Health care reform? What needs changed?

By Josh Harvison - bio | email

POPLAR BLUFF, MO (KAIT) - Town hall meetings about health care reform have been popping up all over the United States. Monday, 2 public forums lead by representatives of Sen. Claire McCaskill's office will be held in southeast Missouri, the first to be held in the Region 8 viewing area. The morning session will be at Southeast Missouri State University in Kennett. The afternoon session will be at Three Rivers Community College in Poplar Bluff.

McCaskill is scheduled to appear at the meeting in Poplar Bluff, which Region 8 News learned was a RSVP event. Susanne Gann with the AARP told Region 8 News Sunday the senator asked her to send her concerns through e-mail. Gann said there were 3 things she wanted to know about.

"One being that the seniors are treated equal as they age. That aging doesn't have anything to do with the benefits that they would receive. And secondly, the cost of it would be something that the middle class and the lower class would be able to pay on a fixed income," said Gann.

Gann also said she didn't want the government to force individuals out of their current health care insurance.

Gann said she'd like to see the forums in southeast Missouri be constructed peacefully, citing events across the country that have been violent.

"Considering the fact that it is a very hot topic, it does not give people, as far as I'm concerned, the right to show a lack of discipline and there's no way that anything positive can be accomplished when these outbreaks occur. It's through sitting down and sensibly talking things out and having the right attitude that we get things accomplished," said Gann.

Gann said several aspects of health care need to be put under the microscope. She said Medicaid is insufficient, a sentiment also felt by the CEO of Poplar Bluff Medical Partners, Michael Burcham.

"There are different facets underneath that. Health care reform, insurance reform, medical malpractice and liability and tort reform," said Burcham.

Burcham said insurance needs to be reformed and believes there are ways of doing so without going to a government option, which has been proposed by President Obama.

He said the insurance premiums he gives his employees have risen 47% since the beginning of the year.

"It's very difficult for us under those circumstances because our bill has gone in the last 3 years from about $300,000 a year for health care to well over $500,000, almost $600,000 a year," said Burcham.

The Poplar Bluff Medical Park has been in operation since 2001. The 90,000 square foot building is worth an estimated $25 million.

Burcham said the medical facility tries to operate within a profit margin of 1-3%. One problem he has with insurance is that it takes an average of 65 days to be reimbursed by the companies. He said that's because nearly 31% of the overall health care cost is administrative.

"When I look at health care reform, the first thing I look at is insurance reform. On one side we pay a lot of money to access the insurance so that our people can have health care coverage. On the back side, dealing with healthcare companies, we invest a lot of time and effort administratively just to get those bills submitted and paid," said Burcham.

Poplar Bluff Medical Partners runs the hospital cooperatively with the St. Francis Healthcare System based in Cape Girardeau, MO. The facility provides local physicians with on-site offices, allowing patients to get all their medical needs in one location.

"Imaging. We do a full array of services. Nuclear medicine, CAT scans, MRI, ultrasound, diagnostic radiography," said Burcham. "Part of our mission is to provide affordable quality health care that is accessible. When we look at affordable healthcare, you've got to take it down to the level of how much does it cost the patient?"

Burcham said he's looked at ways of reducing the overall out of pocket cost for a patient.

"They might have to pay an upfront co-pay, which is required by the insurance company. But the big ticket item is that 20% that they have to pay on the back side that the insurance company doesn't pay in most cases," said Burcham.

Another aspect of health care Burcham said he'd like to see go forward is a prevention and wellness program.

"There's figures out there that state specifically and have been proven that we can lower the healthcare expenditure in the United States, the overall health care expenditure by 40% if we added and paid for prevention and wellness and provided incentives for me as an employer or for me as an employee to be well," said Burcham.

Medical malpractice was another aspect of health care Burcham would like to see changed.

"I look at the patient perspective. If you look at a judgment, a patient goes to court, they had a wrongful incident, and let's say the court rules in their favor and gives a judgment of one million dollars, right up front. Typically, 40% of that goes to legal costs and the attorneys. Now if that number is based on economic loss for that patient for the next 20 years, then basically they've only been given 60% of that," said Burcham. "I fully agree that everybody deserves their day in court. I don't agree that a great percentage of that goes towards somebody other than the patient and there needs to be some rules and there are some pretty neat ideas that have been thrown out there by the AMA (American Medical Association) and other organizations."

One of the biggest priorities for Burcham was keeping the patient/physician relationship stable. He said if a doctor is allowed one-on-one access to his/her patient, then that patient is more likely to follow through with the medicine prescribed.

"Health care reform has to maintain that relationship between a patient and the physician. That's one of the key things. The government or any other entity really shouldn't take away a patient's choice to choose who they want as a physician," said Burcham.

Burcham said revisions also need to be made to Medicaid and Medicare. The money paid through those programs doesn't cover the cost of treatment, according to Burcham.

"They are trying to save money by reducing current Medicare or Medicaid payments to hospitals and providers such as ours, and physicians. Most of what Medicare pays right now falls below our actual cost and there is a lot of disparity in payment through those systems," said Burcham.

Burcham also said more people are qualified for Medicare and Medicaid than are in the program because some are too proud to register.

"We may have the best health care system in the world, but why do we have that? We need it. We've got one of the most obese populations in the world. We've got a lot of people who smoke, a lot of people who don't take care of their diabetes, their hypertension, we treat chronic illness and it goes way on. We have got to develop a system that rewards prevention and wellness," said Burcham.

Burcham said 3 weeks ago the hospital sent out information to 10 insurance companies, allowing them to make bids. Of those ten companies, only 2 offered to bid, according to Burcham.

"There are better ways to make insurance companies more competitive than offering another government option. If a government option was structured appropriately and there was reform in payment to physicians for Medicare and Medicaid, then it might be worthwhile," said Burcham.

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