|How Supreme Court Decision on ACA Affects URMC|
|Thursday, June 28 2012|
In a much-anticipated ruling, the United States Supreme Court today rendered a decision on the constitutionality of the Patient Protection and Affordable Care Act, often referred to as the ACA, a major healthcare reform bill signed into law by President Obama in 2010. The ruling came as a surprise to many observers who expected the law’s most controversial feature – the requirement that all individuals buy health insurance – to be struck down. Instead, the Court decided that individuals can opt not to buy health insurance but must pay a tax if they do so.
“Today’s ruling is terrific,” said Steve Goldstein, CEO of Strong Memorial and Highland Hospital. “We strongly support coverage for all Americans. Now, millions more will have the chance to acquire insurance and the peace of mind that it brings.”
The Court also ruled on the ACA’s provision to expand Medicaid coverage by increasing the income allowances for eligibility. The Bill had mandated that states expand eligibility or risk losing all federal Medicaid reimbursement. The Court ruled that states have the right to choose whether to expand access, without the risk of losing all funding.
Regardless of the Court’s decision today, URMC was committed to continuing the work it began several years ago to improve and expand access to patient care, operate more efficiently, and improve quality, safety and patient-centeredness. Making healthcare more affordable and accessible, especially at the primary care and preventative levels, and improving the health of our community, is central to the mission of our medical center.
“The inefficiency and redundancy in our current health care system needlessly squanders dollars that could better be used to spark innovation in health care and the rest of our nation’s economy,” said URMC CEO Dr. Brad Berk.
“The ACA together with state and federal budget realities have created a wave of momentum that is going to carry reform forward and we’ll continue to work more efficiently and effectively in adapting to a new set of metrics on which reimbursement will be based,” Berk continued. “We have an opportunity to tap into that American spirit of innovation and re-imagine a health system that serves everyone better.”
Healthcare has traditionally been provided through a loosely organized delivery system into a series of independent providers; physicians, hospitals, nursing homes, rehab facilities, home care agencies, etc., all with conflicting financial incentives. As a result, it can be difficult for patients to move safely between various levels of care, there is a lot of wasteful duplication that adds to cost and there is uneven quality and a great deal of variation between the way medical care is practiced between providers and between communities. Another major concern is access to care - particularly for the 50 million Americans who have no health insurance and those denied coverage for pre-existing conditions. These patients end up seeking care in our emergency rooms and clinics, usually long after their symptoms have developed into full-blown disease, which is far more costly to treat and paid for by extra costs embedded in our taxes and our private insurance premiums.
The ACA created a sense of urgency within hospitals to improve quality, patient-centeredness, and cost-efficiency, initiatives which we have embraced and to which we remain firmly committed.
““This is a complicated Court decision, that’s over 190 pages long. We’ll learn more about the details and full implications in the days to come, but on the surface, this certainly validates the direction we’ve been taking,” said URMC Chief Operating Officer Peter Robinson.
URMC will remain focused on practices which allow us to operate more safely and efficiently, including affiliating and collaborating with other hospitals to create a more coordinated approach to care.
Our investment in electronic medical records and other efficiency measures will make substantial improvements in managing patients’ care, reducing redundant tests and treatments, and allowing us to monitor our progress. We’ll also continue to focus on primary care. We know that Medicaid dollars are disproportionately spent on a small group of enrollees with complex, chronic disease. Our patient-centered medical homes, a model adopted by all 22 of our primary care practices that facilitates partnerships between individual patients and their personal physicians and, when appropriate, the patient’s family, help us focus intensely on these types of patients, avoiding costly hospitalizations. Changing the emphasis from disease-management to prevention for all of the patients in the home is good medicine, and it’s only natural that it will lower costs.
Government and private insurers will continue to drive patients to the hospitals that provide the greatest value (best quality at lowest cost) and can prove it. The federal government already holds back 1% of our Medicare and Medicaid payments and requires us to earn those back by meeting quality/satisfaction standards. By fall of 2016, 6% of our payments will be withheld in this way. We already have robust efforts underway – like our “Zero” campaign to reduce hospital-acquired infections, our “Safe Transitions” program to avoid unnecessary readmissions, and our “iCARE” and “Highland Promise” initiatives to improve patient- and family-centeredness— to proactively meet this challenge.
“Each of us has the responsibility and challenge to embrace these types of initiatives to ensure the continued vitality of our medical center, and to deliver Medicine of the Highest Order,” Berk said. “That means delivering the right care, at the right time, in the right setting.”
As health care reform challenges us to expand health insurance to cover 30 million more Americans – and improve the quality and effectiveness of that care, all on a smaller dime – traditional industry arrangements will only go so far. We sat down with URMC Chief Operating Officer Peter Robinson to make sense of how reform’s new financial incentives are rewriting relationships among players.