Legislators visit Whitman hospital for local thoughts on health care

With the next legislative session set to open next week, 9th District Legislators Joe Schmick, R-Colfax, and Susan Fagan, R-Pullman, stopped by Whitman Hospital and Medical Center Dec. 22 to discuss the hospital’s needs from state government.

Schmick, who will take a seat as the ranking Republican on the House Health Care Commitee when the legislature convenes, said drastic cuts are going to be made in state programs as legislators grapple with an ever-growing deficit.

“There’s going to be less services coming from Olympia,” he said. “Period.”

Hospital officials hoped those funding cuts would have as little impact as possible on health care facilities.

They particularly noted the ill effects that cuts from mental health programs would have on hospitals.

Whitman Hospital Administrator David Womack said most of Whitman Hospital’s emergency room’s repeat patients have some sort of underlying mental health issue that has not been treated because of the dirth of mental health professionals on the Palouse.

“That’s kind of the thing with the Palouse,” said Womack. “We have amazing physical health facilities, but there just isn’t anything for mental health.”

He advised the legislators to carefully consider the down-the-road implications of cutting state health funding. Womack said cuts to state programs that benefit the most vulnerable in society mean long-term increased costs for hospitals.

“Always think, if you squeeze the ballon at one point, where’s it going to pop out?” Womack advised the legislators.

With 100,000 Washingtonians waking up uninsured Jan. 1 because of cuts to the state’s basic health program, the hospital figures to be holding more of the bag in medical costs.

Chief Financial Officer Jim Heilsberg said if the state pushes assistance costs down to local hospitals, that would increase the need for those hospitals to put a tax on their local constituents. Whitman Hospital does not regularly tax citizens within its district. A bond issue for the recent remodel is on tax bills, but general operations are covered by the hospital’s revenues.

Womack added those revenues are dwindling as employers institute new insurance programs. Because of the higher deductible plans many companies have put in place to offset increasing contributions, he said, hospital visits from patients with commercial insurance have dwindled.

The aging population of the Palouse means nearly 80 percent of Whitman Hospital’s patients are on Medicare, which only reimburses the hospital for actual costs of treatment. All other costs, from recruiting physicians to capital improvements, all the way down to telephones and televisions in patient rooms must be paid from the hospital’s operating fund, which is fed by the 15 to 20 percent of patients that are commercially insured.

With higher deductible plans, many of those patients put off or avoid visits to the hospital altogether.

“We’ve finally gotten to a point where cost is affecting behavior,” said Womack.

Hospital visits were lagging seriously throughout most of 2010, but rebounded later in the year, when many of the commercially insured had met their deductibles.

Because of the sagging revenue, the hospital is not planning to put any money into its reserve account this year. In 2009, the hospital kept $1.3 million of its $21 million in reserve.

As far as state policy is concerned, Schmick asked if drug testing recipients of the state’s welfare programs would be a problem for the hospital. He said the idea, which would mandate recipients of the state’s general assistance unemployable program pass drug tests, is quite popular in the 9th Legislative District. Schmick said many of those recipients are healthy middle aged men who bounce in and out of drug and alcohol rehabilitation.

Womack said that would not be good for the hospital, as no state insurance would likely mean those patients would have no coverage at all and the hospital would be left holding the bag on treatment costs.

“I don’t want to be in the business of enforcing that, just like I don’t want to be in the business of checking citizenship status,” said Womack. “They still show up in the (ER). We still have to treat them.”

Again, Womack said better state support for mental health programs would be more beneficial than drug testing state aid recipients.

Hospital officials agreed state programs to introduce more physicians assistants and nurse practitioners into the health care sector are good things for small communities, but worried about having those professionals work without proper guidance.

“They are a proven physician-extender,” said Womack. “But you always have to worry about how close the doctor supervision is.”

To fill the gap, Schmick asked about the possibility of a WSU-run medical school in Spokane, and if Whitman Hospital would be in favor of it.

All officials present answered a Spokane medical school would be beneficial for the Palouse. Heilsberg noted the average age of area doctors is advancing, with many closing in on retirement. Having new doctors come from a nearby med school would help attract replacements, said Womack, as students typically practice near their medical schools.

Schmick also said many in Olympia are looking to fund new programs that would allow in-home video monitoring of patients through internet video cameras.

“That is coming. It’s something we’ve been talking about for several years,” said Schmick.

Womack said the VA hospital system is trying that with diabetes and alzheimer’s patients, which are the most costly, and has seen some success. He cautioned, though, that verifying information gleaned from remote locations can be difficult and time consuming for hospital staffers.