I like the health care reform law, known as the Accountable Care Act. Its laudable goals of insuring 30 million more Americans and reducing some of the most egregious insurance company abuses are big steps.

It is, however, a deeply flawed piece of legislation. You can't gut Medicare to pay for reform when the Baby Boomers are just starting to enter the Medicare program. And you surely can't rely heavily on low-and-slow paying Medicaid to cover many of the newly insured and expect to have enough doctors accepting those new patients.

Further, this was the time to go to a single-payer plan like much of the industrialized world, whose businesses are more competitive than many of ours because of lower health care costs. I am so tired of the "No" crowd saying that 300 million Americans aren't smart enough to take the best from other nations' plans and come up the best single-payer plan on Earth.

All that said, there's good stuff in the reform law. I believe its information technology provisions will bring substantial improvements to the industry. These I.T. provisions, many of which complement existing HIPAA and HITECH laws, by themselves would have been a substantial piece of legislation.

The HIPAA transaction standards get a facelift with mandated adoption of "operating rules" that will tighten the standards and bring efficiencies promised 14 years ago. New claims attachment and electronic funds transfer transactions, plus the long-delayed health plan identifier, will further those efficiencies--if they actually become real now.

The reform law authorizes programs to develop best practices for using I.T. to improve nursing home care and home health care. Establishment of Web-based health insurance exchanges at the federal and state levels will make it easier for consumers to compare and purchase insurance.

Development of standards and protocols to facilitate electronic eligibility verification and enrollment of individuals in federal and state health and human services programs will stop so many from falling through the cracks

The HITECH-mandated level of data exchange that's likely required by Stage 3 of the meaningful use criteria will help organizations better prepare for accountable care organizations, the medical home model of care and bundled payments that are coming under the reform law.

Still, these I.T. enhancements could have a very bumpy road to implementation. The insurance industry fought the HIPAA-mandated health plan identifier for many years so I'm real skeptical the new mandate will fair better. I see a lot of cash-strapped states declining to build a state-specific insurance exchange for their residents and instead accepting a more generic version from the federal government, as the reform law enables them to do.

And while reform I.T. provisions will compliment HITECH requirements, I see a lot of state Medicaid programs not fully paying EHR meaningful use incentives--and providers not finding that out until the lighter checks land in the mailbox. Honestly, who trusts Medicaid to pay what's promised?


Register or login for access to this item and much more

All Health Data Management content is archived after seven days.

Community members receive:
  • All recent and archived articles
  • Conference offers and updates
  • A full menu of enewsletter options
  • Web seminars, white papers, ebooks

Don't have an account? Register for Free Unlimited Access