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The Health Care Industry Is Implementing Reform, Regardless Of The Supreme Court’s Decision

By Igor Volsky on April 4, 2012 at 10:02 am

"The Health Care Industry Is Implementing Reform, Regardless Of The Supreme Court’s Decision"

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The fate of the Affordable Care Act now rests with the nine justices on the Supreme Court, but win or lose, the health care law has already changed the health care market and set the industry on a path of delivering and paying for health care more efficiently. Just as “49 states and the District of Columbia have already taken action supporting the law’s implementation” and are unlikely to backtrack on those efforts, health care payers and providers are moving forward with reforms that suggest that the law is definitely here to stay:

PHYSICIANS REDUCING WASTEFUL CARE: “Nine medical societies representing nearly 375,000 physicians are challenging the widely held perception that more health care is better, releasing lists Wednesday of tests and treatments their members should no longer automatically order. The 45 items listed include most repeat colonoscopies within 10 years of a first such test, early imaging for most back pain, brain scans for patients who fainted but didn’t have seizures, and antibiotics for mild- to-moderate sinus distress.”

PROVIDERS ADOPTING DELIVERY MODELS: As Sarah Kliff has reported, the Affordable Care Act has “already significantly catalyzed the health-care system.” With the law’s changes in how Medicare reimburses for care, providers now “have a sense of direction of where the country’s biggest payer is headed” and are now moving in that direction. Chas Roades, chief research officer at consulting firm the Advisory Board Co, recalls that when the Board “surveyed 69 hospital executives in November, just 16 percent said they had bundled payments in place. But of those who didn’t, 75 percent expected to within two years. Two-thirds expected they would have such payment arrangements with Medicare.” Similarly, “the health-care system has become increasingly integrated, with hospitals and insurance plans buying up doctors’ offices.” Consulting firm Irving Levin Associates saw health-care “merger activity shoot up 11 percent, from $205 billion in 2010 to $227 billion. Their analyst, Stanford Steever, attributed that largely to the Affordable Care Act.”

INSURERS WORKING WITH PROVIDERS ON DELIVER REFORM: Karen Ignagni, CEO of America’s Health Insurance Plans, the industry lobby, says insurers are “working with hospitals and doctors to change the way care is paid for and to keep costs down, just as Cigna’s [CEO David] Cordani wants.” She cites two studies that say Medicare plans run by private insurers are succeeding at keeping seniors from being readmitted to the hospital after procedures. “We’re leading the way, according to government data on readmissions,” she says. “That’s a win-win on both sides. There’s real data now to support the contention that these strategies and these tools work very, very effectively.”

In other words, the the law has already created an unstoppable momentum towards change. As the Huffington Post’s Jeffrey Young has pointed out, “health insurance companies, hospitals and the rest of the health care system already have made deep changes to the way they operate: adding new consumer protections to health plans, altering the way medical providers get paid and beginning to work closer together to improve health and save money” — and it’s very unlikely that they will take away these new benefits or obtain efforts to modernize their operations (in an effort to reduce spending). Regardless of the Supreme Court’s anticipated ruling on the law in late June, the changes the ACA inspired are here to stay — in one form or another.

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