Whether the health-care reform passed in 2010 survives or dies, the effects of the controversial federal law already are being seen locally.
As the U.S. Supreme Court prepares to hear arguments this week about the constitutionality of the law, the Beacon Journal asked local health-care industry leaders to answer this question: What impact — negative or positive — has health-care reform had so far in the region and what changes do you expect to see in general or in a specific scenario in the future?
These are their responses:
Dr. Tim Stover, president and chief executive, Akron General Health System:
“In the Akron area, we are starting to feel the impact of the payments for value vs. volume. Value-based purchasing is Medicare’s way of not paying for certain diagnoses if the value equation is not taken into account. For example, in cases where there is a readmission to the hospital for the same diagnosis within a 30-day time period, hospitals not only do not get paid for that readmit but are also now subject to a penalty. Certain quality measures must now be obtained 100 percent of the time per admission in order to avoid the penalties. And hospital-acquired infections, if shown to be the result of a recent admission, will not be paid for no matter what the patient’s original problem was.
“Local payers are piloting programs for primary-care physicians where the doctors can share in the ‘savings’ for certain chronic conditions if the case is managed on an outpatient basis. Therefore, managing a group of patients with the same chronic illness and saving costs on those patients will benefit the PCP, but there is nothing in place that reimburses the physician for pro- actively promoting and teaching wellness. The system in place is all for ‘after the fact’ care, rather than preventive care.
“Many hospitals are cutting costs in myriad areas in anticipation of many more patients coming in for care with insurance, which most likely will be a Medicaid-type product operated through state exchanges. This will cause an increase of patients with a payer source that does not come close to covering the fixed costs of a routine admission. It will also affect providers. With many experts predicting a shortage of primary-care physicians of anywhere from 65,000 to 95,000 within five years, this begs the question, ‘Who will take care of these newly insured patients?’
“Finally, there is no provision for incentivizing wellness to those newly insured patients. It is very likely that individuals with chronic illnesses will strain the current provider system even more, resulting in those individuals with traditional insurance being asked to take the burden of paying for those whose lifestyle choices often caused their chronic problems. Nothing in the current bill addresses this inequity.”
Thomas J. Strauss, president and chief executive, Summa Health System:
“Our position on health-care reform has not changed since the passage of the Affordable Care Act. The current health-care system in our country is broken and cannot be sustained. While the new law isn’t perfect, it is an important first step in changing the way care is delivered in our country, and we look forward to continuing a leadership role in finding meaningful solutions to transform the model from a sick-care to a true health-care system. With that said, we ultimately want the best solution for our communities.
“If repeal brings with it a better solution than the Affordable Care Act, we’ll support that. But we have yet to see that better alternative. If repeal brings us back to where we were prior to the passage of the Affordable Care Act, we will remain strongly opposed.
“Ultimately, what the result of health-care reform will be and the impact that it will have is still to be determined. But regardless of where individuals side on the debate, I’m excited that our nation is finally taking a serious look at the issues. So while we wait for the politicians and lawmakers to work out their differences, we will continue to advance the work that we are doing with our physicians and our communities to transform how we deliver care. Not doing so would be a disservice to our communities, our physicians and our country.”
Shawn Lyden, executive vice president, Akron Children’s Hospital:
The insurance-related elements of federal health-care reform have not had a significant impact on Akron Children’s Hospital. (For example, since Akron Children’s age cutoff is 21, except for adults with congenital or childhood- acquired conditions or diseases and adult burn patients, the required expansion of coverage to include young adults up to age 26 has little relevance to us. Similarly, the law’s creation of insurance pools for people denied private insurance coverage due to pre-existing conditions has had a limited impact on Akron Children’s because of the general availability of Medicaid coverage for children with pre-existing conditions.) Moreover, while the Affordable Care Act contains authorization for a pediatric accountable care demonstration program, that program has yet to be implemented.
“On the other hand, the Affordable Care Act and Medicaid reforms at the state level have triggered market reforms that clearly affect Akron Children’s. Accountable Care Organization (ACO) initiatives are being studied and developed by adult and pediatric health-care systems, many outside of Medicare’s ACO program. The goal of these initiatives is to achieve the ‘triple aim’ of improving the quality of care, improving population health and lowering costs through improvement. Akron Children’s is actively planning to develop its own pediatric accountable care organization, which will be focused at least initially on our Medicaid patient population (representing approximately 50 percent of our patient volumes). The State of Ohio is in the process of developing regulations regarding pediatric accountable care organizations.
“Another positive element of the federal health-care reform legislation for Akron Children’s has been the creation of the Centers for Medicare & Medicaid Services Innovation Center (CMMI). For example, Akron Children’s is a founding member of Ohio Children’s Hospitals Solutions for Patient Safety, which has received a multimillion-dollar grant from CMMI to spread the groundbreaking patient safety work done collaboratively by Ohio’s children’s hospitals to children’s hospitals throughout the country. Children’s is party to another pending grant application with CMMI.”
Dr. Kristine Drummond, chief executive, Akron Community Health Resources Inc., a “sliding-scale” medical practice that treats many uninsured and Medicaid patients:
“With preventive services for families being provided with no co-pays or deductibles by the Affordable Care Act, many persons who have never had the option to proactively engage in managing their personal health will now have options to improve their wellness level.
“Health is not just about treating a symptom but instead reaches deeper into the fabric of our lives and is enhanced when we have opportunities to pilot our health choices. Those opportunities have not been universally available to financially challenged families.
“The Affordable Care Act has the potential to improve the health and well-being of individuals and, consequently, enrich the cultural wealth of the communities in which they live.”
Mary Taylor, Ohio lieutenant governor and director of the Ohio Department of Insurance:
“Since passage of the federal health-care law, we have seen insurance carriers exit our market, leaving Ohioans to find coverage elsewhere and our child-only insurance market has disappeared. Consumers and small businesses are not seeing the relief they were promised in their health insurance costs.
“Moving forward, premiums in the individual and small-business market will increase at a much higher rate. Earlier this month, the Congressional Budget Office projected 3 to 5 million fewer Americans will get coverage through their employer compared to if the law had not been passed. We also know the law is now projected to cost $1.76 trillion and in order to pay for this enormous financial burden, the federal government is collecting $500 billion from individuals and job creators in the form of new penalties and taxes.
“That is why the governor and I oppose the federal health-care law and want to see it repealed and replaced with a solution that works better for Ohio individuals and businesses. We need an Ohio solution that fosters a vibrant health insurance marketplace and actually reduces costs. Keeping those goals in mind, we will continue to evaluate our options in order to do what is best for consumers and job creators.”
Cheryl Powell can be reached at 330-996-3902 or firstname.lastname@example.org. Follow Powell on Twitter at twitter.com/abjcherylpowell.