Although Obama's reelection has reinforced the implementation of the Affordable Care Act, not all hospitals are prepared for the changes coming under the reform law, according to new research from the California HealthCare Foundation (CHCF).
The San Francisco Bay Area, for instance, saw the gap between its "have" and "have-not" hospitals grow, as large hospitals in affluent areas experienced strong finances, while hospitals in poorer areas continued to struggle.
With health reform calling for accountable care, Bay Area hospitals have been teaming up with health plans to establish narrow-network ACOs and coordinating with other providers to disseminate care delivery innovations, according to the San Francisco report.
Meanwhile in Fresno, which remains one of the poorest regions in California, collaboration has been stymied by physicians showing little interest in hospital alignment efforts.
While most Fresno-area hospitals maintained or improved margins since 2008, smaller, rural hospitals suffered from a poor payer mix and single-digit insurance rate increases. Faced with such pressures, Kingsburg District Hospital, for example, had to shut its doors in 2010, according to the Fresno report.
Moreover, Fresno also lagged in preparation for the influx of insured patients under reform, opting out of the Low-Income Health Plan (LIHP) that funds medical care for uninsured adults and creating limited community-wide recruiting efforts to ease the area's "chronic" physician shortage, the report noted.