Other
transcripts
Transcripts
January 28, 2004
Host:
Michael Grant
Topics:
· AHCCCS;
· "The Exonerated," at Gammage Auditorium;
· Vote 2004: Candidate Profiles - Sen. John Kerry and Howard
Dean
In-Studio Guests:
· Tom Betlach, Deputy Director, Arizona Healthcare Cost Containment System
· John Rivers, President and CEO of the Arizona Hospital and Healthcare Association.
>> Michael Grant:
Tonight on "Horizon," small rural hospitals struggle because of
high costs and low patient numbers. We look at a proposal to create
a fund so rural hospitals' payments from AHCCCS cover their costs.
>>> Michael Grant:
Plus, "The Exonerated," an off-broadway play now on stage at Gammage
auditorium, tells the true stories of six innocent survivors of
death row. Good evening, I'm Michael Grant.
>>> Michael Grant:
Those stories in a moment, but first, Senator John Kerry is celebrating
his win in the New Hampshire Democratic primary, and Arizona Kerry
supporters are celebrating with him.
>> Harry Mitchell:
I think it's great news. The history has been no one has won the
Democratic nomination without coming at least first or second
in the New Hampshire primary. It shows that John is on a roll.
First of all what he did in Iowa and now New Hampshire. I think
it bodes well for him and the campaign and bodes well for the
American people.
>> Michael Grant:
The Arizona Democratic party says it expects all the major candidates
to make an appearance in Arizona before next Tuesday's primary.
They also say, judging by the number of "vote by mail" applications,
they expect a record voter turnout here. Turnout records have
already been set in Iowa and New Hampshire. Later in the program,
we will have profiles of two of the presidential candidates, John
Kerry and Howard Dean.
>>> Michael Grant:
Turning to a big healthcare issue now, the disparity of payments
to small rural hospitals was studied from 2000 to 2002 by the
Arizona Healthcare Cost Containment System, the state's Medicaid
agency also known as AHCCCS, and the Arizona hospital and health
associates. The study found that reimbursements from AHCCCS to
rural and urban hospitals failed to meet their costs. The problem
is pushing some rural hospitals to the brink of bankruptcy, but
a senate bill introduced at the state legislature this week seeks
to ease the financial pain felt by rural hospitals. In a moment,
we will talk about that. First, Merry Lucero takes us to one rural
hospital where the legislation is critical.
>> Reporter:
Arizona's rural areas, like Wickenburg, 54 miles northwest of
Phoenix, need vital human services. Healthcare is one of those
needs. But rural hospitals face unique challenges because of their
location. Wickenburg regional health center is a prime example.
CEO Dale Decker.
>> Dale Decker:
We service a rather large rural population that goes west some
25, 35 miles. Our actual service area is about 18,000 people.
So it is obviously much larger than the 8,000 people that live
in the Wickenburg community directly.
>> Reporter:
Their emergency room is one of the vital services they provide.
The federal emergency medical treatment and active labor act requires
hospitals to treat everyone who comes into the emergency room.
>> Dale Decker:
The majority of the people that come to our emergency room are
services that we do not get compensated for at all. We have a
tremendously large writeoff on services that we provide in the
ER. We have a lot of transient people that come through this community.
>> Reporter:
Urban hospitals deal with the same problem, but Decker says costs
at rural hospitals are higher.
>> Dale Decker:
Our unit cost of services simply are higher because we have considerably
lower volumes of patients. For example, we see on an average of
18 patients a day, and our emergency room. Down in the valley
there are ERs that see 18 patients every hour. So when we get
into our fixed overhead and our cost of labor and the payment
to have physicians in this building 24/7, that cost for unit service
is higher than hospitals that have tremendous volume changes.
>> Reporter:
So while rural hospitals are hungry for patients, a recent study
showed that the reimbursement by AHCCCS, Arizona's Medicaid agency
covers just over half of the costs that small rural hospitals
incur. The disparity has forced Wickenburg regional health center
to tighten its belt.
>> Dale Decker:
You spend no money out of operations for the maintenance of your
building. You spend no money to buy new technical equipment or
very minimal investment into technical equipment. You have no
ability to do anything over and above basic healthcare for the
community.
>> Reporter:
Decker says over the past decade, they have depleted a fair amount
of their resources and have had to cut back on many services.
>> Dale Decker:
We have discontinued obstetrics. We have discontinued doing surgery.
We have discontinued our intensive care unit. We have discontinued
any level of intensity of services that we can no longer support
for the community. And all of those patients are transferred down
to the valley.
>> Reporter:
They do about 600 transfers from their emergency room to the valley
each year, so while patients like part-time resident and winter
visitor Dean Hub bettered recover, the hospital hopes for a shot
in the arm and tries to determine whether or not it will survive
as this rural area's health center.
>> Michael Grant:
Here to talk about the legislation proposed this week, Tom Betlach,
Deputy Director, Arizona Healthcare Cost Containment System, and
John Rivers, President and CEO of the Arizona Hospital and Healthcare
Association. John, why don't we clarify here. "Rural" may be too
expansive a term, because there are fairly major hospital facilities
in what we think of as rural areas. What kinds of hospitals really
are we talking about? That kind of smaller hospital?
>> John Rivers:
Wickenburg community hospital is a very good example of what we're
talking about. We're talking about hospitals that fall into two
categories. One, anything outside of Pima and Maricopa County,
we consider to be rural, for purposes of our discussion today.
Secondly, the group of hospitals that's particularly affected
by AHCCCS payments as described by Dale Decker are the hospitals
that are 75 beds or fewer. So it's really the small hospitals,
75 beds or fewer, outside Maricopa and Pima County who are the
most dramatically affected by that payment system.
>> Michael Grant:
So a Yavapai medical center, for example, they've got great facilities
in Flagstaff, others, would not be in the class we're talking
about.
>> John Rivers:
That's right. They are generally doing okay. And a lot of people
who don't get to rural Arizona very often don't realize that we've
got some very large medical centers, big medical centers, Yuma,
almost a 500-bed hospital. Kingman, Flagstaff, Prescott, all very
good examples of large rural medical facilities that are not really
affected by what it is that we want to do here.
>> Michael Grant:
Okay. Tom, let's go back about six, seven, eight years ago, AHCCCS
performed a study to establish baseline for the --
>> Tom Betlach:
Back in 1998, the rates were set and updated again for hospital
reimbursement for in patient. Then in 2001, in response to a legislative
mandate that required AHCCCS to look at the rates and how they
compare to costs, a study was done working with the hospital association
and some hospitals over about a year and a half period to try
and compare what our reimbursement is compared to both other payers
and hospital costs. What we found in the study is in urban areas,
we pay 59% to 98% of hospitals cost. When we looked at the data
for the smaller facilities, we found that on average, we were
in the 50s in terms of the percent for the reimbursement. So AHCCCS,
as it stands now, the rates that we pay, we pay seven different
types of rates, but we pay the same rate to an urban facility
that we would to the rural facility.
>> Michael Grant:
That decision was based upon the study done a number of years
ago?
>> Tom Betlach:
Right, on the data in 196, '97 for the rates that went into place
for 1998. We don't have the ability to change that. We locked
those rates in place. We inflate those rates annually by an inflation
adjustment, but after that, we don't have the ability to go in
and say, okay, we're going to add an amount of money to the rural
hospital reimbursement. That has to be a decision that the legislature
and Governor make.
>> Michael Grant:
John, did something happen wrong in the first study that should
have indicated a disparity in costs between small rural and urban
hospitals? Or have the economics of healthcare delivery for the
small rural hospitals changed in the past years?
>> John Rivers:
I think it's a little bit of both, Michael. The AHCCCS payment
system that was put into effect about a decade ago was developed
collaboratively between AHCCCS and the hospital association. It's
generally a system in which we've had a great deal of confidence.
There are these not so little anomalies that have developed over
the years because the world has changed since that system was
put into effect. So I think the development of the crisis we're
talking about today has occurred very gradually, over about a
10-year period. It was about two to three years ago that our rural
hospitals really started screaming at us about this, but it was
at the same time when the economy in Arizona was taking a nose
dive and the fiscal crisis hit the state legislature, and we had
to say to these rural hospitals, we understand, we hear you, but
there is really not a lot we can do about it in this environment.
But this year, we decided they were just screaming so loudly and
suffering so much, that we simply had to make the effort to do
something.
>> Michael Grant:
Okay. Now, Tom, how much of this is driven by the use of emergency
rooms in the rural areas for, perhaps -- for more routine care,
really?
>> Tom Betlach:
When we look at emergency room, that typically is reimbursed as
an outpatient service. When we are talking about in-patient, we
talk about hospital stays, surgery, maternity, things like that.
If there is more dependence upon an ER, that's covered by outpatient.
That's a different reimbursement system than what we're talking
about here. What we're talking about with regards to the proposed
legislation deals solely with the reimbursement rates for in-patient
hospital stays.
>> Michael Grant:
All right. SB 1191, the save fund. What's the proposed fix?
>> Hohn Rivers:
Well, the fix is to establish a pool of money that would really
be dedicated for the purpose of closing the gap between payment
and cost for our rural hospitals. The bill authorizes about $7
million in state money that would go into the pool, because Medicaid
or AHCCCS is funded on a federal state partnership. That's $7
million in state money would be matched with roughly $14 million
in federal money. So the idea is to create a pool of about $21
million, which AHCCCS would then distribute directly to the hospitals
based on the studies showing where it is needed most. And we're
in the process of working with AHCCCS to conduct that study right
now.
>> Michael Grant:
All right, where does AHCCCS stand on the proposal, Tom?
>> Tom Betlach:
Well, we're not policy makers. It's up to the legislature and
Governor to determine whether or not there is appropriate funding
overall within the budget, but when we did the study, back about
a year and a half or so ago, we acknowledged the fact that rural
hospitals do have unique fiscal challenges, and that certainly
the study and the results of that study indicated the challenges
that are faced based upon the current reimbursement system.
>> Michael Grant:
So no disagreement from the agency in terms of, yeah, we do think
we have a problem?
>> Tom Betlach:
Right, we don't necessarily have problems with the data. I mean,
it was our study that we did. It was working with hospitals to
use their data, but again, determining the dollar amount and what's
available, that's up to the legislature and the governor.
>> Michael Grant:
Well, speaking of money, where does the money come from for the
save fund?
>> John Rivers:
Well, it can come from any number of places. It can come from
the state general fund, or it can come -- I think in the bill,
it's earmarked to come from the medically needy account, which
was established in 1995 when the original tobacco tax initiative
was passed by Arizona voters. So, the suggestion that's on the
table right now is for the legislature to reshuffle some of its
priorities in how it's spending that money and to take $7 million
from that fund to provide the state money for this pool. They
could take it from that fund if they wish or they can take it
from the general fund or they can take it from any place they
wanted to.
>> Michael Grant:
Is there any -- you've mentioned that the problem has been around
for a couple of three years. Let's assume the save fund doesn't
pass. What happens? Do you continue to limp through this? Are
there facilities that really are on the brink of bankruptcy?
>> John Rivers:
Well, we've had probably three or four of those hospitals in this
list of 20 who would be eligible for this special payment who
have been in Chapter 11 at one time or another in the last few
years. You heard in the part that preceded the show, the administrator
at Wickenburg tell you about all of the services they've had to
discontinue over the last three to four-year period. So closing
up the hospital is one option. Obviously it's a drastic one. We
don't want to overstate this case and say that's what's going
to happen across the board if some relief isn't found, but it
is fair to say that this is a more critical problem for some of
these smaller hospitals than it is for others. They would all
be in a bind without relief, but the ones who would be in the
biggest bind would probably be the very smallest ones, and that's
where the threat of a Chapter 11 or something really drastic is
not just idle chit-chat but a real possibility.
>> Michael Grant:
John Rivers, thank you for being here. Tom Betlach, good to see
you.
>> Tom Betlach:
Good to see you.
>> Michael Grant:
An off-broadway play has begun a weeklong run at ASU's Gammage
auditorium. "The Exonerated" tells real-life stories of death
row inmates who were found innocent and freed by the State. The
play stars Mia Farrow and relates the inmates' stories in their
own words. Actors sit on stools and read from scripts with lines
of dialogue drawn from depositions and transcripts of capital
cases. The play also stars John Savage.
>> John Savage:
I hope what they take away is some feeling of personal involvement,
connection, you know. Would the world that they love and they
care about, that feeling that's -- I'm all by myself and I can't
do anything. It's not true. It's not true. Or I have to vote for
this guy because he's the only guy that's going to win. That's
not true.
>> Delbert Tibbs:
In my case, I tried to remain as positive of an outlook as a possibly
could. I was born in the south in the southern part of the United
States, so under what I call Mississippi apartheid where there
were colored and white drinking fountains where I was a child
and that sort of stuff. So I know that a part of that has to do
with race in America. I know that. I knew it when I was in prison.
Fortunately, unlike many people, I was able to -- many of my friends
had been involved in the civil rights movement, had marched with
Dr. King, had organized people and so forth. And sometimes people
tell me well you see the system worked. I said no, we made the
system work. It didn't work I say so facto because it's a system
that works. We forced the issue, and often that's -- in order
to get justice, that's what you have to do. There was a defense
committee. People raised money. People did exactly what I'm doing
now. They did interviews on radio and television and so forth
and they made the people aware of it. So when my case came up
before the Florida Supreme Court, I'm sure they had nothing to
do with the justice's decision, but there were people marching
outside saying "justice for Delbert Tibbs and so on. They couldn't
be lacks about it or cavalier. They had to be focused on it otherwise
they would have been revealed as being unjust and uncaring and
so forth and they are not supposed to be that way. That helped
in terms of my getting a fair trial.
>> Michael Grant:
"The Exonerated" will be at Gammage auditorium through February
1st.
>>> Michael Grant:
An ASU art professor specializes in an unusual media, the art
of architectural restoration. He considers his restoration work
an extension of the lives and talents of those who crafted some
of Arizona's most treasured historic buildings.
>> Randy Schmitt:
I have the skills I do because somebody gave them to me. I learned
them from somebody else. That's why I started to be a teacher.
So it's passing on the information. So when I'm gone, then somebody
else can do it.
>> Reporter:
For the past 32 years, professor Randy Schmitt has been sharing
his mast industry and approach to ceramics with countless students.
He and his colleagues have developed an internationally recognized
program of study that continues to explore new expressions of
this ancient art. He also uses technical expertise to battle the
ravages of time and man that afflict historic architecture.
>> Randy Schmitt:
The restoration work almost started as just kind of a tiny little
afterthought. I was asked by an architect to do something for
the State Capitol. And one thing led to another. I've always been
interested in architecture, especially old buildings. So it was
kind of a natural for me to work down that avenue. Well, this
is where my career in architectural restoration started. I was
asked to make just a few missing parts here of this decorative
molding. All of this had been torn out. So many of the decorative
elements had to be replaced.
>> Reporter:
Schmitt has been involved in a number of the valley's historic
restoration projects. The grandson of a painting contractor, he
at one time worked in the construction trades himself. While relying
frequently on those modern skills, he also calls upon the methods
of his predecessors.
>> Randy Schmitt:
I don't think of worst case of scenario, I think of the simple
scenario, how would the trades have done it? So I go back and
looked for old books that people would have used back then and
from that, see just how they did things, and what materials were
used and wherever possible, I'll try to use the original thing.
>> Reporter:
Schmitt's extensive work took place over many months and included
helping to restore the old house and senate chambers.
>> Randy Schmitt:
What we're seeing in this room, everything has been recreated.
And I was commissioned to make a reproduction of that molding.
They had checked and the original encrestor, which is an embossed
wall paper that was used in Victorian times, it came from Liverpool
and the factory that made it took a direct hit during the war,
so there wasn't a chance to of getting any more. So all 128 feet
of this gold encrestor I made in my studio. We're in the balcony
of the house chamber. One of the things that was a glaring missing
part was one of these capitals. The story is that it was in some
senator's home. But anyway, I would come in and paint latex rubber
on this and build up a mold like we have in the studio, and then
a plaster backing, and then it was taken back to the studio and
fabricated there, and then brought back and replaced.
>> Reporter:
The process of restoring historic buildings is a team effort,
bringing together architects, contractors, and a variety of trades
people. During the recent restoration of old main, ASU's oldest
building, Schmitt also was involved in the two important rolls
he often fills.
>> Randy Schmitt:
I was hired to be the conservator, and I went through and we call
it mining the building. We do detective work and get back to what
was there originally. I presented a paper on that. Then I was
hired to make missing elements in the ceiling, in the ballroom,
which is really the grandest part of the room. In front of me
here, I have a product -- end product, a piece of rope molding,
and this is also in the continue ceiling and originally it was
made out of continue, but nobody had this thing any more. So we
took a piece of the original tin, in fact there is nail holes
in it and made a rubber mold. That's this part of it. I really
overbuilt them. I mean, I have to know that when I walk away that
my thing isn't going to fail. That's my own deal. I also like
to think that if I do a good job, you'll never, ever know what
I did. And so that's what drives the whole thing for me.
>> Reporter:
One of Schmitt's favorite projects is Tovre castle. Built in the
early 1900s, it sustained considerable wear and tear over the
years, but Schmitt, who was at one time the castle's caretaker
knows the building intimately, and remains enthusiastic about
its potential for restoration.
>> Randy Schmitt:
We're on the second floor of Tovre's castle. This is a nice little
architectural detail up here that was covered over in the 50s
by this blown-on stucco paint. But this will have to all be restored.
Otherwise, it'll just be chopped off and you won't see it.
>> Reporter:
Schmitt's role so far has been that of conservator, finding out
what the building was like in its original state, while portions
of the castle have survived in relatively good shape, other areas
have faired poorly. But sometimes amid the debris, valuable secrets
are revealed.
>> Randy Schmitt:
Mother nature has kind of done some detective work for us. If
a building has a poor roof, it's one of the first things that
causes deterioration. But in the conservative effort here, we're
trying to find the original paints and the peeled wall here is
exposing some of the color. If we don't have some exposed work
like this, then we have to go back chemically and physically and
find the different layers of paint. So this gives us a pretty
good idea of what happened in this room.
>> Reporter:
Randy Schmitt's work is an extension of his life. In addition
to teaching and his restoration efforts, he is very much an artist
in his own right and his contemporary work often reflects his
ties to the past.
>> Randy Schmitt:
The restoration work, a lot of it is what I was doing at the capitol
was making molds of existing ornamentation, and we're talking
working months at this thing. Once I was done and made the pieces
that were installed in the capitol, the missing pieces, it was
still in my brains. When I started working with ceramics, I went
back to that.
>> Reporter:
Blending the old with the new is an art as well as an arduous
task. But for Schmitt, it is also an abiding passion.
>> Randy Schmitt:
I've always loved old buildings, as corny as that seems, but crawling
around them as a kid, and then getting to do it now as an adult,
and getting to explore it and see what was there. I just love
the whole thing, to be able to kind of pay back a little something
or be part of the history of the state that I fell in love with.
>> Michael Grant:
Busy time, of course, for presidential politics. Coming on the
heels of the New Hampshire vote, next Tuesday, Arizona Democrats
going to the polls to choose a presidential candidate. As part
of our ongoing coverage of the Arizona primary, here are issue
profiles on Senator John Kerry and Governor Howard Dean.
>> Reporter:
John Kerry has been a United States senator from Massachusetts
since 1984. If elected, Kerry says he would rollback the tax cuts
for the wealthiest Americans to invest in education and healthcare.
He supports continued negotiations with the World Trade Organization,
but he says trade agreements shouldn't move forward without labor
and environmental standards. Kerry says he opposes privatization
of Social Security. He says he'll give every American access to
the healthcare plan that the president and congress already have.
Kerry says he'll replace the Patriot Act because the spirit of
the law has been abused by the Ashcroft Justice Department. He
wants to established a multinational military force in Iraq under
U.S. command. He would require all handguns be sold with a child
safety lock. He would close the gun show loophole and support
the ban on military style assault weapons. Kerry proposes a national
education trust fund. He supports civil unions.
>>> Reporter:
Howard Dean is the former Governor of Vermont. If elected, Dean
says he would repeal tax cuts and start over, reform the tax code
so that it doesn't subsidize corporations who harm the environment
or export jobs. He says we need enforceable labor and environmental
standards and all existing and future trade agreements. He says
he will not privatize Social Security. He says his top priority
is to provide affordable health insurance to all Americans. He
says reconsiderations of certain provisions of the Patriot Act
is warranted. Dean wants to reduce American force levels in Iraq
by getting NATO in. Dean favors improving the Brady law, so that
the instant check system is used at gun shows. He opposes the
pending bill to exempt the gun industry from liability. Dean says
he will rework education accountability standards, and will work
to reduce the reliance on testing. Dean says same-sex couples
should have the same legal rights and responsibilities as other
couples.
>> Michael Grant:
For more information on the upcoming election, go to our web site
at www.kaet.asu.edu, click on "Vote 2004." To see web links related
to tonight's show, transcripts or find out what's coming up on
"Horizon," click on "Horizon" and follow the links.
>> Reporter:
A rift between conservative and moderate Republicans in the legislature
gives a coalition of Democratic lawmakers, a Democratic Governor
and the moderate Republicans more power than they might have otherwise.
We'll discuss the implications of that on lawmaking. Plus a lawsuit
against Arizona's Clean Elections law. We'll talk about both topics
on Thursday on "Horizon."
>> Michael Grant:
Thanks for joining us on a Wednesday evening. I'm Michael Grant. I hope you have a pleasant one, good night.
Back to the top
