FRANKFORT — Your doctor's visits might get longer, you deductibles probably will be higher and you might be paying cash to be treated at a Wal-Mart near you as Kentucky adapts to a vastly changing health care landscape.
Nearly everything you know about how health care is paid for and provided will change during the next few years as patients and providers sort out the nuts and bolts of the Affordable Care Act.
"The old model is rapidly falling apart," said Chas Roades, chief research officer for The Advisory Board Company, a Washington-based health consultant firm. The board led a health care summit organized by the state Cabinet for Health and Family Services, the Kentucky Hospital Association and Gov. Steve Beshear in Frankfort on Thursday.
Hospital administrators and lawmakers, including Lt. Gov. Crit Luallen, made up most of the 150 people in the standing-room-only crowd.
"Ten years ago," Roades said, "it was all about growth and more hospital beds."
Now, he said, the focus is on preventive care that keeps chronic illnesses from growing worse and keeps people out of hospitals.
There were lots of questions from the crowd, including a few who asked whether "Obamacare" was indeed here to stay.
Yes, Roades said, it is.
Even if some parts of the law are dismantled, he said, the health care needs of aging baby boomers are driving a fundamental change in the system. If patients have more choice, he said, it will be important for doctors to make more personal connections with patients. The focus won't be rolling patients through the door at a furious clip but on spending time with them to find out what it is going on.
That is down the line. For now, most people are feeling the shift in their wallets, he said.
Every American must have health insurance under the Affordable Care Act or pay a penalty. Many are opting for the least expensive plans. But, Roades said, in order to keep monthly rates low, insurance companies are raising deductibles. (The deductibles is the amount paid out of pocket before many services are covered.) Currently, he said, deductibles can range from $2,500 to $6,250 a year.
At that rate, he said, most people are essentially self-insured. Instead of leading to better health care, he said, that can lead to "self-rationing" of care. For example, a woman might go to her doctor for a checkup if it is covered 100 percent by insurance. But, he said, when the doctor suggests tests or blood work that the woman would have to pay for, she, like most people, will say no.
There is also a point at which most Americans opt out of paying a medical bill, said Dr. Dennis Weaver, chief medical officer of the Advisory Board. A majority of households in America can't afford to pay a medical bill of more than $2,000 without selling something they own, such as a car. At that point, he said, many people just won't pay, which puts the burden on hospitals to collect.
Wal-Mart has announced plans over the next five years to offer full primary care services, the kinds of things provided by a family doctor, in clinics across the country in rural areas and cities where doctors are hard to find, said Roades. The visit would cost $4 for Wal-Mart employees and $40 for others, and the clinics would take cash only. The plan would have ripple effects that could lower the cost of lab work and diagnostic tools such as X-rays and MRIs because Wal-Mart plans to negotiate the lowest prices and might require a cash-only payment model for those services, too.
That might be good for patients, he said, but it would be "highly disruptive" to other health care providers.
The half-day seminar was paid for with money from a $2 million grant Kentucky received in December from the federal government to create and test ways to improve the quality of health care and lower costs.
Kentucky has been touted as a national leader under the Affordable Care Act, signing up more than 530,000 people for insurance in the past two years. The vast majority of the newly insured are covered by Medicaid, and treating those patients is often a break-even or money-losing proposition for hospitals. Several hospital administrators at the summit said more patients were seeking care, but mostly in the same way they always have — by going to the emergency room.
Much of the talk centered on the extensive change needed to make any new model work, and the time and effort that would require.
"I would just emphasize our takeaway is it is a time of transformation," said Emily Parento, executive director of the state's office of Health Care Policy.
"This is the just the beginning of the discussion," said Dr. John Langfeld, medical director of Kentucky's Department of Medicaid Services. "There is a lot of angst about moving forward."
Beshear spoke to the crowd for about 15 minutes at the end of the summit. He said he knew hospitals and other health care providers were worried about how things will work in the long run. But, he said, they needed to dig deep to move forward.
"We will fall short of our goals if we can't find ways to engage our patients in new and innovative ways," he said.