Becker's ASC Review

21 HEALTHCARE NEWS 21 safety-net hospitals' ED, where we are legally — and morally — obligated to provide care. However, now those thrown off Medicaid due to this bill will be seen when their diseases reach a stage requiring expensive urgent care and whose human suffering will be magnified due to more advanced disease le untreated." Medicaid expansion, he said, has been a financial boon to society because it supports healthier individuals who need less emergency care, and allows people to work lower-paying jobs while still receiving coverage. "Rolling Medicaid back in this manner is self-injurious to America," he said. "As to the proposed cuts to hospital funding sources, we all currently survive with a 1% to 2% margin, on average, each year. Which systems will be able to absorb this reduced reimbursement (more uninsured, fewer [managed care organisation] tax-related subsidies to Medicaid rates) and remain solvent is hard to know." New York stands to lose $7 billion to $8 billion in federal support for safety net care. As the only level 1 trauma center, adult and pediatric burn center, organ transplantation center and regional Level 4 NICU and pediatric hospital between New York City and Albany, Dr. Lubarsky predicts all patients will feel the impact. "Reducing federal support for New York state and for the hospital directly due to increased uninsured patients will hurt our ability to meet our mission on behalf of the rich and poor alike, without distinction," he said. What happens next? EJ Kuiper, president and CEO of Baton Rouge, La.-based Franciscan Missionaries of Our Lady Health System, told Becker's the provisions cutting state directed pay programs by 10% annually and provider taxes by 0.5% in 2028 and 2030 will have the biggest impact on many hospitals. Louisiana and Mississippi will see a $5 billion and $700 million negative impact from the legislation. Despite significant challenges, Mr. Kuiper is looking on the bright side. "Because we are one of the preeminent healthcare providers in the Gulf South, a substantial portion of those cuts will impact us. We are thankful to Speaker Mike Johnson and Majority Leader Steve Scalise for their support in delaying those cuts by several years," Mr. Kuiper says. "While the language remaining in the bill is disappointing, the negotiated delays give us time to mitigate or further delay and perhaps eliminate the contemplated cuts." FMOL has a strong balance sheet and profit/ loss, an advantage over other organizations navigating the new reality. e health system "remains very committed to meeting the needs of all the patients in the many communities [they] serve." Mary Mannix, president and CEO of Augusta Health in Fisherville, Va., is working on a five-year pro forma with her team to fully understand the law's impact over the next decade. e health system expects "significant degradation" of its financial strength because revenue is dropping, uncompensated care will likely increase, and 340B status loss. "Something will have to give in terms of programs and services," said Ms. Mannix. "We have the gi of time to be discerning in this endeavor as well, working under the guidance of our community-based board. And, at the same time, we are committed to building out key specific services for the communities we serve and our workforce. I think the next several years will feel a bit contradictory from an optics standpoint at times, but our goal will be to have the net effect of vibrancy for our community owned health system." Ms. Mannix said the system will continue to improve access and design more "consumer- dynamic touchpoints" for the community, as well as the workforce. She wants to build on the system's innovation culture and support. "I think the next several years will feel a bit contradictory from an optics standpoint at times, but our goal will be to have the net effect of vibrancy for our community owned health system," said Ms. Mannix. "We know we have very hard work and tough decisions in front of us. But we have a lot of strengths going into these very stormy times that we intend to leverage." Building for the future Russsell Cox, CEO of Louisville, Ky.- based Norton Healthcare, is also taking a pragmatic approach to the news. His focus is on providing quality healthcare services; but delivering those services could become more complex. "As a not-for-profit organization, we already operate on thin margins, with any revenue invested in providing quality health care for the patients and families we serve," said Mr. Cox. "Like other providers across the country, we will be impacted and it will require a multifaceted approach to addressing this change. We are reviewing all the nuances of this legislation to understand exactly how it will affect us so we can minimize as many impacts to the community as possible." He called on providers and payers to partner more closely for appropriate and timely reimbursement for quality services. "Healthcare constantly changes, and we have had to adapt in many ways over the years," said Mr. Cox. "is will require even more innovation, but our mission calls us to provide quality health care to our community, and that is what we will continue to do." Not all CEOs feel the same about the bill's impact. Michael Gentry, CEO of Kettering (Ohio) Health, thinks the bill will "likely be a net positive," although his team is still crunching the numbers. "ere are many factors related to how federal matching funds from Medicaid are obtained, the baseline that a state had of matching funds when the legislation was finalized, the use (or not) of supplemental directed payments and local taxing districts," Mr. Gentry said. "And, of course – base Medicare, which varies considerably around the country. But an early call here is net positive – primary credit to Ohio's governor, who worked with the hospitals and challenged us to improve rural care, chronic disease management and lower infant mortality – and funded those initiatives." Kettering has a head start on developing a guaranteed 24-hour access for five key specialties by the end of the summer by using more digital technologies and advanced practice providers. "We are building out clear diagnostic pathways based on primary care findings that create the need for a consult, so the specialists can act when the patient is seen – much of this work has been done by several integrated health systems in the U.S. and we are catching up here," said Mr. Gentry. n

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