The roundtables, set up for me by the good folks at Premier Inc., which is holding its annual "Breakthroughs" conference here in Nashville this week, revealed that these leaders fear less what the government may do in response to whatever decision the Court makes, and more what nontraditional competitors may do to their resource and capital-heavy healthcare delivery systems.
For instance, I wrote back in February about direct primary care, a concept that is helping primary care doctors go the direct-to-consumer route—that is, they don't take insurance. That in itself is not revolutionary, but in contrast to some of the few so-called "concierge clinics" that have sprung up over the past half decade or so, many of these practices are pretty affordable for the regular guy or gal, especially when considering the increasing burden many employers are placing upon their employees to fund a portion of their own healthcare costs.
In a short amount of time, those practices have made significant headway in certain markets. And now that the New York Times has noticed, it seems, it's news.
And it's unwelcome news for leaders of hospitals and health systems that are making an attempt to structure an accountable care strategy. ACOs require changes in reimbursement methodology and care protocols and those are big investments for hospitals, health systems, and others that have no choice but to continue to operate in the third-party payment system.