As the Vice President of Public Policy at Hennepin County Medical Center (HCMC) in Minneapolis, Mike Harristhal is no stranger to institutional penny pinching, fundraising and out of control health care costs. Like many others, HCMC has been preparing for what a government shut down might mean for them. “Even as we sit here today HCMC is under considerable stress,” he said said. “If we break even that means we’ve had a very good year.” Harristhal, who has worked in the health care field for more 35 years, spoke to the TC Daily Planet about the impending state shut down, his take on health care policy and the Affordable Care Act.
How would a state shut down affect HCMC?
It’s likely that health care services would be deemed essential, so we think we’ll continue to cover the full scope of services if the shutdown only goes on for a short period of time. We would be okay for at least the next 30 days regardless of what happens with the shutdown, but if they determine that health care services were not essential, after 30 days we would begin to be in a cash flow difficulty and we would have to look at restricting services, like our clinic system. We do expect that volume will increase a little bit out of confusion and communication–people will be confused about which places they can go for their health care.
What percentage of your funding comes from the state?
We get approximately 45 percent from Minnesota health care programs, which is by definition Medical Assistance and Minnesota Care.
What keeps you up at night?
The fragility of the mosaic of the financial model for health care. It’s a struggle to make sure that we at HCMC are financially viable moving forward. At the same time I recognize that we saw 2,000 patients today, we saw 2,000 patients yesterday, and we’ll see 2,000 patients tomorrow. It keeps me up to know that it’s going to be a perpetual struggle to maintain our business model, but at the same time each day is a success as I think about the people that we serve.
What are the biggest problems in health care policy?
Generally speaking there’s a shortage of primary care capacity. That’s going to be a greater difficulty because our population is continuing to get older and to increase in numbers. At the same time we’re seeing a shift where folks are trying to maintain their health better, trying to access their primary care, and trying to build an affinity with their health care homes. All of that is going to make for greater shortages for primary care relative to the demand for services.
What about problems of access to health care?
Access issues are part of the supply demand equation overall, but it’s also the comparative weakness in the method Minnesota health care programs use to pay for health care. The reimbursement rates for physicians’ services for Minnesota health care programs are about a third of what you typically get from a commercial insurance coverage. So a great many physician practices have to restrict the amount of practices open to people without insurance or with MN health care coverage.
What do you think of the federal health care legislation, Affordable Care Act (ACA)?
ACA is extending eligibility to more people overall, and the industry is trying to create business models that will reward and give incentives for providing good health services, not just sick services. We’re seeing an evolution of payment so that it’s not just about the cost but also the quality of care. It’s an evolution of the business model that holds more accountability of health care systems.
Do you think these evolving business models will really work?
It will definitely make for improvements. There are still a great many things that start with the consumers and citizens that don’t always engage in optimal health care practices. I think the health care industry is making a lot of strides in changing, and that the economic incentives will be a piece of that.
And theory is one thing, but practice is another. People talk about how there are tremendous health care expenditures in the final six months of a person’s life and certainly statistics will say that’s true. At the same time, we don’t always know that you’re in the last six months of your life. So the very practical application of how to rein in that expense becomes difficult when faced with real life challenges.
What are the shortfalls of ACA?
It’s really great that we’ll be covering more lives, but one of the great concerns with ACA is that we’ll still be holding the line on expenses. This is especially true as people try to balance state and federal budgets. That means there will be fundamentally less money per life covered. And that’s going to be a challenge for us to evolve as we’d like to do. Folks are trying to reengineer the health care system, but at the same time do it with less money. So, I think that’s a paradox going forward.