As an association we are called to continue to be the voice of Mississippi medicine. This voice must also take on the most important issue hindering healthcare in our state, the complicated economics of healthcare. Even in this election year, you will often hear the candidates avoid the healthcare discussion, but the issue is real. The tidal wave of support continues to rise by communities affected by the closure of rural hospitals and by large employers needing help with rising health insurance costs. Local politicians are seeing that the closure of the local hospital as not only affecting healthcare in the community, but also closing the largest employer in the community. It is our association’s obligation to continue leverage our influence on foundations and relationships for the healthcare solutions on the horizon. Quality healthcare at reasonable costs through state and federal programs is possible. However, waste, excess, redundancy, and inefficiencies will drive costs through the roof in a poor state like Mississippi.
Let’s look at a few of the complexities. Small towns in Mississippi have redistributed populations over the last 20 years and even since the pandemic. Workers are leaving for larger towns and higher paying jobs that offer health insurance benefits. Farms are much larger and much more efficient in yielding more crops on fewer acres than ever before. Because not every small town can currently support an inpatient hospital system, slowly these rural hospitals are not able to remain open, leaving limited access to care for our patients. Also in the last few years, the Affordable Care Act and Medicare policies like MACRA and MIPS have matured causing redistribution of payments that have pushed reimbursements to more ambulatory surgery centers and outpatient clinics. Large referral hospitals are still needed for the sick and advanced subspecialty care, but how can we allocate those resources that make sense both financially and geographically in our state? How does the trauma, stroke and acute MI system use the network of hospitals to provide access to patients? How do certificate of need laws limit collaboration and the market in making services available?
Access to care can mean a variety of things. It means the right type of care in the right location at the right time with the right cost. The economics of healthcare encompass different reimbursement sources and require a variety of strategies to implement change. It is not a one size fits all solution, nor will fixing one source solve the problem.
From a reimbursement standpoint, the Department of Medicaid covers the lowest income group. The appetite in the legislature is nearing the time to bring out those Medicaid statutes and update the model used by the Governor to run the program. Our physician members are experts on data and evidence driven patient centered medical homes to care for large populations at a controlled cost. Next is the working lower income that do not have private health insurance but make too much money for Medicaid. This is the group that is in the discussion for expansion of Medicaid services. How many working Mississippians can be financially supported by state and federal funding programs. Besides higher paying jobs to move them into the private insurance market, how can we shrink this group of uninsured that result in uncompensated care? How many people will be added to the Medicaid roles? How much economic impact of federal subsidies benefit local communities?
Next is the private insurance patients. More authority and more oversight is needed from the insurance commissioner and legislature to keep large health insurance companies playing fairly in the sandbox. MSMA worked with the insurance commissioner to recoup physician payments withheld by BCBS during the covid pandemic, but there is more work to be done.
Finally, there are the Medicare patients that seem to set the baseline for the other reimbursement rates. I think you will hear of the work done by the AMA regarding physician payment cuts that is weakening our ability to care for medicare patients.
We have the physician expertise to work with our state and federal leaders to come to a reasonable and efficient system of care. MSMA needs you now more than ever to add to our organization to make the next reimbursement models more efficient and more cost effective. Today’s economics of medicine are complex, but so is the art and practice of medicine.
We cannot let economic headaches and frustrations steal the joy from our calling to be physicians. We are still blessed to be a part of one of the greatest professions in history, the practice of medicine. Ever since ancient civilizations, patients have needed physicians.
Being a physician requires more than ever before. We are called to step out of the exam room and advocate for our patients with policymakers. The vehicle for change is driven by politicians in Jackson and Washington, but they are looking to us for directions on how to get there.