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VOL 9 | ISSUE 442 | SEPTEMBER 15, 2023
Going global? ADJUSTING BUDGETS TO SALVAGE RURAL HEALTH CARE By Holly J. Wagner Sun Correspondent
H
ealth care is one area of life where one size does not fit all. That can be a real problem for small, rural communities like McKinley County, which rely on local hospitals for a full range of care – some of which isn’t available locally. Fixing the situation won’t be easy and it’s going to take commitment, a panel of local providers told a community audience Sept. 10 at an event sponsored by Community Health Action Group. Attendees were treated to a screening of the activist fi lm American Hospitals: Healing a Broken System, which asks the question: “How can we
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incentivize hospitals to provide the highest quality care with the lowest affordable cost to the community?” The fi lmmakers make the point that rural communities are often not well served by a system built around huge, urban medical centers. Large hospitals are increasingly profit-driven, pushing expensive interventions when a patient is in dire condition and focusing less on the dayto-day care that may be just as important but doesn’t ring up as much on cash registers. This is partly because private investors have taken a stake in the health care business and look at hospitals like any other business. “Pr ivate equity-backed firms have been attracted to
emergency rooms in recent years because ERs are profitable and because they have been able to charge inflated amounts for out-of-network care — at least until a federal law cracked down on surprise billing,” as stated in a Kaiser Family Foundation study published in April. The article cited a doctor/CEO of a startup job site for emergency physicians, who found that private equity-backed staffi ng firms run 25% of the nation’s emergency rooms. Another study published by Becker’s Hospital Review in February found that less than 15% of hospital board members at the country’s highest-ranked hospitals have any medical exper ience, but 44% have backgrounds in private equity, banking and fi nance.
The film focuses on how for-profit health care often puts physicians at odds with their mission by putting pressure on visit times and expensive services. Local providers Dr. Valory Wangler, Dr. John Mezoff and Dr. Warner Anderson provided commentary and took audience questions after the screening, with CHAG leader Dr. Constance Liu acting as moderator. One solution the fi lm proposes is replacing the feefor-service model with global budgeting, which sets an overall limit on health care spending, leaving it to providers and payers to determine how to keep spending under budget. In global budgeted systems, providers are paid an agreed amount to treat a population for a specified length of time. Such a system might help rural hospitals attract and retain the kind of talent they want, rather than physicians whose f irst motivation is profit, the doctors suggested.
Dr. Valory Wangler, Executive Director of Gallup Community Health “It changes the attitude from teaching services that make money and cutting those that don’t make money, like labor and delivery, but which are very community important,” Mezoff said. Anderson lamented how a shift away from service hurts rural hospitals. “In the past, 40 years ago, people came here because they wanted to serve…What
RURAL HEALTH CARE | SEE PAGE 18
Gallup Sun • Friday September 15, 2023 1