While things were a bit murky at first, what emerged from the Supreme Court was some much-needed clarity on how providers can move forward with accountable care initiatives and other efforts fueled by health reform, according to two hospital CIOs asked for their first impressions on the ruling.
“No one likes uncertainty,” says Chuck McDevitt, vice president and CIO at Self Regional Healthcare, Greenwood, S.C. “I was a little worried because some news outlets initially got it wrong, but I’m excited it was upheld. Stability was needed.”
Chuck Christian, CIO at Good Samaritan Hospital, Vincennes, Ind., said he was surprised at the reasoning behind the decision—that the individual mandate could be considered a tax—since the crafters of the health reform bill took pains to ensure it wouldn’t be considered a tax. Christian adds that while it’s clear health reform will move forward, the true impact of the provisions won’t be evident for years. “I’ve seen very different financial models on the impact of state insurance exchanges, so it’s going to take time to see how this really plays out.” In addition, he’s waiting for some clarity around the tweaks to Medicaid, which, he says “will take a couple days for the attorneys to sort out.”
One significant reform benefit, however, will be a more cost-conscious patient as reform requires them to purchase insurance and lay more of their own money down for that coverage, Christian says. Good Samaritan recently opened a convenient care clinic to take some pressure off its emergency department, which like EDs everywhere is treating many patients with non-emergent health issues who are getting treated wihtout making co-pays.
Some of those patients instead started going to the convenient care clinic, but after finding out it required a minimal co-pay, started going back to the ED, even though that care cost them and Good Samaritan more in the end. “With the expansion of health insurance and the move to shift more of the cost burden to patients, I think we’ll see a shift in this kind of behavior, and the payers will help: I’m already hearing about payers calling patients and telling them about lower-cost options for MRIs and other treatment, so I think we’re going to see more consumer awareness about the true costs of health care.”
But McDevitt and Christian agreed that whatever the Supreme Court had ruled, their I.T. initiative plans would have changed little. Self Regional has an ACO pilot underway—with McKesson Health Solutions—that’s already yielding big financial benefits. The health system’s employees are the first to test the model, which offers lower insurance rates for employees who exercise, lose weight and stop smoking, among other measures. The medical center has already reduced its health care expenditures for employees by $2 million, so the model is proving itself, McDevitt says. “We’ve already invested about $1.5 million in the initiative, and with or without the individual mandate and the rest of health reform, we were moving forward. This ruling just took away any doubt we had about the direction we were going and the investments we made.”
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