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We are one of the few states that has started a healthcare exchange. Do you see it becoming a much more robust marketplace?
BINGHAM: I definitely think it will become an option. We have clients that are inside and those that are outside, and we never portray it as a cost-savings mechanism. Maybe it’s a way to control an employer-defined contribution. It doesn’t necessarily solve the cost component. It maybe allows employees to drop to a higher deductible plan to lower their costs.
But what we’ve seen is most employees don’t understand benefits. We are not to that point where an employee can do a good job of getting out there. As consumers, we’ve gone online and bought something—we just go for the cheapest, but then come to find out, it wasn’t what we expected.
SANPEI: I would say two things. One is that the exchange in and of itself is not going to reduce costs unless the options in the exchange are at lower costs. And the options in the exchange become lower cost if we can do the macro forms that we are talking about.
Put that on the side, though. To answer your question directly—exchanges, in general, will expand if for no other reason that there is going to be a lot of premium subsidies available through the exchanges, some pretty significant subsidies to significant portions of the population.
The question is does that mean that Utah’s state exchange will expand? Not necessarily, because Utah’s state exchange does not currently meet the federal requirements to make it eligible for those federal subsidies.
A number of studies show that we’re on track to have a shortage of healthcare providers in Utah. What are we doing to address that shortage?
LEE: Utah is among the lowest in the country in terms of primary care physicians per capita. We are around the fourth from the bottom. And with projected population growth—we are the second-fastest growing state in the country—that gap is only going to continue to widen. On top of that, with the expansion of Medicaid—or even just taking in the eligible and then possibly expansion—the demand on the system just far exceeds the capacity right now.
We do think there are strategies that we should move forward with, including expanding the medical school class size to produce more physicians. That is part of our request this year to the legislature. We are at 82 students per year now, and ultimately over two or three years we would like to get to 122, an increase of 50 percent.
We also recognize that there is a lot of room for discussion of how we can look at mid-levels—medical assistants and other healthcare professions—and recognize that the whole weight of the healthcare system shouldn’t be on the physicians.
MCOMBER: We absolutely support the expansion of the medical school in Utah. We were very concerned when the medical school dropped by 20. At that point in time, we were actually supporting an increase of 20 percent. So we have great concerns about not having enough physicians moving forward.
There is discussion right now about opening up osteopathic schools in Utah. We would also support that, as long as the credentialing and the appropriate pieces that need to be in place for schools are part of that. We know we are facing a shortage with physicians.
We do support physician extenders and utilizing allied healthcare personnel as appropriate. We may not always agree with everybody on what that means, but we are willing to discuss who it is that should be providing care in different circumstances and in different environments.
JOHNSON: For the first time since I’ve been around we have students who are graduating from our nursing and other programs who can’t find jobs. That’s never been a problem before. Obviously, because of the economy, folks have come back to work. We don’t think that’s going to last, however, and so we continue in Utah to enjoy a huge demand among students who want to get into the health professions. It’s not the same throughout the United States, but in Utah we still turn a lot of potential applicants away. So the supply is there for the future if we can support the infrastructure.
One of our challenges has always been clinical rotations, and we’ll still have to face that down the road. But we have a huge supply of folks that really want to get into the health professions. Long-term care has always struggled with CNA and nursing turnover. They have multiple people applying for those jobs now. They are enjoying a rich pool of applicants that they haven’t had in the past.
HAMILTON: We are closing in on 3 million people in Utah, so the population has tripled since I was in high school in the ‘70s. Ruff and I started med school in 1977. There were 102 students. So here we are triple the size that we were when Dr. Ruff and I were in medical school, and yet we have fewer med students in the class. If we just kept up with population from that time, we would probably have close to 300 students.
I have many who want to go to med school but have trouble getting in. But the market is in some ways taking care of that by starting new schools, these proprietary and sometimes osteopathic schools. I worry about the quality of those schools compared to the University of Utah.
Regarding what was termed mid-level providers—we call them advanced practice clinicians. Those are the physician assistants, the advanced practice RNs. We use a lot of those in our system. They are invaluable to us and they will become more valuable as we go forward. They are well-trained. We couldn’t run many of our services in our hospital without advanced practice clinicians. So I see that as a growth area as well.