A dozen new doctors ceremoniously donned white coats when Billings Clinic launched Montana’s first internal medicine residency last week.
This new physician training program will expand efforts to produce home-grown primary care doctors so badly needed in Montana and throughout the nation. The new doctor training at Billings Clinic is a shining example of how health care providers are driving the changes needed to keep Montanans healthy.
Training more primary care doctors is key to providing health care access to all Americans in an aging population. Compared with other developed nations, America has few primary care doctors and many specialists. The Affordable Care Act provided some new support for primary care training. Since then, the Montana Family Medicine Residency at RiverStone Health has expanded and a new family medicine residency started in Missoula.
In the political arena, health care reform has been a bitterly partisan issue for more than two decades. The divisive rhetoric has only grown louder since Congress took up the Affordable Care Act and narrowly approved it.
On the front lines of U.S. health care, reform has proceeded partly because of the ACA, partly in spite of it. Health care leaders recognize that change is imperative in a nation with an aging population, unhealthy habits, millions of uninsured folks and a care system that is way too complex and too expensive.
Look no farther than Billings’ medical corridor to see change in action. For example, knee joint replacement that used to require hospitalization now is performed outpatient. Patients can check their own medical records from their home computer. Every step in care is being scrutinized to boost quality and control costs.
The Gazette recently spoke with leaders of Billings Clinic and St. Vincent Healthcare about what’s driving reform.
“Changes are afoot,” said Steve Loveless, who recently was named CEO for St. Vincent. “It’s a good thing for patients.” Care is much more patient centered and patient focused, Loveless said.
The Affordable Care Act heightened price awareness, Loveless said. U.S. health care organizations are responding by moving more care to outpatient settings. High deductible insurance plans are making patients more sensitive to prices.
“We’re forced to address our costs,” Loveless said. “You won’t survive into the future if you don’t address costs.”
Care providers are using generic medicines whenever appropriate because they cost less.
Independent physicians in Billings are partners with St. Vincent in an affordable care organization designed to deliver consistently high quality care at lower cost.
“Our greatest challenge is transitioning from the fee-for-service model to managing care as we assume risk,” Loveless said.
Four years ago, Dr. Nick Wolter, Billings Clinic CEO, told The Gazette that “the status quo” in health care was unacceptable. Since then the clinic has concentrated on increasing quality while driving down costs. The result: Expenses have been decreased by $8 million to $10 million annually while “we’ve held our charges pretty close to flat for four years,” Wolter said.
“Our inpatient costs are below the national average,” Wolter said, adding: “Health care is still too expensive. Without Montana Medicaid expansion, there are still people without access to care.”
One Billings Clinic effort to improve patient care while preventing unnecessary costs is a pilot project bundling payment for all inpatient care and all care within 90 days of hospital discharge for joint replacement patients. St. John’s Lutheran Ministries and RiverStone Health are working with the clinic's pilot.
Over the next four years, the biggest challenges for hospital organizations will be reductions in government reimbursement and the need to recruit and retain health care professionals, Wolter said. Reimbursement already is inadequate for primary care, geriatrics and psychiatry, he said.
In its health care policy, the Billings Area Chamber of Commerce notes:
Health care accounts for 15 percent of the Yellowstone County economy.
Total health care spending in Billings exceeds $1 billion annually.
Montana Medicaid expansion would provide coverage to 70,000 low-income people statewide, create about 1,400 jobs in Yellowstone County and generate $60 million in annual labor income here.
Billings residents can be proud to live in a community served by two nonprofit health systems deeply invested in our state. As the specialty medical center for a vast area of four states, Billings enjoys local access to a range of health services rarely available in a city of 105,000.
While members of Congress and the Montana Legislature argue over health care reform, remember that real reform is happening in our hometown. Our hospitals are dedicated to serving those in need regardless of ability to pay, increasing quality and controlling costs. Those principles should guide health policy makers in Helena and in Washington, D.C.