By RYAN MURRAY/The Daily Inter Lake

As 2014 arrives, and with it many health-care changes as a result of the federally mandated Affordable Care Act, local hospitals and health officials still face looming questions.

For Kalispell Regional Medical Center, North Valley Hospital and the Flathead City/County Health Department, there are yet-unknown ramifications of the health-care legislation.

But one of the biggest changes for health-care providers is a seemingly minor one.

“Honestly, some of the biggest problems we’ve had have been with the electronic medical records,” North Valley Hospital Chief Executive Officer Jason Spring said. “It’s a struggle for some. It’s a steep learning curve.”

As part of the Affordable Care Act, medical practices are mandated to keep electronic records of diagnoses, prescriptions and treatment.

For some local doctors, this is a bureaucratic headache wrapping health care in red tape. For others, it doesn’t seem to be a big deal.

Jim Oliverson, vice president at Kalispell Regional, said some pushback already has happened from doctors.

“I’ve seen some docs complain about it,” he said. “They said they would have had this thing done 20 minutes ago if it wasn’t for the electronic records.”

Oliverson said he wasn’t sure exactly how much more difficult it will be to do it electronically as opposed to manually writing it, but clearly some doctors are having difficulty.

The provision, while it may make for more clerical time, is aimed at stopping a preventable problem in the medical community.

A 2006 study by the National Academies of Science’s Institute of Medicine found that more than 7,000 deaths a year in the United States could be attributed to doctors’ sloppy handwriting, with another 1.5 million Americans suffering preventable harm from medication mistakes.

These findings and others like them, according to Flathead Public Health Officer Joe Russell, have pushed along electronic records for years.

“The whole electronic records thing started well before the Affordable Care Act,” he said. “This movement is only the latest in its history.”

The new law also has created concern among some physicians about job security and the level of care they are going to be able to provide. This is a false worry, Oliverson and Spring agreed, as both hospitals have hired rapidly in the last several years and have no intention to cut positions anytime soon.

“We have no plan to lose doctors,” Oliverson said. “We want to keep going forward and grow with the program. The trick simply is the capital to do that.”

Spring echoed that sentiment, saying North Valley plans on expanding its birth center and a primary care clinic in Columbia Falls.

“We haven’t had a direct impact from the Affordable Care Act yet,” Spring said. “But it is hard to predict, and Montana did not expand Medicaid, so we are even less sure.”

Montana, one of 24 states that either did not expand Medicaid or are not expanding key parts, turned down 100 percent of federal aid for three years and no less than 90 percent thereafter for residents making less than 133 percent of the federal poverty line.

If the state had expanded Medicaid, it was estimated that nearly 70,000 low-income Montanans would have become eligible for the funding.

The local medical community had mixed feelings about the expansion failure.

“Even if Medicaid expansion happened, I don’t know how much we would have been impacted,” Russell said. “You’ll see a rise in patients now, but if we would have expanded we might have had a negative effect.”

With uninsured Montanans getting health insurance for the first time, Russell believes they might go to family practitioners and other doctors instead of the health clinic run by Flathead County. That exodus from the public health clinic would have been increased with expansion of Medicaid. With Affordable Care Act money the county health clinic has hired three more employees in recent months.

Both hospitals are concerned that at least initially bad debt will rise until more people buy into the exchange or prices come down.

“I think we’re going to see higher deductibles and co-insurance at first,” Spring said. “I would think we’d see higher bad debt, but people who did not have insurance now have it, so it might even out somewhat.”

For Oliverson and physicians at Kalispell Regional, many of the unknowns about how the law will unfold come from the vague language in the various documents.

“If you were to arbitrarily pull out pages, you’d see a lot of ‘must’ language with words like ‘appropriate,’ ‘relevant,’ and ‘significant.’ What do those words mean?” Oliverson asked. “That’s up in the air.”

Despite the challenges of the new law, all three health officials believe it is a step toward a more comprehensive health-care system.

Russell, a fan of the German system (a multipayer system with strong competition), said regulations would steer the law toward true universal health care.

“Medicare is heavily regulated and is social medicine,” Russell said. “Honestly, Medicare is a model we need to look at if the Affordable Care Act is going to work like it is supposed to.”

Spring believes the legislation was not the penultimate solution, but it’s at least a good way to start.

“Eventually, it will be a step to fixing our system,” he said. “The current system is fairly well broken. We will have to struggle through to a more complete system.”

Oliverson agreed, saying no one should have to worry about the cost of staying alive.

“I think most people think there is no excuse to have anyone go to sleep at night hungry, cold and without access to health care,” he said. “And maybe this isn’t perfect, but you can’t go back.”

Reporter Ryan Murray may be reached at 758-4436 or by email at rmurray@dailyinterlake.com.