If PPACA is repealed it will be interesting to see if it is repealed in whole or in part. The Supreme Court of the United States (SCOTUS) may excise the individual mandate requiring health insurance coverage, or it could strike it down entirely. There is an excellent discussion regarding a case that both sides are expected to use, known as Wickard v. Filburn on Forbes, and other cases, entitled The 10 Cases You Must Know To Understand The Obamacare Case. Widely read conservative Hoover institution has a post today referring to ACA as
An Unconstitutional Misadventure, however it only addresses the individual mandate component of PPACA. Let’s look at some of the proposed benefits in terms of efficiencies. The biggest danger may be that popular press only review the impact of the Affordable Care Act in its simplest form, without reviewing several efficiencies that are embedded.
Note: our intent is to provide a non-partisan view of the HIT impacts, which are separate from the highly politicized consumer impacts.
You have no doubt read that the biggest resistance to PPACA is in response to consumers being required to buy health insurance. The Constitutionality of this provision regarding the Commerce Clause of the Constitution is being heard because some believe that it over-regulates consumers for the apparent national good.
Many don’t realize that other legislative measures such as The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 are separate from PPACA.
From a clinical data and efficiency perspective, the HITECH Act is focused on creating efficiencies:
- Meaningful Use of Electronic Medical Records ($27 billion plus in stimulus funds to wire up the hospitals and physicians in this country so that health records are electronic enabling efficiencies, analytics, etc. as well as standards for health care data interoperability which are desperately needed in health care to modernize it and remove paper. Estimates are $77 billion in cost savings over time for EMRs.)
- Health Care (Payment) Reform (using comparative effectiveness research [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][“…compare the effectiveness of different treatments for the same illness…”] to apply what the industry calls ‘quality measures’ to change physician payments from per procedure [FFS or fee for service] to pay for performance). In essence this means that if a physician or hospital meets certain benchmarks of quality and patient population health they can receive more reimbursements for Medicare patients, and health insurance companies who support these health care providers can receive incentives as well.
- Health Information Exchanges (ability to share information across multiple physicians, hospitals, and geographies, realizing efficiencies and enabling some of the provisions of payment reform), although HIEs are impacted by PPACA because Health *INSURANCE* exchanges are viewed as the mechanism by which consumers will purchase insurance. HIEs that exchange information about population health may have actuarial impact and pricing impact on the policies offered by Health INSURANCE Exchanges.
There is less uncertainly about a mandate that is separate from PPACA. We provide services to clients who must transition to a new medical coding standard called ICD-10. ICD-10 is a HIPAA mandate. Although CMS has delayed ICD-10 it is appears certain that this mandate will go forward.
The World Health Organization (WHO) sets this standard, and it was mandated prior to Obama’s election by Health and Human Services (HHS) Centers for Medicare and Medicaid (CMS) that it had to be used in this country. But CMS just announced a postponement in this mandate from October 1, 2013 to a future, yet to be specified date.
We’ve taken on some ambitious speaking engagements this spring covering these areas. One where we’ll be presenting is the American Academy of Professional Coders (AAPC) in April is entitled, “How ICD-10 and Payment Reform impact Hospital Revenue Cycles.”
Follow the discussion on Twitter athttp://www.twitter.com/marrigo, using hash tags #PPACA and #SCOTUS, as well as here on our blog. Discussions available for health plans, hospitals and other providers at http://www.linkedin.com/groups?gid=1777488&trk=hb_side_g
- Patient Protection and Affordable Care Act (PPACA) Will Not Save Costs
- Meaningful Use Assessment
- ICD-10 Implementation Consulting Best Practices
- ICD-10 Postponement Opens the Door to ICD-11?