|
Health care services suffering under budget
cuts
BY DEBRA GEORGE SIEDT
Capital News Service—Maryland
hospitals and some of their poorest patients receiving Medicaid
may be faced with higher costs because of budget cuts on health
services effective on Jan. 1.
In September, health care administrators told the General
Assembly's Health and Government Operations Committee of the
harm repeated budget cuts will wreak this year and next.
Hospitals face a $10 million cut in the first six months
of 2004, which will mean an increase in uncompensated cases.
And patients may face a limited number of days in which they
can stay at hospitals.
Insurance company limits on hospital stays could shift the
cost burden to patients or hospitals, when patients have no
insurance. The Health Services Cost Review Commission, which
met on Sept. 10, ultimately will determine if insurance rates
will rise. Hospital rates have already increased 6.5 percent
for fiscal year 2004.
"We're dealing with some incredibly difficult problems,"
said Nelson J. Sabatini, secretary of the Department of Health
and Mental Hygiene.
Nursing homes, mental health services, and pharmacies also
are affected. Nursing homes suffered a $10.6 million cut last
spring, and now face another $4 million in reductions from
state and federal government sources. Medicaid accounts for
about half of all nursing home spending in Maryland. Hospital
stay limits would also place an additional burden on nursing
homes, which would have to take hospital patients needing
extended care.
The Mental Hygiene Administration sustained $10.1 million
in budget cuts for fiscal year 2004, and community mental
health service providers must turn away uninsured consumers,
reduce authorized services and complete more paperwork.
Pharmacies, facing a $2.2 million state and federal cut,
will also feel the crunch. Beginning in January, the state's
reimbursement rate for pharmacies will drop from the average
wholesale price less 11 percent, to that price less 12 percent.
"Hopefully, some of these measures will be temporary,
one-time measures," Sabatini said.
In an era of nursing shortages, one Maryland hospital's healthy
relationship with its employees is paying off. North Arundel
Hospital in Glen Burnie has a nursing job vacancy rate of
only 1 percent–a fraction of the statewide average of
13 percent.
North Arundel officials attribute that to the incentives
they offer their nurses. Educational benefits include a seven-week
internship program for all new nurses, and a career-training
program that allows someone to begin work as a nursing assistant
and end up a registered nurse, said Kathy Poehler, the hospital's
manager of compensation and benefits.
Congress is now trying to expand such benefits to the rest
of the country, in order to help head off a projected shortage
of 800,000 nurses by 2020.
An amendment to the fiscal 2004 appropriations bill for health,
labor and education would increase federal funding for scholarship
and loan repayment programs for nurses who work in facilities
with a critical shortage. The amendment, sponsored by Sen.
Barbara Mikulski (D-Md.) boosts the Nurse Reinvestment Act
and other nursing workforce development programs by $50 million,
bringing the total to almost $163 million. The House did not
include that language in its version of the health appropriations
bill, and the difference will have to be settled in conference.
The Nurse Reinvestment Act has the potential of recruiting
more nurses, but the work environment needs to improve as
well to prevent nurses from leaving, said Donna Dorsey, executive
director of the Maryland Board of Nursing. As the profession
ages, for example, nurses increasingly suffer back injury
from moving patients.
Nurses at North Arundel are encouraged to keep a "Love-Me
Box" full of mementos from thankful patients – to
open whenever they're having a bad day. The hospital also
offers retention bonuses to nurses every six months, Parker
said.
And as Hurricane Isabel loomed, fifth-floor nurse manager
Diane Jewer thanked everyone for coming in.
"We really value these employees," said Jewer,
who oversees more than 100 nurses at North Arundel. "I
don't think that a lot of institutions do that."
Since nurses are largely underappreciated and overworked,
they are increasingly looking for other opportunities, experts
say. It isn't like 50 years ago, when women entering the working
world were largely limited to becoming either a nurse or a
teacher, Jewer noted.
Today, women are more likely to enter medical school than
nursing school, so the nursing field is trying to recruit
more young men. For reasons that are not entirely clear, men
and minorities remain in nursing jobs longer than women, Dorsey
said.
"You have to have a certain mindset to be a nurse,"
said Jewer. "It's very hard work."
|
