Federal health-care law spurs state, forum told

— Arkansas is using the federal health-care law as an opportunity to improve health care in the state, Surgeon General Joe Thompson said Monday, by modernizing access to records, changing the payment system, getting doctors where needed, and doing other things.

“Largely, we’re locked into a 20th century health-care system,” Thompson said. “Arkansas has a unique opportunity to really get it right and to move our heath-care system, to be in a position to serve our citizens’ needs in the 21st century.”

Thompson and leaders of state agencies said at a forum how they are addressing health matters in the state, including the shortage of physicians in rural areas, electronic access to medical information about patients, how doctors will be paid for services, and what the federal 2010 Patient Protection and Affordable Care Act means for the state.

The act ushers in changes to health insurance and health care, banning the denial of coverage because of pre-existing conditions, providing tax credits for low-income people to buy insurance, requiring online pools where people can shop for health insurance, among other things.

“It’s important to bring everybody along and have people see how interconnected things are and how much we need to move the whole system into the 21st century. We can’t let any piece of it lag,” Thompson said. “We’ve got to make sure that people not only have an insurance card, we have to make sure that there are providers ... to give them the care that they need, and the payment system is aligned to get the outcomes that we want.”

The forum was held at Arkansas Children’s Hospital in Little Rock. It was scheduled to be broadcast to 15 locations across the state, but technical problems prevented that, said Debbie Pate, spokesman for Arkansas Center for Health Improvement. She said another forum may be held.

Thompson is heading the effort by about a dozen agencies to change how Arkansans get health care.

Dan Rahn, chancellor of University of Arkansas for Medical Sciences, and state Health Department Director Paul Halverson are leading a plan to direct people into medical fields the state needs, including primary-care physicians and nurses in rural areas.

Rahn said 73 of Arkansas’ 75 counties are either partially or fully underserved medically. Rahn said Arkansas’ health care focuses on treatment and recovery after an illness and not enough on prevention.

State Department of Human Services Director John Selig said that’s one reason he wants to change how the health-care industry is paid. He said the state needs to move from a fee-for-service payment model, in which providers are reimbursed for every procedure, to a system that would bundle the cost of medical services for a particular condition or “episode” into a single price.

“We have tried for years to manage cost and get it to a sustainable level. While we’ve made some improvements it always feels like we are kind of making improvements on the margins and we still come back to pretty rapid growth,” Selig said. “I think that the idea ‘If we just leave it alone we’ll be better,’ I just don’t think that’s possible.”

In May, Gov. Mike Beebe received approval from the federal government to propose an overhaul to the state’s Medicaid system and switch to an episode payment model. The Centers for Medicare and Medicaid Services will decide whether to approve the final plan for the Medicaid overhaul once it is developed.

Arkansas’ Medicaid is a $4.3 billion-a-year program. The federal government pays about 78 percent of the cost. The state pays the rest. In 2010, the program served about 771,000 Arkansans.

Selig said changing the payment model could also stem the rate of private health-care costs.

Ray Scott, Arkansas Health Information Technology coordinator, said his team is working on a statewide infrastructure for electronic access to medical records. In February, Arkansas got about $815,000 through the electronic health record incentive program established through the federal stimulus program, or the American Recovery and Reinvestment Act of 2009.

An electronic medical record contains information about medications, immunizations, doctors’ notes, X-rays and laboratory results.

Scott said allowing multiple doctors to access a patient’s medical history can prevent them from duplicating tests or procedures, which should cut costs. He said patients would also have access to their own medical information.

“What health information can do is help make this a more patient-centric process,” Scott said. “We’re still using health information in much the same way we did in 1965.”

Scott said it will be difficult to create a statewide system — the infrastructure will be available for health-care providers by the end of 2012 but it could be up to seven years before it is widely used, he said. About 40 percent of Arkansas’ primary-care providers have switched to using electronic records.

State Insurance Commissioner Jay Bradford’s team is working on preparing the state for the insurance pools, called exchanges, required by the federal law.

Bradford has pushed for an Arkansasrun exchange, saying it will be tailored to Arkansas’ needs, but lawmakers have said they want to see whether the U.S. Supreme Court upholds the healthcare law or whether Congress changes it. Lawsuits over the law are moving toward the high court.

During the legislative session this year, lawmakers didn’t authorize the state Insurance Department to create the exchange, and lawmakers have signaled repeatedly that they haven’t changed their mind.

Planning and creation of the exchange is funded by the federal government through a series of grants. The grants can be requested without legislative approval, but the ultimate creation of a state-controlled exchange must get lawmakers’ OK because Beebe has declined to allow it without their consent.

The federal government will create and manage exchanges for the states that do not make progress by Jan. 1, 2013.

Bradford said that even if the Supreme Court strikes down part of the federal law, the exchanges will likely be left in place and Arkansas’ exchange will be under the control of the federal government because of legislative resistance.

“We will not have an Arkansas exchange at this time. That train has left the station,” he said.

After the meeting, several Republican lawmakers approached Bradford, saying that he was blaming them for the state not moving forward on the exchange.

Sen. Jason Rapert, R-Bigelow, told the Arkansas Democrat-Gazette

that he doesn’t want the state to have a federally mandated health-care exchange, but that Bradford shouldn’t blame the minority party if the governor chooses not to move forward.

“Right now, today, the governor of this state, Gov. Mike Beebe, has the authority to do everything the Insurance Commissioner Jay Bradford wants. He has the authority today, so to get up and make this a political situation and throw that back at the minority in the Legislature is laughable at best,” Rapert said. “I’m disappointed that we are using Arkansas tax dollars to conduct meetings around the state on something the governor has already said is a done deal.”

Pate said that Children’s Hospital did not charge the health center to hold the summit.

“There was no budget and there was no expense. Just our time, which I guess some people would say is an expense, but it’s part of our job,” she said.

Front Section, Pages 1 on 11/08/2011