Friday, November 22, 2013

How the Affordable Care Act affects the MGH


KNOWLEDGE EXPERTS: Fogarty, left, and Johnson

New options for health insurance through the recently rolled out federal Affordable Care Act have created challenges for Massachusetts hospitals. Medicaid is expanding, and Commonwealth Care and Commonwealth Choice are being eliminated and replaced with an entirely new continuum of insurance options.

“We have already been through a version of health care reform, whereas most states have not,” says Joseph Ianelli, associate director, MGH Admitting. “We are used to following state regulations, but now we have to take federal regulations into account.”

Effective Jan. 1, 2014, the new federal health care reform law requires states to participate in health care exchanges through which individuals can shop for health insurance. Even in Massachusetts, which already had a health insurance program in place prior to the federal rollout, some residents must apply to sign up for a state health insurance plan.

“What’s making it really complex for us as a hospital and all Massachusetts hospitals is that we are not going to be contracting with the same insurance providers we contract with now. We are consolidating insurance options and helping patients understand their options, should they want their care plans to remain at MGH. So there are a lot of different moving parts,” said Ianelli.

Admitting staff faces another set of challenges. For years, the hospital used “The Virtual Gateway” to fill out online applications to help patients apply for state benefits but the new portal currently is not available and the state website, is fraught with many of the same complications as the government’s fledgling site.

“Eventually we will have an assister portal where we will be able to submit applications on behalf of the patient,” says Kaylin Fogarty, outpatient supervisor in Patient Financial Services. We were supposed to have access Dec. 15, and they’ve pushed that back with a date to be announced.”

Patients who do not have insurance can apply on their own, through the consumer portal, but so far, there have been a limited number of successful applications. Fogarty says the website is often slow or returns errors. “There is a 38-page paper application or they can apply over the phone with Health Connector customer service representatives but wait times are long and the representatives are using the same consumer portal with the same issues.”

The state has extended Commonwealth Care coverage until March 31 to give residents the full six months of open enrollment to change plans, but that extension adds a new set of issues for the hospital.

“The state did a really good thing,” says Ianelli. “The complexity for us is that we built a contracting strategy around these public payers for a go-live date of 2014, meaning we have consolidated what we are going to accept. We are supposed to switch patients now, and we can’t. Everything has been delayed.”

Katie Johnson, senior manager of Financial Services in Admitting, says they are doing their best to deal with patients on a case-by-case
basis. “If someone doesn’t have insurance, we use the current Gateway for immediate coverage and fill out the paper application for future coverage. We have to stop and think – what are the regulations now and what will they be in January?” says Johnson.

Both Fogarty and Johnson are optimistic that the Health Connector will be a good system once it is working. For now, it is a juggling act.

“There have been some bumps in the road,” says Fogarty. “But we’re hoping to be successful, and we want all of our patients who have health insurance today to have health insurance next year. That is our goal.”

For more information, contact Patient Services at 617-726-2171. 

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