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The American Public May Be Increasingly Pessimistic About Obamacare, But Hospital Leaders Aren’t

By Sy Mukherjee  

"The American Public May Be Increasingly Pessimistic About Obamacare, But Hospital Leaders Aren’t"


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CREDIT: Shutterstock

A recent Washington Post poll found that Americans are split on Obamacare, with 46 percent approving and 49 percent disapproving of the law. Earlier surveys have found disapproval of the law rising as a series of negative stories about the dysfunctional Obamacare website and canceled insurance policies have dominated the news cycle; an Associated Press poll from earlier this week suggested that many people with insurance are afraid that the law will impact them negatively next year.

But setting aside the current public pessimism, what do hospital executives and health system managers — the people largely tasked with running the American medical enterprise — think Obamacare will do to their industry?

That’s what Andrew Steinmetz, Ralph Muller, Steven Altschuler, and Ezekiel Emanuel asked 74 executives from large hospitals and health systems across the country. The results were striking. “Unlike politicians, pundits, and the public, the leaders of America’s leading hospitals and health systems are optimistic about reform,” wrote the authors in the journal Health Affairs.

In fact, the overwhelming majority of respondents said they thought Obamacare would help curb their health systems’ costs (91 percent), improve the quality of care they provide (93 percent), and bolster the U.S. health care system generally (65 percent):

health execs obamacare optimism

CREDIT: Health Affairs

The executives cited several key provisions of the Affordable Care Act — including new medical care models meant to more efficiently track and treat sick patients and fiscal incentives to discourage wasteful hospital re-admissions — as major reasons for their optimism.

“Every respondent indicated that his or her institution has undertaken new initiatives to improve care delivery for chronically ill patients within the last two years,” wrote the survey authors. “They are utilizing electronic health records and predictive analytics to intervene before patients are admitted to the hospital. They are reorganizing their support staffs to enable more effective remote care management, allowing healthcare to move out of the hospital and into the home. They are constructing team-based, integrated systems that enable physicians to focus on value, not simply volume. And many are already seeing positive results in quality and/or cost.”

Hospitals that have to readmit large numbers of Medicare patients within 30 days of a stay face stiff financial penalties under the Affordable Care Act. A recent report by the Centers for Medicare and Medicaid Services (CMS) suggests that particular carrot is beginning to have a tangible effect as 2012 readmission rates fell for the first time in six years (note that the graph’s vertical axis is incomplete):

CMS hospital readmissions

CREDIT: Centers for Medicare and Medicaid Services

The executives also told the study authors that Congress could further spur positive trends in health care quality and spending by shifting Medicare from a wasteful fee-for-service system into one that “bundles” payments more efficiently.

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