In his 30 years as Flathead County’s public assistance director, John Gardner has never seen so many people walk through his door asking about food stamps and Medicaid eligibility: married couples with $250,000 homes who have been laid off; young working folks who are feeling squeezed; hundreds of people.
The recession is changing the dynamics of health care at a time when the Obama administration is pushing heavily for sweeping health care reform and lawmakers at the state level are voicing their concerns as well. In the Flathead, which has endured hundreds of layoffs in recent months and has one of the highest unemployment rates in the state, the issue is particularly relevant.
Both the health care providers and general population are feeling the pinch. The number of people without insurance rises with every job lost, yet people continue to pour into the ever-growing Kalispell Regional Medical Center, North Valley Hospital and other area providers. The same concerns are associated with dental care and every other facet of the health care industry.
As a result, said KRMC’s vice president Jim Oliverson, health care providers are bracing for a year of “belt-tightening” with the expectation that the number of people being cared for but who are unable to pay their bills will remain high, or increase. When a hospital doesn’t receive reimbursement for care, it absorbs the costs as “bad debt” or charity care expenses.
Oliverson doesn’t anticipate layoffs, but he says costs are being cut in a variety of ways, including a 20 percent slashing of the advertising budget. He said: “Last calendar year we began to pull back and say, ‘This is not good.’”
A new presidential administration, for better or worse, makes it even harder for Oliverson and other health care officials to plan for the future.
“We don’t know what’s going to come, but we do know there’s going to be bad debt,” Oliverson said. “You can’t turn people away.”
“It’s a very complex and very expensive business,” he added.
Health care is the largest industry – and one of the fastest-growing – in the United States, employing more than 14 million people and providing seven of the 20 fastest-growing occupations nationwide, according to the U.S. Bureau of Labor Statistics. KRMC, with more than 2,000 people on its payroll, is the largest employer in Flathead County. The payroll includes everybody from part-time lifeguards at the Summit Medical Fitness Center to surgeons and administration.
As the health care industry continues to grow, so do concerns over costs and insurance. Nationwide, 15 percent of the population doesn’t have health insurance. The number is slightly higher in Montana at about 16 percent. But Montana’s uninsured rate has declined significantly in recent years, down from nearly 20 percent in 2000, when the state had one of the highest rates in the nation.
John Flink, vice president of government affairs for the Montana Hospital Association, said a major factor in the decline is the increasing prevalence of the Children’s Health Insurance Program (CHIP). To date, there are more than 17,000 kids insured in Montana through CHIP. Also, Gov. Brian Schweitzer has worked in conjunction with the state auditor’s office to establish Insure Montana, a program designed to help small businesses with health plans.
The past year’s economic woes have tempered the good feelings associated with the increase of people with insurance. Gardner, Flathead County’s public assistance director, said Northwest Montana’s layoffs and other economic ills have sent unprecedented traffic to his office, which deals mostly with Medicaid and food stamps. He said he used to get 20 people on a typical Monday inquiring about eligibility for food stamps or Medicaid. Now it’s more than 50.
“The baby boomers are aging, so that’s going to keep growing,” Gardner said.
The populations of Kalispell and Whitefish are two of the fastest-growing cities in the state, according to recent U.S. Census figures. So it stands to reason that KRMC, the main hospital in Northwest Montana, and Whitefish’s North Valley Hospital are growing steadily as well. North Valley has expanded its staff and facilities, including its clinic in Eureka and its seasonal clinic at Whitefish Mountain Resort. At KRMC, 22 new doctors – many of them specialists – began working last year.
KRMC has also beefed up its technology and equipment, including a PET/CT scanner, which is the only in-house model in the state. The scanner combines the technologies of PET and CT scanning capabilities to provide a more efficient and thorough imaging test. The technician who runs the scanner, Oliverson said, is one of only 449 qualified operators in the world.
“In the past they’ve been two separate tests,” Oliverson said. “We’re laying claim to the fact that ours is the first in-house in the state.”
This year, KMRC will bring in partial breast radiation technology, which Oliverson said reduces breast cancer treatment from once a week for seven weeks to two times a day for five days, adding to the region’s already advanced breast care capabilities. Kalispell Regional employs a highly specialized oncology surgeon, Loren Rourke, and a breast radiologist, Debra Accord.
The hospital also has a breast cancer treatment van called the Winkley Women’s Center that travels across the state, focusing on rural areas that otherwise would not receive proper testing and care.
“There were several cancers that were discovered that wouldn’t have been,” Oliverson said.
North Valley recently added an OB/GYN position and is planning to increase its orthopedic services and surgery coverage. Over the past several years, it has expanded its facilities in Whitefish and achieved critical access status, as well as adding a number of new programs. Like KRMC, North Valley officials are preparing for a belt-tightening year. The hospital’s new chief executive officer, Jason Spring, begins in March.
“We’re definitely ready to move on to that next step in our growth and our future,” said Carol Blake, North Valley’s foundation executive director.
Of the 22 new doctors KRMC brought in during 2008, there was a neonatologist, a pain interventionist and an assortment of other specialized physicians. Along with KRMC’s specialists, people in this region also have access to highly focused experts at places such as the Flathead Orthopedic Center. Oliverson said he’s amazed by the variety of specialized sub-disciplines in the modern medical world, but there is a flip side. Since more doctors are becoming specialists, fewer are becoming general practice family doctors.
“They don’t want to be working 90 hours a week,” Oliverson said.
The shift away from family medicine is a national trend that has hit Montana and is seeping into the Flathead. Flink, of the hospital association, said he doesn’t think it has hit the urban centers of western Montana as hard as it’s hit the rural areas of the state’s eastern side, but it is evident nonetheless. Both Flink and Oliverson said it’s something to closely monitor.
“It’s a great concern,” Flink said.
It’s too early to tell what effect Barack Obama’s presidential administration will have on the health care industry, but hospital officials are keeping close tabs on the president’s claims to make health care reform a foremost priority. Oliverson is wary about dramatic reform measures, which tend to be the order of the day during times of instability and economic uncertainty.
“We’re going to be very cautious with the Obama administration,” Oliverson said.
Flink, on the other hand, is optimistic about the possibility of a major restructuring in the nation’s health care system.
“There’s tremendous momentum behind some kind of comprehensive health care reform,” Flink said.