It has been over a week since the U.S. Supreme Court handed down its landmark decision, upholding the constitutionality of the Affordable Care Act (ACA) and the repercussions still are being felt across the country. More importantly, those for and against healthcare reform have been putting their own spin on the decision.
Well, I am no different and here is my take on this decision.
I believe the court, especially the conservative Chief Justice John Roberts, tried to find a middle ground that would give everyone something to crow about. The mandate lives for another day (perhaps at least until after the November elections), which cheers the liberals. However, the Medicaid expansion now is left up to the states, which can be problematic for those of us in the red states.
To me, all of this is mainly irrelevant. Why? Because health care is responding to the market, which is driving change much faster than the Supreme Court can.
The biggest change for hospitals is getting ready for the end of fee-for-service. There are some who believe this won’t happen, but I am not one of them. Fee-for-service drives volume, which drives costs and, in some cases, even drives negative patient safety. Most hospitals and systems are putting their toes in the water, looking at bundled payments or capitation.
The jury is still out as to whether or not this will actually halt the steady drive of ever increasing healthcare costs, but something definitely needs to be done. I believe it will force all hospitals to look at population health and prevention instead of episodic care, which, at least in the short run, can’t help but drive costs ever higher.
The biggest impediment to getting there is congress’ lack of action to moving hospitals away from fee-for-service (FFS). Almost universally, hospital CEOs I have talked to say they want to get all they can out of the FFS system while they can. There is no reward in keeping patients out of hospitals and until that happens, it will be a FFS world.
If I were the healthcare czar or congress, I would decree hospitals would be moved from fee-for-service within five years. I find if hospital executives are told where the system should be, we find a way to get there. If we don’t act soon, it may be too late for all of us.
There are ways to keep the best of what health care has to offer and control costs. Hospital executives can lead the way if given the chance.
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