The Ruling

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.

I will be on vacation next week and not blogging.  Please have a safe and happy 4th of July.

Today's the Day, but First.

The Supreme Court is to announce their ruling today on the Affordable Care Act at around 10 AM.  I routinely write my blog first thing in the morning based on reflections from about 4 AM on.  So, once again, I will write about another "burning" issue and blog about the decision tomorrow.

I think that I have written before that I am a Yankee fan.  I have been one since I was a young child when I would watch the Yankees with my grandmother sitting in her rocking chair with her rosary beads in her hands praying for her boys, Maris and Mantle throughout the game.  This week most would say that it is a great time to be a Yankee fan as they are 5 games ahead in first place heading into the All -Star break in a week or so.  Actually, I am embarrassed to be a Yankee fan at least for this week and it's about integrity or a lack there of.  On Tuesday, leftfielder Dewayne Wise didn't make a catch in the outfield as he fell into the stands, but the umpire called it a catch and the inning was over.  All of the follow up articles and press coverage was about the umpire not making the correct call and that Dewayne did what any player would have done.  Really?  I'll take you back to my father in law's memorial service when his best friend and high school football teammate got up and told the story of my father in law and the extent of his integrity.  During a football game, he caught a pass and ran it down the sidelines for a touchdown.  Everyone was cheering on the field and in the stands except my father in law who walked back along the sidelines and pointed to the referee where he stepped out of bounds as he was running down the field.  Needless to say, everyone was angry with my father in law that he came clean.  His friend told him that he was crazy to have told the referee since no one would have known.  My father in law said that he knew and that was enough for him.  Ask yourself, would you rather be known as the guy with his integrity  well in check or the one who sheepishly ran off the field after not catching a foul ball and then getting to see yourself all over national TV in what should be an extremely embarrassing moment?  Some might chalk it up to a different era or winning is everything.  From perspective, about one's personal integrity and it's a core value of this health system for a very good reason.

Drug Shortages - Who is to Blame?

OK, I know that I said that I would blog all week about tomorrow's Supreme Court decision, but so is everybody else.  Blogs, newspapers, radio and TV, the story is everywhere.  Can't wait for tomorrow so we can all get on with our lives.  Outside of the hospital, I have never had so many people ask me about an issue as they have with the upcoming Supreme Court's decision.  So, today I am taking a break from the Affordable Care Act and blogging about a recent poll on the drug shortage issue. 

Recently, a Congressional Committee stated that the FDA is responsible for the shortages because of their over-regulation and not allowing new drugs to the market fast enough.  The results are as follows: Drug Companies - 42.2%; FDA - 11.3%; Both - 42.7% and Neither - 3.8%.  I am in the both category.  I think that the FDA shares in the blame but to a much lesser degree than Big Pharma.  Of course, Congress is going to blame the FDA in an attempt to embarrass the Obama administration.  Congress is not going to bite the hand that feeds them, the drug companies!  We need to stop pointing fingers and work on viable solutions to the drug shortage issue, especially when it is avoidable, as is the case here.

If ACA is Overturned

Needless to say, no matter what happens, a firestorm will result from either side of the aisle--Democrat or Republican--if the Affordable Care Act is overturned.   Everyone from politicians to insurers to providers are preparing for the "what happens if" scenario.  For Congress and the President, it is back to the drawing board.  For others, like insurers and providers, many of the provisions created under the Affordable Care Act will continue.  Hospitals and physicians will continue to work with insurers, policymakers, regulators and each other to do what's right for patients and to build upon many of those reforms already in place. 

A focus on the inability to financially sustain the cost of health care will continue with greater emphasis on the value of the care over the volume of tests, procedures and admissions.  Providers and regulators will continue to focus on quality and patient safety initiatives as well as linking quality with payment reform.  The triple aim of health care reform (better quality, reduced cost and enhanced population health) will also continue to be the focus of all of those groups previously mentioned in today's blog.  States would also individually enact stand-alone legislation on some of aspects of the Act.  Fortunately, Maryland will continue to make changes and build upon those components of reform already in place. 

So far, I am shocked that the Supreme Court's ruling hasn't been leaked to the media, especially in DC where un-named sources run rampant.  Actually, that gives me a good feeling about the integrity of the Court.

The Waiting Continues

This is the week for the Supreme Court's ruling on the Patient Protection and Affordable Care Act (aka Obamacare).  Everyone is weighing in on what the ruling will be.  So I figured why not weigh in, as well.  Actually, I have about as much to offer in the area of expertise as everyone else so why not.  My guess --because it is simply that, a guess--is that the individual mandate will be struck down, but other aspects of the law will be upheld. The Court will focus on the constitutionality of the law as they did with Arizona's Immigration Reform, which they ruled on today.   What such a ruling means, however, is that it presents a number of challenges for Marylanders.  It puts pressure on Medicaid with increased enrollment; access to care may be threatened; those with pre-existing conditions may be denied coverage; varied premiums for healthier employees would be put in jeopardy and the increase in uninsured will increase the amount of uncompensated care. 

I read about an interesting poll today whereby the majority of Americans like the provisions in the Act but don't like how it was enacted by Congress and the President.  Tomorrow, I will blog about what it would mean for Marylanders if the entire Act is overturned. In fact, I will blog all week about the Affordable Care Act leading up to the Supreme Court's announcement of their ruling on Thursday.

Traveling

Last night, I was in Pittsburgh at the Petersen Event Center on the campus of the University of Pittsburgh (by the way, my alma mater is celebrating its 225th anniversary this year) for the James Taylor concert.  Wow, what a show.  His first for his summer tour.  At age 64, he still has it; actually he may be at his best.  Wow!  Also, my first for a concert.......floor seats, about 12 rows from the stage. 

I will be leaving Pittsburgh this AM and heading to my New Jersey roots, actually to the Jersey Shore for a wedding and pretty much a family reunion.  The Ronan Report may be on hiatus until Monday so, enjoy the weekend. 

Congratulations!

The Western Maryland Area Health Education Center sponsors health professional caucuses that meet regularly to give their members a way to network, discuss issues, and plan continuing education courses and other events.  Many of the caucuses recognize one member each year for their outstanding contributions to their field.  Three members of the WMHS family were so honored recently:

Kim Bittner, Nurse Practitioner of the Year

Jennifer Hoover, Registered Dietitian of the Year

Mary Lou Perkins, Social Worker of the Year

Congratulations to Kim, Jennifer, and Mary Lou; all are most deserving recipients of these awards.  Recognition is always nice but means even more when it comes from your peers.