JAN 4, 2012 3:52pm ET

Stories to Watch in 2012

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1. June or July: Health Reform Ruling

The most significant story of course will be the Supreme Court ruling on the Obama health reform plan. My colleague Joe Goedert gave a good overview of the potential impact of the ruling in our January issue. Given the court’s close liberal/conservative divide, it’s impossible to predict exactly what will happen. But if the court tosses out the individual mandate to purchase insurance, my fear is that the country will be in an even bigger heap o’ trouble on the health front than it is now. Such a ruling could enshrine for years the already profound disconnect between consumers and health care economics. For years, health care has been something that somebody else paid for, something that somebody else did to us, and something that somebody else was to blame for if we didn’t like the outcome. We currently have a system of such misaligned incentives and a public in such denial about risky health behaviors it’s no wonder costs are out of control and chronic diseases are beginning to choke our resources.

Don’t get me wrong: there’s no magic industry bullet—just as there’s little guarantee the reform bill will actually hold down costs if it is upheld. If the court tosses out the mandate (which in my estimation would all but gut the law’s already dubious shot at reducing costs), the industry will continue to muddle along as it has, treating everybody who shows up at the door in the ED, shifting those costs back to the commercial patients, and putting the continued reimbursement squeeze on everybody else in the food chain. We need a mandate to begin to not only broaden the pool of insured people, but to expand the number of people with an economic stake in their own health outcomes. Beyond that, we need to begin a national dialogue about what health behaviors we will and will not tolerate. I just shudder every time I see a young hipster lighting up a cigarette because I know that in not that many years this person will transform into a major cost liability on the nation.

2. March: 5010 Progress

The health reform ruling will be the big policy decision of the year. But whichever way the court rules, the impact will be years in unfolding. On a more practical, immediate scale, I’ll be watching the transition to the 5010 claims transaction standard. It was supposed to go live on Jan. 1, but CMS granted an extension due to widespread concern over lack of industry preparation. Now this is a narrowly defined technical standard, and by most accounts, the conversion to 5010 will not upset the day-to-day operations of either payer or provider operations. It does allow for more detailed electronic transactions and submissions, setting the stage for more sophisticated data exchange. Most important, the 5010 format enables the expanded data fields of ICD-10—which is mandated to go live in October 2013. Compared to ICD-10, the conversion to 5010 is fairly trivial. So if the industry is struggling just with the technical data field, think about the implications for ICD-10. CMS has insisted it won’t back off the ICD-10 deadline, but watch for more industry pushback this year. The AMA was the first to throw down the gauntlet, calling for a halt to ICD-10 last year. I can’t imagine it will be the last.

3.  June: New Children’s Hospital in Chicago

This coming June 9, Children’s Memorial Hospital moves to a spiffy new location downtown adjacent to Northwestern Memorial. It will be called the Ann & Robert H. Lurie Children's Hospital of Chicago. I’ve been watching this architectural gem rise over the past couple of years and am eager to see the operation. Despite all the industry troubles, a new hospital is cause for celebration as these organizations represent hope for a better future.

4. August or September: Cubs Mathematically Eliminated?

My crystal ball is a little hazy on this one, but this annual event usually takes place late summer. This season would be the 104th year anniversary of the Cubs’ last World Series win in 1908. The team last appeared in the World Series in 1945. To put this event in historic context, on November 19 that year, President Harry Truman introduced to Congress a plan for national health insurance. Part of the deal: compulsory insurance. Concern: rising health costs.

Who knows what will happen in 2012? I’ve got enough of the Cubs stalwart Ron Santo optimist in me to dream of a year in which health reform passes and succeeds, the industry masters electronic data interchange, Americans start getting in better shape, a new hospital opens without a hitch, and yes, the Cubs win the World Series. I also remember how Santo, the ever-enthusiastic third baseman turned broadcast journalist, used to sit by the phone every year anxiously awaiting the notification call from the Hall of Fame. And indeed, he was elected to the Hall of Fame— the year after he died.

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