I have no problem myself seeing a mid-level for my primary care."

What concerns are you hearing from your physicians and specialists?

"I think the providers have the same concerns that the hospitals have as more and more of the payment shifts to government based, which is not paying us the full cost of providing that care.

It's making it more and more difficult for us to be able to stay in business.

The ability to cost-shift that to others just isn't there, nor should it be. 

So, the economic challenges are really what is primary, I think, in many minds."

"Again, it's important for us to understand that when the healthcare industry, specifically the hospital industry got behind support for the Affordable Care Act,  it was under the assumption that we woudl take the cuts in medicaid payments, and that would be balanced by increased coverage through medicaid expanstion.

Now that many states have decided not to expland medicaid, and the cuts are still going into effect, I think it's creating a real economic hardship, specifically on hospitals like Community that are safetynet hospitals; hospitals that have a disproportionatly high medicaid load. We need to do something about that. 

We have talked to our legislatures relative to passing legislation to change that.

With the support of the Hospital Association, Washington is beginning to listen, and I am hopeful this error for unjust position we have today ultimately will be corrected."

What do you need Washington to do? Do you need more money?

"If you have decided you are not going to expand Medicaid, which we have decided here, then you can't impliment the dish cuts, or the medicaid cuts until that expansion has been reconcidered and hopefully embraced. 

You have to have balance.  These are very tight.

When hospitals operate, as we do at about a 2% margin, we don't have a lot of room for error.

so, when we thought we were going to have a balanced solution, we can't take the cuts until we get the opportunity to cover them in some way."

"Could we see fewer doctors here if that balance doesn't happen?"

"Ultimately, we have to reduce our costs and that could result in us rethinking what services we can afford to offer.  So, yes, as in any business, if we don't have the economics to support it,  Then we are going to have to make changes."

Does that mean eliminating a specialty, or having fewer doctors in that specialty?

"Many of the specialists in our market are independent and not employed by the hospital. Both hospitals are focused primarily in employing primary care physicians.  Where would you see the cut-backs?  I think you would see the cut-backs likely in in-patient services.  Trauma centers like St. Pats may have to reconsider whether they can afford to continue to provide that service, if they are seeing reductions in reimbursement without any counterbalances.

So, I think it will be questions like that: can we continue to offer all the services that we've had.  Do we have to eliminate some services, or do we have to reconfigure how those services are delivered? 

Likely a combination of both."