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Whether you appreciate or hate the nearly 3,000 pages of complexity it contains, one has to respect the tenacity and courage of President Obama in being willing to risk his legacy, popularity and even his chances of a second term to muscle this historic bill through a bitterly divided Congress. You can’t unring this bell. It would take a majority of 60 Republicans in the Senate (there are 40 now) and a Republican president to repeal it. Of course, over a dozen state attorneys general have filed suit to get the courts to block the law’s implementation, but my sense is that reform will proceed despite them. America arguably has the best health care in the world, at least when things work at their best. Unfortunately, all too often that is not the case. Today’s U.S. health care system is, in reality, a non-system, with major access problems for 50 million citizens. The status quo is uneven quality, patient safety and care coordination; and it is far more costly than it needs to be in terms of return on investment (ROI). Extolling the virtues of the status quo, given its massive and growing contribution to the national debt and to economic non-competitiveness in a global economy, is virtually unpatriotic. But change is risky and unnerving, and the implementation of the PPACA will certainly be a rocky five- to 10-year course of amendments, modifications and market-driven changes in how health care is delivered and financed. The insurance reforms in the bill that eliminate underwriting based on illness, lifetime coverage limits, coverage denials and excessive profit-taking are long overdue.
Interestingly, Wall Street has given a preliminary but clear thumbs-up to how private insurance companies, hospital systems and cardiovascular care will fare financially in this changing future. The markets have taken notice that the government alone will spend an additional $1.1 trillion over the next decade to fund:
• coverage of the uninsured
• expanded pharmaceutical and other coverage in Medicare and federal programs
• new small business subsidies
• prevention services• workforce training and incentives
• more research
• substantial information technology and payment innovation experimentation
Somebody’s going to get that money. There will be winners and losers here, of course. I believe the winners will be those who succeed in innovating, and the losers will have clung to the status quo. But, there is a nagging and legitimate fear that reform will have little or no impact on reducing unnecessary spending, waste, fraud and rising national debt: a house of cards. We can make sure that the future evidences more patient- centered value. The ACC realized years ago that the nation had to move beyond the status quo to more aggressively deal with the country’s problems in health care access, quality, cost and ROI. The current convoluted and flat physician payment systems, legal costs and singular use of price controls to ineffectively reduce rising costs already have just about killed off the private practice of cardiology. Ironically, the risks we fear about reform already are with us today. We need to focus on the opportunities that change could now bring for those who act together to redesign delivery and payment. Our redesigned system should reward quality and prevention; be more patient-centered and team-driven; promote registries and health information technology to measure progress in clinical care; reduce waste; and promote science, research and more rapid clinical innovation.
Health care reform is here. It needs to be. There are inherent risks and opportunities, likely victims, and potential winners. The College under-stands it must largely be focused on the opportunities. Ultimately, that is lucky for you. And, incidentally, if you can find a way to see things this way, what an amazing time this is to be in health care! If you are like many of your peers, our bet is that you’ve been considering various strategies and alternatives that enable your cardiology practice to confront decreasing reimbursement and growth in practice overhead for many years. Responding to clinical and business change is part of what you do for a living. When viewed in this light, the health care reform law has merely confirmed what many cardiologists and cardiovascular administrators already had determined: In order to sustain quality cardiovascular care, the private practice business model must change. Motivated by the combined forces of health care reform and market pressures, cardiologists and health system leaders are aggressively evaluating strategic alternatives and options that would result in new physician-hospital integration models and relationships. Among other changes, the new law will result in significant reimbursement reductions. In addition, the law calls for alternatives to Medicare’s current fee-for-service model with methods such as bundled payments and the banding together of providers into accountable care organizations. These new cost-saving, quality-improving methods will likely necessitate physicians and hospitals aligning much more closely.“ It’s not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change. ”Cardiologists and hospital leaders turn their attention to selecting the “right” integration model. Of course, there are many physician-hospital models to consider: practice acquisition combined with subsequent employment, co-management relationships and professional service agreements, among others. These considerations are important, but there’s more to a successful partnership that avoids the potential pitfalls of integration. While you are evaluating how to best (re)define a partnership with a hospital and other cardiologists, make sure that all sides are clear on the following fundamental components of the new integrated relationship: Goals/Objectives.