Here’s a look at how much of the Affordable Care Act would survive a Supreme Court ruling against subsidies.
Mike Kaufmann, who recently became chief financial officer of Cardinal Health Inc., a distributor of pharmaceuticals and other medical products, told The Wall Street Journal that the Affordable Care Act has put ”a tremendous emphasis on cost-reduction. And customers are being held accountable for outcomes. Each year as time passes for instance there’s more and more procedures that, when they’re done in a hospital, if a patient is readmitted within a certain amount of time the hospital’s going to have to cover that cost. And so hospitals don’t want a patient to be readmitted….”
”We at Cardinal have been working hard on coming up with ways to help [hospitals] manage for instance those discharged patients. How do we help capture them? How do we make sure, for instance, that we maybe have a pharmacist call that patient, at their home, make sure they’re taking their seven different medications exactly right so they don’t get sick and have drug interaction and end up back in the hospital and the hospital has a lot of cost.”
They write that the recent U.S. Department of Health and Human Services announcement by that Medicare will work to accelerate the transition to new payment models was … ”an important step in the right direction. But without significant regulatory—and perhaps legislative—changes to current models, HHS’s ambitious goals are not likely to be achieved. ”
The writers conclude:
”First, the financial model for ACO’s should offer them a greater share of their initial savings (to help fund start-up costs), provide stronger incentives to induce and maintain participation from low-cost provider organizations, and foster alignment of payment schemes across all payer types—not just in Medicare. This strategy will encourage the growth of shared-savings models and motivate high-performing healthcare systems to join the ACO programs.”The second strategy would improve patient engagement in ACOs by modifying how Medicare beneficiaries are assigned to an ACO: Beneficiaries should be given the opportunity to choose to join their ACO; for those not actively choosing, those eligible should be assigned at the beginning of the year (so that their ACO can contact them). Medicare should also test a benefit design that uses modest financial incentives to encourage patients to seek care within their ACO or from providers outside the ACO whom the ACO recommends. Simultaneously, to make such incentives possible, supplemental Medicare plans should be restricted from covering first-dollar beneficiary costs for non-ACO services.”
Consider that, as Hospitals & Health Networks reports, a “major shift is taking place in Medicare’s Physician Quality Reporting System program, while the National Quality Forum is examining a group of relatively unpopular patient-safety measures for possible revision.”
”{S}ome physicians — including specialists who work in ambulatory care — continue to be concerned that they will have a difficult time finding measures that realistically can be met.
”Some of the worry is driven by changes to the measures that can be used in PQRS reporting. Emergency department physicians face a limited number of choices that can be applied to their specialty. ”
H&HN said that Catherine Polera, chief medical officer for the emergency medicine division of Sheridan Healthcare, noted that ”the Centers for Medicare & Medicaid Services removed some of the core measures that may have worked in an emergency department setting and replaced them with ambulatory care measures. The new measures ‘relate more to primary care than they do critical care.’
”Although primary-care measures have some application to the ED, ‘we see more trauma, we see more chest pain patients, more abdominal pain patients, and I’m not seeing those related measures,’ she says.”
‘”Determining the implications for a hospital is a little more complicated,” Akin Demehin, senior associate director of policy for the American Hospital Association (AHA), told H&HN {which is part of the AHA}. “‘It mainly boils down to whether a physician bills for the procedure or whether the hospital bills for the physician. Whoever submits the bill, generally speaking, is going to be responsible for the reporting.”’
Rosemarie Nelson writes about the value to physician offices of benchmarking income and expenses. She also suggests in arranging for an annual outside oding audit to ensure that the practice is “appropriately billing for all documented services”.
The authors of this HealthAffairs piece conclude:
”Our findings highlight some of the challenges of making major budget cuts in healthcare. Reducing ineffective spending remains a significant opportunity for the US healthcare system, and the English experience may hold valuable lessons.”
Hospitals are trying to formulate contingency plans in case the Supreme Court decides, in response to a Republican-inspired lawsuit, to end insurance subsidies under the Affordable Care Act in most of America.The revenue gains that hospitals have gotten from having a a big increase in insured patients from the ACA will disappear if subsidies for people who buy health plans from the federal exchange disappear.
“The uncertainty and the instability make it difficult for systems just to plan,” Mike Lappin, the chief administrative officer for Aurora (Wis.) Healthcare, told Modern Healthcare.
”Nonetheless, the health system’s leaders will attempt to game out multiple scenarios in the months between Wednesday’s oral arguments and the decision expected in June.
”That will include coming up with a strategy to communicate with the estimated 48,000 patients who received premium subsidies through the state’s federally run insurance exchange,” Mr. Lappin told Modern Healthcare.
A rejection of subsidies ”could threaten credit ratings for not-for-profit health systems, credit rating agencies have warned. On the for-profit side, however, analysts have estimated the loss of subsidies would jeopardize less than 4% of pre-tax earnings,” the publication reported.
The Providence Journal reports that the state Health Department ”is distributing about $2.15 million to communities to create ‘health equity zones’ aimed at preventing chronic diseases, improving birth outcomes and supporting neighborhood environments.”
The paper says that the project addresses areas “experiencing high rates of obesity, illness, injury, chronic disease or other public-health problems.”
“Health is not possible without community. Health equity zones give communities the resources they need to focus on creating collaborations and building health through relationships,” said state Health Director Michael Fine, M.D.
Cambridge Management Group has been working on similar community-health projects in the Pacific Northwest.
The project will support “community collaboratives involving municipal leaders, residents, businesses, transportation and community planners, law-enforcement agencies, education systems and health systems,” says the newspaper.
Hospital execs’ walks-and-talks around their facilities to listen to staff and patients pay off in patient-safety and other improvements, says Catherine Miller R.N., J.D., risk- management and patient-safety specialist for the Cooperative of American Physicians Inc.’s CAPAssurance Program.
She says that “nearly every major patient safety organizations considers rounding to be one of the best way leaders can show their commitment to patient safety. It reinforces to staff that their work matters,” Hospital Impact reported.
“Investors interpreted commentary by Justice Anthony Kennedy, a potential swing vote among the nine judges, as favorable to the Obama administration’s defense of the subsidies that help consumers in more than 30 states.”
“I am hopeful that the court will recognize and uphold the intent of Congress, which was to expand coverage as broadly as possible,” Bill Carpenter, chief executive of LifePoint Hospitals, said in an interview.
If the court rules against federal subsidies, Carpenter and other executives interviewed by Reuters said they expected the justices ”would allow for a transition period before patients lose access to healthcare.”
”Alan Miller, CEO of hospital chain Universal Health Services, expects the Obama administration would reach an agreement with Republican opponents of the law to keep subsidies in place through the end of 2015. He believes that is enough time to create a workaround to the Supreme Court ruling.”
