Reform's Bright Side: You Get to Reinvent How Care is Delivered

Philip Betbeze, for HealthLeaders Media , November 12, 2010

You've got a lot of re-engineering to do. The Patient Protection and Affordable Care Act promises nothing less than a tectonic shift in the way your organization is paid and otherwise incented, whether you lead a health plan, physician practice, hospital, or health system. It's not hyperbole to say that survival is on the line for many such organizations.

Meanwhile, you get to soldier on under a highly regulated current system that essentially pays you per unit of service, with precious little of the equation connected to quality. Your payer mix is getting ready to change, and not for the better it appears, in many cases.

One only needs to look at the Massachusetts experiment with near-universal healthcare for a road map as to how things can go wrong when such a large number of people instantly get health insurance and overrun an already taxed primary care system. And oh yeah, that state's insurance exchange, meant to manage the risk of bringing so many uninsured under the umbrella, is hemorrhaging money, thanks mainly to political cowardice relating to penalties for not meeting the individual insurance coverage mandate.

Bricks and mortar expansion to meet this expected new patient demand, depending on what form it takes, is expensive, and it takes years to come online from the planning stage to construction. Meanwhile, more attention will be paid—and less money, too—for outcomes that don't reach or surpass some minimum standards, many of which are yet to be written.

And on top of all that, 20 million people will still be uninsured in this country (mainly illegal immigrants and a few other small groups) even when the major insurance provisions in PPACA go into effect. Of course, that group's lack of insurance doesn't mean you don't have to incur the expense of treating them, like always.

But despite all these storm clouds on the horizon, there is a silver lining. Healthcare is about to find out, as so many other industries have, that offering a quality product or service at a competitive cost means your services will always be in demand, and that eventually, you'll be paid fairly for them.

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4 comments on "Reform's Bright Side: You Get to Reinvent How Care is Delivered"

hsr0601 (11/14/2010 at 4:30 AM)
Title : The reps Will Stomp On Middle Class & Economy. ? The SHAMELESS reps' principal : No principal & power-only ! ? 1. The reps' campaign slogan, spending cut, has nothing to do with the deficit cut. ? The Bush tax cut for the wealthy will add an additional $700 billion to the deficit over a decade. Under the existing Bush tax cut for lavish bonus parties, a sole job plan for the republicans, the country already saw millions of job cuts. And hence it's the right time to ask themselves as to how they can pay for it. ? As for the Democrats, sound investments = deficit increase. As for the reps, empty giveaway policy = SHAMELESS top priority. ? 2. Over the duration of healthcare debate, using the preliminary cost analysis of CBO, the reps opposed the public option stubbornly, but after the release of final score, they have been defiant on the referee. ? Inaction cost in relation to health care reform totals $9trillion over the next decade. The nonpartisan Congressional Budget Office estimates that reform will reduce the federal deficit by $143 billion over the next 10 years and as much as $1 trillion during the following decade ? 3. In view of Medicare & Social Security : ? "Don't Let Government Touch Your Medicare & Social Security" "We will instead Stomp On Your Medicare & Social Security" ? 4. Jobs ahead in another Bush era ( = Entire Downfall ) ?? I think D.S. is going to realize vividly how Bush era wrecked economy.

Robert Trinka (11/12/2010 at 6:48 PM)
I appreciate your optimism and that of the provider community, misplaced as it may be. I don't think everyone really understands how potentially toxic PPACA is to the healthcare system. PPACA can only succeed if costs are [INVALID]ntly controlled. If you are a doctor, hospital or other provider, your reimbursement will be reduced and reduced and reduced some more!! Since 85% of the insurers' "premium" must be spent on actual healthcare costs and the "premium" is regulated by the government, how is it that providers think they can come out ahead? The federal and state governments will grind down the premium that the insurers that participate in the exchanges can charge and the insurers will grind down reimbursement to providers. Utilization and reimbursement will be controlled to the point where obtaining timely care becomes a public problem. Then, some stability may take hold, but few will like the new status quo. You can safely assume that the federal government's support of the yet undefined ACOs and "Medical Homes" are a facade and will not result in more reimbursement for higher quality. If any provider wants to control their own destiny and control the quality and cost of care, the PPACA legislation will need to be repealed. I suggest that the short and long term planning be dedicated to that end - repeal. Read the bill and the regulations that are being promulgated!! Don't take the Democrats word on this. This reform is premised totally on control of care, of reimbursement,of medical decisions, of patients, of hospitals, of insurers and of the healthcare system generally. There is no indication of empowering providers to take charge and improve the system. Sorry, but that is the way it is.

Patrick Plemmons (11/12/2010 at 1:41 PM)
Phil - An excellent article, but the headline doesn't fit the body of the piece. Providers are most certainly not going to be allowed to "Reinvent How Care Is Delivered". If by that you mean doing the same or more and getting paid less, then sure, reinvent away. Through Obamacare, the Feds now have the means to control the healthcare industry to a much greater degree than currently, and it should be clear that their end game is a government-run, single-payer system. Anyone who thinks private sector innovation is going to flourish under this crew is naive. They are all about command and control and any outbreaks of innovation will simply be window dressing. Let's hope Obamacare can be repealed and true market-based solutions can be found.




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