Physician leaders from Cleveland and surrounding area hospitals sat down with state lawmakers to talk about how healthcare reform will play out in the state.

What will it mean for providers, patients and pocketbooks?

Issues raised included: the impact of the new law on the state’s Medicaid program, potential doctor shortages, reimbursement rates and new fee structures, and creation of the new health exchange, where people will be able to comparison shop for insurance.

There’s a lot to digest, and many unanswered questions.

For example, the Supreme Court decision on the Affordable Care Act ruled that states can opt-out of its provisions for expansion of Medicaid – the health insurance program for the poor; the Kasich administration hasn’t signaled what Ohio will do yet and lawmakers are divided.

Republican House Representative Barbara Sears from Lucas County says Medicaid spending is already crowding out other needs.

“We are either educating you, medicating you, or incarcerating you, and that is about 90 percent of our budget.”

House Democrat Armond Budish from Beachwood is in favor of the expansion.

He points out that the federal government will provide the bulk of the financial support, and he says we need to get people out of the ER and into preventive care.

“The current system does not have long-term sustainability. We’re paying for these people, we’re just paying at the most expensive place, at the worst place, which is emergency rooms.”

Hospital leaders on the panel, from MetroHealth, University Hospitals, and the Cleveland Clinic, wanted the lawmakers to hear about their efforts to deliver better, more coordinated and preventive care for patients, at a lower cost.

Some came away feeling the conversation was useful but that two groups also talked past each other.

Dr. David Longworth is the Chair of the Medical Institute at the Cleveland Clinic.

“Well I think we learned from my perspective that from the legislative standpoint, it’s about the money.  From the care provider standpoint, it’s about how we’re going to transform clinical care.  And I do think there’s a little bit of a disconnect.”

Longworth said there’s still a long way to go before the health reform law is aligned with optimum efficiency and care.

“We’re going to have to fundamentally rethink how we deliver healthcare.  We’re going to have to figure out new models that are team based, proactive, that focus on those patients who have chronic illnesses especially who need aggressively managed over time.”

No follow-up session is immediately planned though medical associations continue to offer events like this where doctors can sit down with lawmakers and talk about implementing health reform in Ohio.