Gov. Katie Hobbs participated in a roundtable with Northern Arizona Healthcare (NAH) providers at Flagstaff Medical Center last Thursday to discuss the potential effects of proposed cuts to Medicaid funding on healthcare in rural and northern parts of the state.
Hobbs said she had also met with groups of hospital administrators, healthcare center directors and Medicaid patients to learn about potential effects.
NAH is the healthcare system that operates both FMC and Verde Valley Medical Center, with a service area throughout northern Arizona.
NAH leadership and representatives of several of its service areas met with Hobbs after she toured FMC the afternoon of June 12. They outlined anticipated effects, most of which they said would have a wider impact than only those patients using Medicare for their insurance.聽
Colleen Little, the clinical manager of FMC's pediatric intensive care unit (PICU), said the 14 beds in her department are the only PICU beds in the northern half of Arizona.
Several forms of treatment these patients receive after discharge require insurance coverage, meaning it will take longer to safely discharge or transfer some patients. Those patients occupying the PICU beds longer could lead to delays in care for others in need of that space.
鈥淭his decreased access coupled with inevitable delays in seeking care of our uninsured population will mean sicker patients arriving here,鈥� she said. 鈥淪ome will arrive too sick to be saved, even with preventable and treatable illnesses and diseases, injuries. This will affect emergency access for all members of this community, regardless of their age, their insurance coverage, their status or their ability to pay."
Little said finances are often a factor in the decision to seek care, leading to patients coming in with more serious illness that could have been addressed or prevented with earlier treatment. Cancer diagnoses are one example, she said, and she mentioned that during the pandemic, families brought in their children with appendicitis after a rupture, leading to hospital stays of a week or more rather than two to three days.
Other causes for delayed care were also discussed in the meeting.
If a health center in a rural area closes, the increased travel time needed to access care could also lead to patients delaying. Or people who still qualify for Medicaid after the cuts could lose insurance because of a lack of awareness or ability to manage the paperwork.
Rachel Levitan, interim chief medical officer, said 30% of the hospital鈥檚 trauma patients use Medicaid.
鈥淲hen you combine high-quality care with timely care, we see that patients can do incredibly well, so access to care is so important,鈥� said interventional cardiologist Andrew Atiemo. 鈥淭he concern is that basically when you lose funding for Medicare, we鈥檙e going to lose access to care -- which will lead to, unfortunately, preventable deaths.鈥�
It also funds support services, such as therapists, nutritionists and social workers at the Children's Health Center鈥檚 Children鈥檚 Rehabilitative Services (CRS) program, said pediatric nurse practitioner Diana Holt, preventing families from needing to travel to Phoenix.聽
The providers said this could also affect staffing, as a lack of resources to provide care are a primary reason nurses and other employees leave for other work. It could be more difficult to recruit quality doctors, said COO Bo Cofield, adding that this is already a problem in rural areas because of a lack of resources and educational opportunities.
鈥淧hysicians, healthcare providers, we don鈥檛 like to fail our patients, and we take it personally,鈥� Levitan said. " ... That鈥檚 a big piece of people leaving in rural areas: they cannot provide care that they feel like they can sleep with at night because they don鈥檛 have those resources, and cuts will do more of that.鈥�
Brandon Abbott, hospitalist/pediatrics, said NAH has recently had success in this area, hiring 90 recruits over the course of a year, a positive that he attributed to its facilities, status as a level one trauma center and investment in providers. He also mentioned NAH residencies and educational programs from Northern Arizona University and North Country Healthcare.