I will be on vacation next week and not blogging. Please have a safe and happy 4th of July.
Friday, June 29, 2012
Well, I didn't see that coming. Both Chief Justice Roberts siding with the liberal side of the Supreme Court and upholding the individual mandate by it's treatment as a tax were unexpected. First, it was kind of refreshing to see the Chief Justice take political ideology out of the decision and rule on the reform law based on it's constitutionality. As for the ruling as a whole at least from the hospital side, we can now continue on our path toward reform with more certainty. My prediction was that there was going to be little impact in Maryland if the law was overturned being in a State with a Democratic governor who has embraced the Affordable Care Act from the onset. As the Governor said in his press conference, it's full steam ahead. After yesterday's ruling, I was asked to serve as part of a webinar panel for the Huffington Post. They needed a hospital CEO who had a dissenting opinion of the Supreme Court ruling. I don't know if I fully fit the bill since there are aspects of the ACA that I am not crazy about starting with its treatment of the individual mandate as a tax, that is quite a reach for me, especially since it was clearly stated by the Obama administration and Congress that it wasn't a tax but, argued before the Supreme Court that it was tax. You can't have it both ways. I like the idea of more people being covered with access to health care coverage, but I don't like that we are now destined for a single payer system for health care. I also don't think that the Act goes far enough in a number of areas especially with medical malpractice. As an industry, we still practice defensive medicine and over utilize ancillary testing as well as physician consultants in the care of a hospitalized patient. On the positive side, I have seen firsthand what can be done when hospitals and providers focus on value based care which translates to improved quality, reduced cost and a healthier community. Congressman Roscoe Bartlett said at the groundbreaking for our new medical center in 2006, that the US needs to become truly a "health" care system and not continue as a sick care system. He said that we are focusing on treating the illness, but not enough was being done to prevent the illness. He was right and at the Western Maryland Health System our focus has become just that: we are there if you are sick, but our goal is to get you better and keep you out of the hospital. And it is working. We are seeing dramatic difference by more efficiently and more effectively caring for patients while they are in the hospital, but making sure that once they are discharged they have appropriate follow up care, that they are able to see their physician within a week of discharge, if need be, that high risk patients have their medications upon discharge, that patients and families are educated on the patient's illness while in the hospital and that there is a clear plan to keep them as healthy as can be to avoid readmission. All in all, the Affordable Care Act and the Supreme Court's affirmation of the law have removed barriers for full implementation of the reform law and allow for the continued transition to value based care as a nation. As I have blogged before, US health care is financially unsustainable in its current form. We now have a clearer path for better, more cost effective care, covering more people when they are sick and focusing on their overall health and wellness in an effort to prevent hospitalization going forward. I find it amazing that I was not a fan of the Affordable Care Act in its entirety in 2010, but as I have worked under the value based care delivery model for the last year and a half, there are aspects of the reform law that make sense and should be built upon. We need to take the politics out of health care and focus on improving what has already been started. However, some additional areas of focus would be tort reform, ensuring that health care remains affordable for businesses and individuals, aligning incentives of providers since many physicians are still reimbursed on a volume of service basis, more is done to support and grow the practice of medicine across the US, especially in rural areas, less onerous regulation and immediate attention to what has become the absurdity of the CMS RAC audit process, just to name a few.