HJAR Mar/Apr 2022

DIALOGUE day. We have more people aging out of com- mercial insurance into the Medicare pro- gram. Medicare is not a great payer. Medi- care’s goal, generally speaking, is to try to pay you about what it costs. That’s the his- tory of the Medicare reimbursement pro- gram. And, it still exists today because it hasn’t changed much in decades. That’s kind of what they’ve always targeted — we don’t want to pay you too much; we’re trying to just keep you alive and providing services to seniors at a cost level. So, when more and more people are becoming Medicare eligible, that’s more and more reimburse- ment that’s at that lower level. Arkansas is both a rural state and an aging state. There is that dynamic going on, but within the Medicare program, there’s a wage index — the Medicare wage index. A large portion of our Medicare payment is a local wage calculation. That factors into howmuch we get paid. The wages of both our healthcare workforce and our community workforce is part of a relative wage calculation that determines how much we get paid from Medicare, and it’s a really a complex calcu- lation, and it doesn’t make a whole lot of sense. It’s not a geographic wage adjustment like if you’re an FBI agent in California, you’re going to make more than an FBI agent in Arkansas. There’s a cost of living difference. It’s very clear. The government uses it all the time. Medicare however, chose not to do it the simple way. They’ve made this compli- cated way, so that you have this dispropor- tionate lowering drop at the low end and lift at the high end. And, it’s a budget-neu- tral calculation. Arkansas would have to get better, faster than everybody in the country to move up and to get a better wage index, which would drive a slightly better Medi- care reimbursement. That is part of what drives the low rates in Arkansas. And then what happens is, with a very low Medicare rate, the commercial payers like to base their rate off of Medicare, so you hear talk, “Well, we want to pay at 150% of Medicare, 180% of Medicare.”Well, if Medicare’s lower here than everywhere else, then we’re going to have a lower commercial rate on top of that. it just kind of compounds the problem. One thing that has made a positive differ- ence inArkansas is the Medicaid expansion. More people have coverage and access to healthcare because of that. It’s also helped many of our healthcare providers, particu- larly those in rural communities. Arkansas has been very progressive, in my opinion, because of the way we’ve approached this. Editor Let me get into your brain a little bit more. How have you protected your men- tal health during the pandemic? On the darkest days, what gave you light? Wells That’s a great question. Well, I think it starts with my faith in God and Christ and it has to do with what I know about that. It helps keep me going in a crisis or a very challenging situation or an extended period of difficulty to have a foundation. I feel like I came into this with a good foundation. I didn’t find religion when COVID hit. So spir- itually, mentally, perhaps physically, I had a good foundation for what was coming and the ability to deal with a lot of stress. Now, part of my belief is that we’re all cre- ated for certain things, and I have a person- ality that is probably well suited for situa- tions like this. I don’t get too riled up over much, and I don’t get down about much. I live in this middle range of emotion and reaction. Personally, I think I’m just well suited for this and what we’ve been through the last few years. You may not believe that based on some of the energy I have around certain subjects, but I generally am not a person that gets too riled up about anything. I think the risk to me is I have such a great ability to suppress any kind of extremes that it gets bottled up inside, and then I could potentially blow up one day. The way I deal with that is I have people in my life who keep me in check on those types of things — who help me understand better when I need to get something out, and I have a place to do that and a place to communicate what is going on with me and how I feel. It is about having a committed spouse who can listen. It’s about having a close network of people, “The aspirational part for all healthcare providers is we want the consistency to always be perfect. Now, we’re not; but that’s the goal, that’s the drive. The ambition is that we’re always working toward perfection, even if it’s unattainable. By doing that, we’re always getting better.” 16 MAR / APR 2022 I  HEALTHCARE JOURNAL OF ARKANSAS