Health facilities feel budget pinch

A budget squeeze may force some hospitals to limit services.
YOUNGSTOWN -- Proposed cuts in Medicaid services and a reimbursement freeze would have a huge impact in the form of lost medical care for clients of the Youngstown Community Health Center's clinics here and in Warren, a local official says.
Likewise, freezing Medicaid payments would affect all hospitals profoundly, said Alfred Mansfield, senior vice president for finance and chief financial officer at Humility of Mary Health Partners.
If hospital budgets are squeezed too much, they may have to limit or eliminate some services, Mansfield said.
Major concern
What has health-care providers concerned is that Gov. Bob Taft has proposed in his two-year budget, beginning July 1, the elimination of dental, vision, chiropractic, podiatry and psychological services for adults under Medicaid; lowering the Medicaid eligibility standard from 100 percent of the federal poverty level to 70 percent to 90 percent; and freezing Medicaid reimbursements.
The proposed cuts would reduce the growth of Medicaid costs by $468 million in state funds and about $1.1 billion in combined state and federal dollars, supporters say.
Services for pregnant women and children would not be affected, but dental care for adults and the income eligibility standard would be, said Dr. Ronald Dwinnells, chief executive officer of YCHC.
Dwinnells said cutting adult dental services would cause 2,500 of the center's 3,200 dental patients to lose services.
He said eliminating people from services by lowering the income requirements would force them to use emergency rooms for care, a much more expensive alternative than the clinic.
He said YCHC has about 10,000 patients here and in Warren, and the number is growing. About 60 percent have either Medicaid or Medicare; 20 percent to 25 percent are uninsured working poor; and the rest have some form of commercial insurance.
The Ohio Hospital Association said hospitals in Mahoning County will see a combined loss of $4,488,087 in Hospital Care Assurance Program (HCAP), federal funding based on a formula that includes the number of uninsured that are treated, and Medicaid revenues in fiscal 2003-05.
Trumbull would lose $2,552,206; Ashtabula, $1,466,290; and Columbiana, $942,653.
Salem Community Hospital expects a minor impact because of the level of Medicaid services provided, said Howard E. Rohleder, president and chief executive.
If the loss of income causes any area hospital to limit services or close, the remaining hospitals would be called upon to care for the additional patients.
Draining the system
Given the number of hospitals that have closed in the Mahoning Valley over the last several years, further reductions could negatively affect the safety net of services, Rohleder said.
With the cost of doing business -- pharmaceuticals, technical equipment and labor -- continually going up and reimbursements being lowered or frozen, hospitals will have to find ways to become more efficient in delivering care, Mansfield said.
Also taxing the system are the growing number of elderly residents who need more medical care, and the growing number of people without insurance, Mansfield said.
Uncompensated care is being paid for by others, and when dollars are taken out of the system, it creates a bottleneck and some services could be curtailed, he said.
The reality is, if hospitals are to stay open, the books have to balance, Mansfield said.

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