlay.
Let's consider what is now before us – Partners
Healthcare System and the Massachusetts Attorney General Office’s proposed
settlement agreement with respect to Partner’s acquisition of South Shore Hospital
and Hallmark Health Corp. Such commandeering healthcare transitions would ultimately have long term public repercussions not only on the local communities
involved but also throughout the Commonwealth.
Private and public insurers, employers, and consumers may inevitably be
compelled to cover the ‘cost’ of an increasingly, anti-competitive healthcare industry.