Russ Johnson is CEO of the San Luis Valley Health

Conversations have recently highlighted concern about the number of providers willing and able to accept new Medicaid patients.  Now with the potential increase of approximately 16 million patients, nationwide, under the proposed Medicaid Expansion in 2014 there is even more concern.   Kaiser Health News says that in Colorado, slightly less than the national average of doctors agree to take on new patients who are on low-paying Medicaid. The Colorado rate is about 66 percent, just under the national average of 69 percent.

Local Reality Different than State Reality

As a rural provider serving a low income population, I always have a sort of amused/astounded reaction to this issue.  Of course I know that many providers in private practice don’t or can’t see more than a handful of Medicaid patients.  However, in our market, its 35% of who we care for – even more if we count the uninsured.  These are our patients just like any others.

As they say, “necessity is the mother of invention”.    Because of our demographics and mix of payers (Medicare, Medicaid, commercial insurance and uninsured), over the years we’ve had to adjust and do things differently.  Most businesses in the Valley deal with the same reality of our local challenges.  For healthcare here this has meant that out of the 80 or so providers in the Valley, there are only about four in private practice.  The rest are part of our organization, Rio Grande Hospital or Valley-Wide Health Systems.   That’s understandable.  At the same time, we couldn’t employ the 55+ providers in our system and expect them to earn 20% less than their colleagues because we serve a significant number of low income families.  So, we have to be innovative, thoughtful and committed to a business model that keeps us vital and fulfills our Mission/Vision.  And we have.

The Mission Drives the Team

The most important factor of our success is that our providers share in our Mission with us.  They know and understand the challenges of serving our community.  They are aware of and engaged in our strategies and goals.  They serve in governance, leadership, strategy, clinical excellence and other areas.  Without providers as partners, there’s no way we could continue, much less expand and grow the services we offer to all of our patients – Medicaid, CICP, Medicare, Commercial, and uninsured.

We’re usually about 3rd or 4th  in the State in terms of the percent of patients we care for that are Medicaid or uninsured.  And, I believe we’re the only private, not-for-profit among the top five.  That means we don’t receive any additional tax dollars from State, County, or City contributions.  We do receive Medicare/Medicaid “Disproportionate Share” support and the Provider Fee has been important to our efforts.  My point is, it can be done.  We can care for these patients while keeping a modest operating margin and reasonable balance sheet.   And, in the last year, we’ve added a full-time cardiologist (the first ever in the Valley), a second orthopedic surgeon, a second chiropractor, and additional primary care providers.

All Patients Welcome

So for our part, we will welcome all patients to our practices and hospital.  This includes folks who have no coverage now.  Encouraging everyone to choose  a primary provider, keep up with wellness checks and prenatal care, and address an illness or injury early enough for a good outcome is what we want to have happen.  And that’s just what we’ll keep doing.

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