Regardless of what happens with the Affordable Care Act, euphemistically known as Obamacare, the finances relating to hospital stays in this country are in flux and probably will continue for the next few years.
Locally, that means plans for a multimillion dollar replacement of Harford Memorial Hospital in Havre de Grace have been put on hold.
To a large degree, hospitals with emergency rooms, which is to say most hospitals, have been a driving force behind most health care reform efforts undertaken in the past three decades. Hospitals are obliged under the laws in just about every state to treat anyone who shows up suffering from a true medical emergency, regardless of ability to pay.
There are two major financial implications of this reality: a certain percentage of emergency room visits end up not being paid for, which varies from community to community, and people with no or limited ability to pay for medical care often wait until medical problems like infections turn into emergency situations before seeking treatment.
While no money generally ends up being collected in these situations, the medical care rendered is the most expensive available: emergency care.
Uncompensated, expensive emergency room visits end up being paid for by someone, and that someone is usually people who have insurance.
The real costs associated with these – or really any – kinds of medical care are all but impossible to nail down. Emergency room visits are expensive, and made all the more expensive by the need to pay for people who receive care but don't pay. There are more complicating factors. Different insurance companies negotiate different payment schedules for varying procedures with different hospitals at, presumably, reduced rates on the theory that they're buying in bulk. Medicare does the same thing. So rates end up being set, at least in part, based on the knowledge that they will be negotiated down.
Who would have thought figuring out the cost of setting a broken arm or delivering a baby had so much in common with negotiating the cost of a used car?
It remains to be seen the degree to which the Affordable Care Act will address the serious flaws in the payment schedules associated with medical care, in general, or specifically that related to hospitals. Certainly, however, it has become clear that making sure everyone who ends up in an emergency room has a level of health insurance is a key goal of the act.
What does this mean for hospital finances? If it works, there will probably be a major reconfiguration and standardization of hospital billing policies. If it doesn't work, the act will be revised, and there will be a reconfiguration and standardization of hospital billing policies. Or maybe it will end up being repealed. Or maybe something entirely different will happen.
The only reasonably sure bet is the financial picture for hospitals will be changing over the next few years.
In light of these realities, embarking on an effort to replace the existing Harford Memorial Hospital in downtown Havre de Grace with a from-the-ground-up facility on the city's western edge might not be the sound idea it seemed like just a few years ago.
Harford Memorial is probably in need of replacement, and its owner, Upper Chesapeake Health, was on the right track with its plan to build a new hospital near the Havre de Grace exit on I-95, but previous timetables for the construction project put it squarely in the middle of the Affordable Care Act's rollout, which is bound to face some problems even beyond the persistent political efforts at repeal.
At this point, waiting seems like a good idea.