Being one of the healthiest states in the nation, North Dakota is also known for providing high-quality healthcare at a low cost, according to the Executive Director of North Dakota Medical Association Courtney Koebele.
Approaching the North Dakota caucus on March 6, also known as Super Tuesday, Healthcare Finance News Associate Editor Kelsey Brimmer spoke to Koebele about some of the biggest healthcare issues pertaining to those in North Dakota, including Medicare reimbursement and rural healthcare.
Q: What do you think residents of North Dakota believe are the important healthcare issues in the state – especially when it comes to it being an election year?
A: We have a large Medicare population here. We have approximately 108,000 people on Medicare in North Dakota - and in some specialties as many as 50 percent are Medicare patients. So what we’re looking for is support on the federal level of the Medicare program and fully funding physicians and hospitals on payments for Medicare patients because that’s a program that is not going to go away.
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I think people in our state do realize there’s a cost to that, however, and I think that it’s an issue of balance. Medicare is a huge program in North Dakota. We need to recognize that. People in the state tend to be very conservative but they also recognize that there are these federal programs. So it’ll be interesting in North Dakota this year I think.
Q: Can you tell me a little bit about where North Dakota stands as far healthcare IT?
A: We are very active in the North Dakota Health Information Exchange (NDHIN) – our state’s health information network (HIN), which we are in the process of establishing. The state provided funding for NDHIN the first couple of years and as a state, we’re very engaged with many physicians interested in the process. I think we’re one of the leaders nationwide as far as how our state’s HIN is going forward. We have concerns about wanting to always have the physicians’ and patients’ safety and well-being at the forefront at all times, but we’re working very well with the NDHIN. I don’t think there are any controversies – it’s matter of getting it implemented at this point.
Q: I understand that rural healthcare is a huge issue in North Dakota. Can you talk a bit about this?
A: It is a huge deal in North Dakota and that’s another issue at the legislature for us – supporting the medical schools here and their pursuit of expansion, It’s kind of common sense that if you educate and home-grow positions in your own state, then those students are more likely to stay in-state. Therefore, we’re trying to enlarge the medical school classes and residency classes, as well as residency programs that focus on the rural areas in our state. Studies have shown if students do their residency stays in-state they are more likely to remain in state. It’s a challenge to attract people to do their residencies in rural areas, so we 100 percent support the medical schools’ efforts to expand their rural programs.
Q: Does the use of technology and telemedicine help serve the rural populations in North Dakota?
A: I think it does help. We do have rural telemedicine options that come into play a lot in the areas of psychiatric care. It does help. Those physicians practicing in telemedicine must be licensed to do so in the state. Sometimes that is a challenge. But I do think that’s an area which we need to pursue.
Q: North Dakota is one of the healthiest states in the nation and among those in which people tend to live the longest compared to some other states. How does this affect healthcare in the state? Is there a large population of older adults in North Dakota?
A: We are a healthy state. It goes back to the large population on Medicare as well. We do have a healthy state, and it’s also one of the top in quality and top in full-utilization of Medicare funding. We’re one of the states that gets the least in Medicare funding but one of the top in quality, and we’re very proud of this fact. Our physicians and hospitals are very judicious in their use of the resources.
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We do have an older population, although we are getting an influx of some younger people coming to the state. It’s frustrating sometimes because we’re at the lowest point in Medicare reimbursement. It’s a fight we’ve been having with the Frontier Amendment in our state. The Frontier Amendment, which is a huge deal to us, was an amendment unfortunately contained in the healthcare bill. I say unfortunately because the healthcare reform bill has a bad name here in a lot of circles. The Frontier Amendment brought our reimbursement rate for Medicare up to 1.0 - we used to be below 1.0 in reimbursement because of the rural nature of our state and other factors. It’s frustrating because we pay the same as before for our doctors and equipment and tests. But the frontier amendment has been in place since the healthcare reform passed. It’s frustrating for me as an advocate for healthcare in North Dakota because we are top in quality, low in usage, but we don’t get paid at the same rate as some other states. It’s an interesting situation that we’re in with healthcare reform.
Q: If a Republican were to win the election this year, do you see healthcare reform changing at all?
A: It depends on what Congress ends up looking like after the election. In healthcare reform, North Dakota is conservative and healthcare reform is not a popular idea, which is part of the reason our state voted down having a state-run health insurance exchange – a healthcare market online. As for Republicans in the White House, we’ll see what happens. There are some things in the healthcare reform law that I think Republicans like and we’ll see them support, and I also think the U.S. Supreme Court decision in June will have a big influence on the elections in November and how it will all shake out. If a Republican is in the White House and Congress defeats the healthcare reform bill, I think the Republican in the White House would sign off on it.
