Posts Tagged ‘SCOTUS’

Aftermath of SCOTUS Healthcare Reform Ruling: The Country Reacts

June 29th, 2012 by Patricia Donovan

From retailers to religious groups to every sector of the healthcare industry, reactions were immediate, passionate and divided to yesterday’s Supreme Court validation of the Affordable Care Act — a.k.a. Obamacare.

The highest court in the country upheld the constitutionality of the individual mandate built into the healthcare reform bill, but rejected the law’s right to penalize states that choose not to participate in new Medicaid programs by taking away their existing Medicaid funding.

Many states and healthcare organizations were waiting for the ruling before deciding whether to implement the many programs spelled out in the Affordable Care Act.

Here are excerpts from official statements published around the Web yesterday:

American Medical Association

“…We are pleased that this decision means millions of Americans can look forward to the coverage they need to get healthy and stay healthy….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. The expanded health care coverage upheld by the Supreme Court will allow patients to see their doctors earlier rather than waiting for treatment until they are sicker and care is more expensive. The decision upholds funding for important research on the effectiveness of drugs and treatments and protects expanded coverage for prevention and wellness care, which has already benefited about 54 million Americans…” (Jeremy A. Lazarus, MD, president)

Restore America’s Voice Foundation

“The Court threaded a Constitutional needle in redefining the individual mandate as a federal tax. It’s disappointing but not the final recourse for the American people. Now it is time for the legislature to do its job representing the will of the American people for full and final repeal of this ill-considered legislation…It must be repealed in its entirety or Senate Democrats will have to go home and explain their flawed definition of faithful representation. If they won’t represent the will of the people, then how have they earned the right to serve?” (Ken Hoagland, chairman)

Kaiser Permanente

“Today’s Supreme Court decision on the federal healthcare reform law resolves much of the legal uncertainty over implementation of the law’s provisions. While acknowledging that political uncertainty still remains, in the interest of our members we plan to continue our extensive reform implementation efforts, which began two years ago when the law first became effective. We want our members to know that they need not be concerned about any disruption of their coverage resulting from the Supreme Court’s decision today…” (Unattributed, published as “Our Point of View”)

America’s Health Insurance Plans’ (AHIP)

“…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. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.” (Karen Ignagni, AHIP president and CEO)

Primary Care Development Corporation (PCDC)

“We are enormously pleased that the Supreme Court recognized the importance of the Affordable Care Act to millions of Americans and upheld the law, though it is disappointing that the ruling also weakened a provision supporting Medicaid expansion. (Ronda Kotelchuck, CEO)

National Association of Public Hospitals and Health Systems (NAPH)

“We are pleased by the Court’s decision today to uphold the Affordable Care Act’s (ACA’s) individual mandate, which will broadly expand health care coverage. We also are pleased that the decision retains other positive elements of the ACA, including initiatives to promote innovation, preventive care, and community-based collaborations. But our initial assessment of the decision leaves us concerned by its potential to limit Medicaid expansion, which could strand millions of our most disadvantaged people without access to basic health care coverage.” (Bruce Siegel, MD, MPH, NAPH president and chief executive officer)

National Retail Federation:

“As the voice of retailers of all types and sizes, we’re disappointed by today’s ruling. The Court missed an opportunity to redress the many shortcomings of the law. As it stands, the law wrongly focuses more on penalizing employers and the private sector than reducing health costs. For these reasons, NRF has been a consistent skeptic of the Affordable Care Act….Although the Court upheld the law’s constitutionality, many problems remain: it penalizes employers too much; it doesn’t do enough to reduce the cost of healthcare; and it is unreasonably complicated and difficult to implement and administer…This law will have a dramatic, negative impact on every employer and employee in the United States and further constrain job creation and economic growth.” NRF President and CEO Matthew Shay

National Lutheran Church — Missouri Synod

“In light of today’s ruling by the U.S. Supreme Court on the constitutionality of the Patient Protection and Affordable Care Act (PPACA), we remain opposed to the controversial birth control mandate, which is one of the requirements included in the law. The Court’s decision today guarantees that we will continue to bring awareness to the threat to religious liberty represented by the birth control mandate, which requires virtually all health plans, including those of religious organizations, to cover birth control drugs and products that could cause the death of the unborn. We are opposed to the birth control mandate because it runs counter to the biblical truth of the sanctity of human life and creates a conflict of conscience for religious employers and insurers, who face steep penalties for non-compliance based upon their religious convictions. (Rev. Dr. Matthew C. Harrison, president)

American Hospital Association (AHA)

“Today’s historic decision lifts a heavy burden from millions of Americans who need access to health coverage. The promise of coverage can now become a reality. The decision means that hospitals now have much-needed clarity to continue on their path toward transformation.” (AHA President and CEO Rich Umbdenstock)

Blue Cross Blue Shield Association (BCSA)

“BCBSA has long been committed to ensuring everyone has high quality, affordable healthcare coverage. We will continue to implement the law while working with policymakers to fix provisions that will increase costs, such as the health insurance tax that will add hundreds of dollars to families’ premiums each year. On behalf of our 100 million members, Blue companies will continue to lead efforts in their local communities — partnering with doctors, nurses, hospitals and others — to rein in costs, improve quality, help people stay well and better manage their care when they need it.” (President and CEO Scott P. Serota)

New Market Data: ACOs Can Survive a Supreme Court Challenge

June 15th, 2012 by Patricia Donovan

The accountable care organization, the number of which has doubled in the last year, is here to stay, no matter how the nation’s highest court rules on healthcare reform legislation.

So say two-thirds of respondents to the second annual survey on ACO activity conducted by the Healthcare Intelligence Network.

The nation’s highest court is expected to release its opinion on the Patient Protection and Affordable Care Act (PPACA) before the end of this month. But the majority of healthcare organizations responding to the ACO survey said the accountable care model is robust enough to survive a Supreme Court challenge.

Almost a third of this year’s respondents — 31 percent — participate in an ACO, up from 14 percent in 2011. 200 healthcare companies completed the second annual survey, which also tracked trends in ACO size, administration, lead time, and early results.

“These results make it clear that the healthcare industry is prepared to go forth with accountable care, whether or not the U.S. Supreme Court upholds PPACA,” notes Melanie Matthews, HIN executive vice president and chief operating officer. “Even though many ACOs are still in their infancy, the accountable care model is already driving improvements in care coordination and a decline in hospital readmissions for patients cared for by an accountable care organization.”

Other data highlights from the survey include the following:

  • Just over half of responding ACOs participate in the CMS Shared Savings program, an ACO for Medicare beneficiaries.
  • Physician-led ACOs are the most common, with a quarter of 2012 respondents reporting physician administration of their ACO. In contrast, the number of ACOs with a hospital at the helm has dropped dramatically, from 32 percent in 2011 to around 5 percent.
  • The typical ACO is smaller in 2012, as the number of active ACOs with 100 to 500 physicians dropped almost 50 percent in the last 12 months. One-third of current ACOs have between 1 and 100 physicians participating.
  • Staff management and buy-in is the greatest challenge organizations must overcome during ACO creation, say 21 percent of respondents.
  • Organizations have become more efficient in ACO creation: 41 percent say it took less than a year to launch the ACO, up from 25 percent in 2011.

Download a complimentary executive summary of ACO survey results.

Self-Examination: Industry Questioning Necessity, Cost Irregularities of Healthcare Services

May 2nd, 2012 by Cheryl Miller

Regardless of whether the Supreme Court overhauls health reform, the industry is seriously thinking about ways to cut healthcare spending, either by reexamining the need for commonly administered services or unraveling the mysteries of medical bills.

As we reported in a recent news story here, a coalition of nine leading physician specialty societies representing nearly 375,000 physicians have identified specific tests or procedures that they say are commonly used but not always necessary in their respective fields.

Coordinated by ABIM Foundation’s Choosing Wisely campaign, the lists of “Five Things Physicians and Patients Should Question” provide specific, evidence-based recommendations physicians and patients should discuss when making healthcare decisions. Among the tests that patients might not necessarily need are stress imaging tests for annual checkups if the patient is an otherwise healthy adult without cardiac symptoms, according to the American College of Cardiology, and chest X-rays for patients going into outpatient surgery, according to the American College of Radiology. Most of the time, the x-ray images will not result in a change in management and have not been shown to improve patient outcomes, college officials say.

A recent opinion piece from the New York Times echoes the feeling that more evaluation of health services and costs is necessary, and sheds some light on the abundance of medical tests. The article, Why Medical Bills are a Mystery, written by Robert S. Kaplan and Michael E. Porter, professors of accounting and strategy, respectively, at Harvard Business School, states that:

The lack of cost and outcome information also prevents the forces of competition from working: Hospitals and doctors are reimbursed for performing lots of procedures and tests regardless of whether they are necessary to make their patients get better. Providers who excel and achieve better outcomes with fewer visits, procedures and complications are penalized by being paid less.

The article goes on to cite a lack of uniformity for healthcare costs and reimbursements, and suggests that by analyzing costs, hospitals can save money and improve care:

Because health care charges and reimbursements have become disconnected from actual costs, some procedures are reimbursed very generously, while others are priced below their actual cost or not reimbursed at all. This leads many providers to expand into well-reimbursed procedures, like knee and hip replacements or high-end imaging, producing huge excess capacity for these at the same time that shortages persist in poorly reimbursed but critical services like primary and preventive care.

A new University of California San Francisco (UCSF) study published online this week in Archives of Internal Medicine underscores the concerns voiced by Kaplan and Porter:

The study looked at nearly 20,000 cases of routine appendicitis at 289 hospitals and medical centers throughout California. The patients – all adults – were admitted for three or fewer days. The researchers uncovered an enormous discrepancy in what different hospitals charge, ranging from a low of $1,529 to a high of nearly $183,000. The median hospital charge was $33,611. The startling cost variation reveals a “broken system,” the authors said.

“Consumers should have a reasonable idea of how much their medical care will cost, but both they and their healthcare providers are often unaware of the costs,” said lead author Renee Y. Hsia, MD, an assistant professor of emergency medicine at UCSF.

What to do? The Journal of the American Medical Association (JAMA) weighed in on ways to cut waste and improve quality in U.S. healthcare. In a recent article researchers identified six categories where cuts could result in a significant reduction in healthcare costs. In these six categories: overtreatment, failures of care coordination, failures in execution of care processes, administrative complexity, pricing failures, and fraud and abuse, the sum of the lowest available estimates exceed 20 percent of total healthcare expenditures.