Monday, June 25, 2012

Why the Supreme Court Decision on Health Care Reform “Doesn’t Really Matter”.

At Forbes online, Dr. Bob Kocher and Dr. Mohit Kaushal argue why the Supreme Court decision on health care reform “doesn’t really matter”.

Find this article here:

Here’s where things stand as we hear it from the many media sources: If the Court upholds the Affordable Care Act in its entirety, this will be seen as a positive for the President. If the Court strikes down some or all of law down could be a boon for the Republicans and Governor Romney’s campaign. Whatever the outcome, much punditry will follow.

The doctors write that the current and likely subsequent debate misses one essential fact: “the Supreme Court’s decision does not matter as much as political pundits think.”

Here’s why:

The American healthcare system is in the midst of intense experimentation and change that cannot, and will not be stalled by the whims of the judicial system.

The major forces behind the changes in our healthcare system are “rising costs, an older, sicker population and technological innovation,” and these show no signs of abating and do not depend on Federal legislation. Instead, they are fuelled by private sector demand, not “policy preferences” coming out of Washington.

So, according to the doctors, “while coverage may not come as soon as hoped for the uninsured, the systemic efforts to make our health system more affordable and higher quality will continue.”

Here are the things to look for:

Some changes, like the widespread replacement of paper records by electronic medical records, are visible from a patient’s-eye-view.

Other changes, such as changes in the relationship between insurers and hospitals are not immediately visible, but are “potentially even more profound.”

Some of the most important changes involve the financing of health care.

In the traditional way of doing business, insurers pay hospitals and physicians under a “fee for service” system – where providers are paid for the quantity of medical services provided, regardless of the outcome. HMOs grew in the 1990s in an attempt to fix these incentives, but patients hated their HMOs because they restricted choice without proving that they were delivering better care.

The current wave of experimentation, such as bundled payments for “episodes” of care, accountable care organizations (ACOs), and new penalties for excessive hospital readmissions are all tactics to try to fix these misaligned incentives and aim to cut costs and improve care for the patient, while preserving choice.

And here is what we don’t hear: Insurers such as United Healthcare, the nation’s largest private insurer, as well as Aetna and Humana, have pledged to follow many of the regulations anticipated under the ACA even if the law is repealed.

The doctors also note that even with congressional gridlock, CMS is driving innovation at the federal level, using its authority to experiment with a variety of demonstration projects that do not require congressional approval. Example: the current project to award bonus payments to Medicare Advantage plans which score well on the program’s Star rating system for providing better and more cost effective care.

There is also experimentation at the state level. Eighteen states representing 42% of the US population are in the process or have already laid the legislative groundwork to establish health insurance exchanges – creating a marketplace for individuals to purchase health insurance.

Again, here’s what we don’t often hear: “Many of these states, including California, have indicated that they plan to continue with the exchanges regardless of the Supreme Court’s decision.”

Finally, the doctors report that patient attitudes are also changing. Patients are increasingly worried about the costs of their care and taking steps to control it. “This means that they are more likely to scrutinize their health insurance benefits and opt for high-deductible health plans (HDHP). While attitudes can be slow to change, the inexorable force of the millions of patients choosing health plans that reward shopping for lower cost and better quality care will not be stymied by the Supreme Court’s ruling.”

The doctors conclude: “So while it is uncertain how the Supreme Court will rule, or how the ruling will impact November’s results, it is a certainty that our health system will continue on the path of more affordability, more integrated care, and more focus on patients because consumers are demanding these changes. These unassailable trends are led by the private sector and, if anything, will accelerate regardless of the Supreme Court’s views of the meaning of the Commerce Clause. Moreover, since the private sector contributes virtually all the profitability in the health system, it is a force far more powerful than politicians.”

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