Under the knife

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Let your voice be heard

Area residents may contact state lawmakers and make their opinions known regarding the budget process:

* Governor Ed Rendell:

(717) 787-2500

* Sen. Jake Corman:

(717) 242-2410

* Sen. John Eichelberger:

(866) 509-3424

* Rep. Kerry Benninghoff:

(814) 355-1300

* Rep. Mike Fleck:

(814) 644-2996

* Rep. Adam Harris:

(717) 242-0423

Editor's note: "Cutting to the Core" is a five-part series examining the effect the 2009-2010 Pennsylvania budget debate could have on the residents of Mifflin and Juniata counties. Today's articles examine health care and social services.

LEWISTOWN - State and local health care officials say hospitals serving residents of the Juniata Valley could see some significant cuts in funding under the 2009-2010 state budget.

Proposed cuts include the elimination of funding for a variety of medical services and a Medicaid reimbursement cut of up to $279.5 million.

According to a press release issued by the Senate Democratic Policy Committee, Gov. Edward G. Rendell has proposed a $77.9 million cut in Medicaid reimbursement. The recently rejected Senate Bill 850 sought to cut an additional $201.6 million from the program, but it's not the only health care category faced with a potentially serious shortfall.

Checking for vital signs

In addition to Medicaid funding cuts, the Senate budget proposal did not include any new funds for outpatient disproportionate share; medical and health professional education; community access fund; critical access hospitals; trauma centers; obstetrical and neonatal services; and burn centers, according to information posted online by The Hospital and Healthsystem Association of Pennsylvania.

Paula Bussard, the association's senior vice president for policy and regulatory services, said many hospitals have been, in a way, preparing for budget cuts due to the economic recession. Bussard said hospitals already are crunching numbers and scrutinizing their expenses and programs.

"What else can they do?" she said regarding the proposed cuts.

Some hospitals may have to eliminate personnel, but then they likely will face the problem of inadequate staffing, she said.

With the Medicaid cuts, hospitals would have to make some hard choices, such as whether to continue providing certain services, or how to adjust their work force, Bussard said.

"To retain the basic hospital services, they sometimes have to make those difficult decisions," she explained.

Bussard said some hospitals in Pennsylvania already have had to close their doors, while others have had to shut down various units.. The number of acute care hospitals has dropped by 20 percent in the last 10 years, Bussard said. Of those, only 111 provide obstetric services.

"When you see closures, you don't see new hospitals opening up," Bussard said. "Once those services are gone, then what?"

In guarded condition

Lewistown Hospital's chief financial officer and vice president of finance, Randy Tewksbury, said one budget item that could have a dramatic impact on the hospital would be a proposed reduction or elimination of funding for disproportionate share, which involves government assistance received by hospitals to help offset the costs of services not fully covered by Medicaid. Tewksbury said the proposal, if enacted, would result in a $350,000 loss in funding for the hospital.

"It would take payments away from us," he said.

Funding for disproportionate share is used to help Medicaid patients, Tewksbury explained. In addition to regular payments, the hospital's Medicaid payments are evaluated annually. Under the proposal, the hospital would continue treating Medicaid patients, but without the financial assistance from the state, he said.

Tewksbury also said payments from Medicaid itself already come in "well below our cost."

Other potential funding losses, especially in light of the current economy, could lead the hospital to consider making cuts in programs and services, he said.

The hospital already has sold its homecare and hospice program, as well as its occupational health program, to outside companies, Tewksbury explained. In the future, the hospital may not be so lucky and could have to discontinue some of its programs rather than selling them, he said.

A stitch in time ...

Tom Sokola, chief financial officer for Geisinger Health System, said his company isn't necessarily looking to cut programs in response to the possible budget shortfall; instead, it's looking to make things better.

Geisinger's Accelerated Performance program, or G.A.P., recently was created to help ensure the institution is the most efficient and patient-centered it can be, Sokola said.

"We're very serious about the G.A.P. initiative," which is led by executives and involves employee input, he said.

The program was created not only in response to possible budget cuts, but also as a way for Geisinger to stay ahead of the ongoing changes in health care, Sokola explained. G.A.P. also helps the medical system in its efforts to remain within the top percentile of health care providers, he said.

"It's just an additional focus on improvement. We think we've been ahead of the curve, and that's where we want to stay," Sokola said.

If the proposed budget cuts become reality, the G.A.P. program also allows Geisinger to be prepared so it doesn't have to take drastic measures, he said.

Deeper cuts

According to a report prepared by the Pennsylvania Department of Community and Economic Development, a comparison of the Democratic House Bill 1416 and the Republican Senate Bill 850 shows no funding for diabetes programs and health care-associated infections under the Senate bill.

The report also shows no funding for health literacy, trauma programs coordination or rural cancer outreach included in either bill.

The proposed health budget under the House bill is $253,140,000, while health spending under the Senate bill is $230,862,000 - a difference of $22,278,000, or 8.8 percent, according to the report.

Under the governor's proposed budget, programs and services such as regional cancer institutes, rural cancer outreach, trauma programs coordination and emergency care research would receive no funding. In total, $25,462,000 would be cut for health programs and services under his plan.

For additional information, visit the Hospital and Healthsystem Association of Pennsylvania's Web site at www.haponline.org.