Most of the many-faceted segments of the healthcare industry appeared pleased with Thursday’s majority Supreme Court decision to uphold most provisions of the Patient Protection and Affordable Care Act, even as they vowed to work toward the repeal of pieces they still find objectionable.
“Today’s ruling does give clarity to hospitals as they move forward to transform the way they provide care and work with patients and communities as well,” American Hospital Association president and CEO Rich Umbdenstock said in a media teleconference. But the ruling “opens up new questions as well,” one of which is the impact on hospitals in those states that opt not to implement the expansion of Medicaid to patients earning up to 133% of the federal poverty level.
The court determined that states could choose not to enroll those patients without suffering reduced federal subsidies under the Medicaid program.
Additionally, he said, hospitals still have concerns about the Independent Payment Advisory Board, which PPACA empowered to take over from Congress the responsibility of making payment decisions affecting providers. “We have concerns about IPAB and its existence …and we’re on record there thinking that Congress should maintain that decision-making authority,” Umbdenstock said.
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For other parts of the law being rolled out in regulation, such as penalties for higher rates of readmissions and preventable hospital-acquired infections and other conditions, readmission penalties and requirements to reduce hospital-acquired conditions, which Umbdenstock said hospitals will work to change through the regulatory process already underway. And the AHA will work for quick results from the Patient Centered Outcomes Research Institute for comparative effectiveness conclusions.
And Umbdenstock said, the AHA will continue efforts to strengthen the legislation with parts that were dropped before passage, such as tort reform and clarity on how providers help patients make decisions about end-of-life care, a divisive point during the pre-passage debate.
“The nation still needs to have a responsible and continuing dialogue end of life care, and the best way for all of us to plan for the day when we have an advanced illness, and to make decisions before that time as to the way in which we would like to receive that care,” he said.
Other key segments of the industry responded favorably to the court’s opinion, with some caveats.
“This decision protects important improvements, such as ending coverage denials due to pre-existing conditions and lifetime caps on insurance, and allowing the 2.5 million young adults up to age 26 who gained coverage under the law to stay on their parents’ health insurance policies,” Jeremy Lazarus, MD, president of the American Medical Association said in a statement.
The law’s expanded healthcare coverage “will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive,” he said. And, Lazarus said, the court simplifies administrative burdens, including streamlining insurance claims, so physicians and their staff can spend more time with patients and less time on paperwork.”
David Goodman, MD, co-principal investigator of the Dartmouth Atlas, whose research on national healthcare cost variation influenced the legislation by demonstrating that high quality care does not have to be expensive, said the ruling “identifies the legislative branch as the locus of policy development for these important problems.”
The Atlas “showed that healthcare differs widely from place to place in volume of services, much of it unnecessary, is an important driver of healthcare costs. The fee-for-service payment has been permissive of that rapid growth,” he said. Now, sections of the PPACA incent healthcare organizations to minimize duplication and maximize care in the patients’ best interests with bundled payments and care continuation models long after they’ve left the hospital, thereby preventing their deterioration.
The health plan trade organization, America’s Health Insurance Plans, issued a mixed response.
“As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries,” said America’s Health Insurance Plans CEO Karen Ignagni. “The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.
She pledged that health plans will continue to work with policymakers “on both sides of the aisle” to make coverage more affordable, give families and employers peace of mind and promote choice and competition.”
Other reaction to the landmark decision:
• Institute for Healthcare Improvement CEO Maureen Bisognano said the decision is great for its ability to expand access to care for millions of Americans.
But that alone isn’t the answer, she said. Still ahead is necessary change to achieve the so-called triple aim of “better health, better healthcare, and lower per capita cost. “With this court decision now behind us, our nation’s attention should shift” to the challenging task of making our healthcare system sustainable, she said.
• Bruce Siegel, MD, of the National Association of Public Hospitals and Health Systems, said in a statement that he’s “concerned by (the decision’s) potential to limit Medicaid expansion, which could strand millions of our most disadvantaged people without access to basic health care coverage” by allowing states to opt out of Medicaid coverage for those below 133% of the federal poverty level.
“We are concerned many states will choose not to expand coverage. Indeed, in the 26 states that participated in the federal lawsuit, more than 27 million people have no insurance and many who would have been eligible for Medicaid in 2014 might no longer have that option,” he said.
“Safety net hospitals and health systems lead innovation in quality of care and access, and do so with limited resources. We must support safety net patients and the hospitals and health systems that serve them with a stronger funding commitment.”
• Moody’s investor service issued a statement advising that the impact of the decision will be neutral to slightly positive economically for the industry because expansion of insurance coverage “will lessen hospital operators’ exposure to bad debts, which in turn will improve margins and cash flow at for-profit hospitals.
“However, we expect that the growth rate of Medicare reimbursement will also slow down, offsetting the benefit of lower bad-debt expense. Provisions in the healthcare law call for reductions to annual updates and for lower disproportionate share payments, which are government payments designed to help compensate hospitals for treating uninsured and indigent patients.”
• Premier Healthcare Alliance’s President and CEO Susan DeVore issued a statement saying that the ACA’s quality requirements, such as hospital value-based purchasing (VBP) rules, creation of Medicare-based accountable care organizations and national pilots to test bundled payments “are important policy levers that are moving healthcare forward, and each of these enhancements has strong public and bipartisan support,” as is the Center for Medicare and Medicaid Intervention, to increase transparency, reduce variation and avoid unnecessary costs.
• The Association of American Medical Colleges said it, too, is pleased with the decision. But President and CEO Darrell G. Kirch, MD, said in a statement that the law may be insufficient unless Congress increases the number of federally funded residency training positions to meet the demand of larger numbers of insured, “a number that has been frozen since 1997.”
“We urge Congress to move quickly to provide more federal support for additional doctor training to ensure that Americans have access to care—not just an insurance card.”
• The Pharmaceutical Research and Manufacturers of America (PhRMA) said it respects the court’s decision and will work with the administration and Congress on refinements. But it also wants to change the law, specifically strive “to repeal the Independent Payment Advisory Board.”
Source: HealthLeaders Media