A Band Aid fix for a broken-leg problem


If you go to the hospital with a broken leg and the doctor puts a Band Aid on it, you received medical attention, but you didn’t really get help and you won’t be any better off than you were before.  A compromise was recently reached to save GAMC, which made me wonder – is it simply a Band Aid, or is it a real fix?

A short explanation of the new GAMC:

  • There will be a temporary program extending the current structure of GAMC through April and May. This temporary program is underfunded, paying providers 37% of previous reimbursement rates.

  • June 1st, the new GAMC begins. The hospitals will be divided into two tiers. The first tier will consist of hospitals currently serving a majority of GAMC patients. These hospitals will be encouraged to develop “Coordinated Care Organizations” or CCOs, which will function as comprehensive systems taking care of all aspects of the health care needs of GAMC patients. The hospitals will negotiate contracts with local providers and clinics to ensure that patients have access to all needed care. The second tier will be made up of all other hospitals. From June through November these hospitals will be reimbursed for providing hospital care to GAMC patients out of a $20 million pot. During these six months, the hospitals will hopefully develop CCOs in their region. After November the uncompensated care pot is closed and the hospitals will only receive reimbursement for GAMC care if they are part of a CCO.

  • GAMC recipients will be required to enroll in a CCO system and receive all their care through that system.

  • First tier hospitals will be paid a lump-sum reimbursement based on the hospital’s recent share of GAMC patients.

The problems with the new GAMC are many, but the biggest problem is that the program does not fit those it intends to serve. Mark Eustis, CEO at Fairview Health Services explained that it [GAMC] is “conceptually a good idea. Unfortunately, it’s underfunded, and starts with a population that would have been our last choice.”

It will be a challenge for providers to explain to a population that has come to the ER as the only reliable and accessible form of care that they should now start going to regular appointments at clinics. And there is concern that this hard-to-reach homeless population who don’t have watches, day planners, and phones will be able to schedule an appointment and keep it.

Another caveat with the new arrangement – there is still a lot of uncertainty as to what kinds of services will be included. A third and major caveat is that the program is underfunded. Although the state has capped the cost of the program by giving out these ‘block grants’, there is no cap on hospitals’ spending. As nonprofit institutions, the hospitals will have to provide charity care, even if the cost of that remains with the hospital. Hospitals will then have to consider cutting services and raising costs for private patients to avoid huge deficits.

There are some positive sides to the new GAMC as well. The GAMC population will continue to be eligible for a public health care program, they will continue to have access to affordable prescription drugs, and the Health Care Access Fund lives to see another year.

But the question remains, is this a real fix? There will be care provided, but at what cost and to whom? The governor has successfully managed to negotiate a bill that shifts an increased portion of the cost on to health care providers. The program is not sufficiently funded and the chances of its success are therefore limited.

Although a little bit is better than nothing, it is an exaggeration to claim that this is truly reform and that the needs of the GAMC population, and those who serve them, are now met. A flimsy Band Aid will not fix a broken leg. We can and should do better.