MOSES LAKE - The Moses Lake Rotary club welcomed the administrators of three Grant County health care providers Wednesday for a panel discussion on health care.

The panelists were Andrew Bair, administrator, Samaritan Healthcare; David Olson, administrator, Moses Lake Clinic; and Bob Reeder, administrator, Columbia Basin Hospital.

The trio fielded questions about cuts to Medicare, changes in critical access hospital designations, and how technology is changing health care.

The first question was how reductions in Medicare payments will affect operations at the hospitals.

Samaritan anticipates at least $3 million dollars in cuts, said Bair. The hospital has worked to withstand the hit to their budget, he said.

"We don't think it's going to devastate us, but $3 million is a chunk of change," he said.

The cuts are a "pretty good" percentage of the hospital's net revenue of $65 million, he said.

The Moses Lake Clinic anticipates a cut of 5 to 10 percent of their budget, amounting to between $3-4 million, said Olson.

"Health care cost has to go down," he said. "I don't think, frankly, the government has any choice."

As a critical access hospital, Columbia Basin Hospital is more concerned about changes to the critical access designation, said Reeder. Seventy cents of every dollar the hospital receives is from the state or federal government, he said.

"When the country and the state are in the financial crisis that they're in, it always trickles down into our back yard," he said.

The federal government is considering redesignating critical access hospitals so that any hospital within 10 miles of another hospital would lose its critical access designation, he said. That would not affect Columbia Basin Hospital, but would affect six state hospitals, he said. The federal government is also considering tweaking reimbursement rates for the remaining critical access hospitals, which would cut $70,000 from the hospital's budget, he said.

Cuts the state may make to critical access hospitals could have a greater impact on the hospital, Reeder said.

"Every dollar the state gives us for Medicaid is matched by the federal government, so where the state might be saving $25,000, hospitals are actually losing $50,000," he said.

Columbia Basin Hospital would lose $600,000 if the cuts passed, he said.

Cuts to medicare would not limit the number of patients Samaritan sees, said Bair. By law, emergency rooms cannot turn patients away, he noted.

The same is true of the Moses Lake Clinic, said Olson.

"Our commitment is to the community and not just segments of the community," he said. "The bottom line is there are people in the community who need help. We're going to have to figure out a way to give it to them. The burden is on us and, frankly, should be on us and not on the patient."

Reeder said Columbia Basin Hospital will continue to take all patients that come to the hospital's emergency room and clinic.

When it comes to collaborating to improve patient care, health care providers receive conflicting messages from different parts of the government, said Olson.

"Part of the problem is that one part of the government says, 'You guys need to collaborate.' The other part of the government says, 'And we'll throw you in jail if you do.' Because we're competitors and the (Federal Trade Commission) says, 'Don't do too much together,' and yet, Medicare and Medicaid want to incentivize us to do things together. Short of staying out of jail, the bottom line is, what's in the best interest of the patient and to that end, sometimes it's having doctors do outreach to outlying hospitals."

Olson pointed out that it would save health care providers money if they could share patient information with each other electronically. A member of the audience asked if HIPAA laws would prohibit sharing patient information electronically. While HIPAA laws protect patient information, that information may be shared with health care providers if it would improve patient care, said Olson.

All three administrators praised Big Bend Community College's nursing program, saying it has provided them with an adequate supply of nurses where hospitals in other areas have experienced a shortage.

"We enjoy something here that most of the nation does not and that is we have an adequate number of nurses in this community," said Bair. "Most organizations are spending a tremendous amount of money in their recruiting. They have recruiting budgets. I don't have one."

Big Bend's nursing program ensures he doesn't need a recruiting budget, he said.

Earlier this year, Samaritan and Wenatchee Valley Medical Center, on behalf of Moses Lake Clinic, donated money to Big Bend to save an instructor position for the nursing program.

In response to a question about the future of health care, the administrators predicted that payment mechanisms and new technologies would change the face of health care.

The way doctors and hospitals are paid will change in the future, said Olson.

"I don't see a doctor getting paid twice as much to see two people as they do one person," he said.

Payment will be based on the outcomes of patient care rather than solely on the number of patients doctors see, said Reeder.

Olson predicted there would be a greater emphasis on doctors treating people in their own homes. He cited new technology that allows patients' blood pressure and other vital signs to be sent from their homes to their doctor's offices.

Some Samaritan physicians consult with specialists remotely, Bair noted.

"The ability to do things remotely, to do things electronically will be one way that we'll be able to reduce costs such that the system can survive," said Reeder. "Every time there's a major change, the health care industry is like, 'Oh, what are we going to do?' ... But we're able to work through it and use innovative ways to solve each of the issues at hand."