Special guest speakers Dr. Ron Stollings of the West Virginia Legislature, George Mathis of the Guyan Conservation Agency, Logan Regional Medical Center CEO John Walker, Bill France of WVOW Radio and Lisa Calderwood of the West Virginia Insurance Commission addressed different topics.
Also attending were Robbie Queen, a local representative for Congressman Nick Joe Rahall, Shannon Meade of the Logan Family Resource Network, Teresa Maynard of the Logan County Community Fund and Roger Bryant, executive director of the Logan Emergency Ambulance Service Authority.
Moderator Bobbi Jo Muto said there have been many myths, rumors and a lot of misunderstanding about the reforms.
Meade said there is a lot of concern about healthcare reform from the public, especially from people who had trouble getting basic care under the current system.
"The majority of people are confused," she said, noting that eye care, dental care and mental health care are problematic for many people to get the help they need. Meade said public education was needed to help the public navigate through the system and said the state's system of Family Resource Networks might be able to help.
Meade said many grandparents were left to raise grandchildren on limited resources.
"I have deep concerns with that," Meade said, noting many people denied themselves the health services they needed due to cost.
Mathis said the reforms were confusing to many people and noted that this week Congress had voted to repeal them.
"It is hard to say at this point how this will all maintain in its present form," Mathis said.
Dr. Stollings agreed that there needed to be more focus on preventive care and communication. He and Walker gave examples of how sometimes caregivers did not communicate well and patients wound up having unneeded x-rays or scans and noted sometimes a doctor and a hospital were not on the same page when dealing with the same patient.
"We treat illness well, but we don't maintain a healthy population well," Stollings said, noting that the current system is "fragmented."
Stollings also addressed how many medical school graduates had abandoned the primary health field to go into higher paying specialty fields.
"I've been offered higher paying jobs to leave the area," Stollings admitted saying he felt there needed to be more focus on the patient and prevention.
Stollings said a primary care doctor had to act as a quarterback when getting the patient through a system that could get bewildering at times.
"It's a complicated maze," he said. "We need to do this in a better way."
Stollings criticized some providers for loading patients up on duplicated services noting "quality was never rewarded," under the prevailing system.
Dietitians, nurse practitioners, preventative treatments and better electronic communication could save millions, Stollings said, noting the West Virginia Health Information Network is addressing better communications.
West Virginia has an older population and the array of services available is confusing for many of them. They need help navigating through the new series of state exchanges. Stollings said elderly patients were not as impressed by high tech as they were by the human touch.
Many people in West Virginia are affected by diabetes and other disorders that could be assisted by preventative care and Stollings said there is nothing in the new legislation that would address the problem of patients who do not follow their doctors advice, however it did punish doctors and hospitals for patients who had to be readmitted.
Stollings said preventive treatment is relatively inexpensive and has been long overlooked.
"We spend a huge amount of money the month before a patient dies," he said.
Stollings said ongoing care from a family doctor is a lot cheaper than getting the same care in a hospital emergency room.
"Very poor people have in-home care provided for them, very rich people can afford it, but working folks in between them are left without."
Stollings said a very sick patient could wind up hurting his health care providers under the new system.
On the other hand in-home care could be a major improvement and opportunity for entrepreneurs.
"If you can get people trained and pay them to provide care in the patient's home, that is still cheaper than putting somebody in a hospital or a nursing home," he said.
Walker said most hospitals don't profit much from Medicare and have to rely on patients with insurance.
"Whenever you get the government involved it always raises concerns about how well it is going to be handled," Walker admitted noting the old system was "complex."
Walker said the system needed to focus on preventative treatments, which tend to be cheaper than repairs once a person's health has been compromised and said a focus on primary care would be a good place to start.
Walker said the provisions punishing hospitals or doctors when a patient returned 30 days later did not address the problem of whether or not the patient followed the providers advise.
Walker said many low income patients would go without medication or split their pills in half and lesson the dosages due to financial strains.
Walker said there were also examples of where doctors and hospitals and other providers were not on the same page and needed to better coordinate their efforts.
Walker said there were many excellent services available and picked out at-home patient care as an interesting concept. Walker said more primary care doctors were needed, but wondered, "where are we going to come from?"
"We do need to expand disease management and rely on primary care physicians," Walker said.
Walker noted that getting information to the public could be problematic in a state where many people did not have access to high speed internet.
Bill France of WVOW said that for most people what mattered was "how does this affect me?" France noted that many people put their own situations first and admitted he was concerned about the removal of discriminations against those with preexisting medical conditions. France said decades earlier he went to work in radio and could not get insurance because of one, initially.
"If you are sick, that is no reason to single you out and not give you insurance," France said adding that the lack of affordable insurance also affected him when an opportunity arose to expand his own private business, but couldn't because he could not afford to offer insurance. "That stops a lot of people," France said.
Everyone in the media had their own spin on the healthcare reforms and France said that made it important for the public to educate themselves about the facts of the new legislation.
"This is the first major overhaul in 40 years," he said. "There are things in there that may be good and things in there that might not be so good. So it is important to know what is in there."
Lisa Calderwood said the new health care exchanges would work "like travelocity or expedia.com" in that they would allow the public to choose which plan they wished. She said grants had been discussed to address the lack of high speed broadband internet service across the state.
Many people in the audience had questions and comments.
Bryant said in the past people got caught up in reforms that left them hanging high and dry, noting that years ago one example was one where people were sold on a reform only to become angry when they found out they had to pay a $250 deductible for ambulances. Bryant said he agreed that there needed to be reforms but noted "I don't see how dumping 20 million people into a system that is overtaxed already will work."
"I don't see where we will get any savings from that," Bryant said.
Teresa Maynard discussed an example of when a parent tried to get their 21-year-old college age child back on their insurance, but were told they could not.
Perry Bryant made a 40 minute presentation about The Affordable Care Act, the majority of which dealt with insurance reforms. Perry Bryant agreed with Ron Stollings and John Walker about the need for more primary care physicians, noting "The emergency room is a lousy place to get primary care."
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