Health law ruling's aftershocks will impact EHR adoption, use


The U.S. Supreme Court's ruling on the Affordable Care Act (ACA) is imminent. So a number of people have asked me if the Meaningful Use incentive program will be terminated if the Court rules that the entire law is unconstitutional and strikes it down.

The answer is no. The incentive program was not created by the ACA, but by the American Recovery and Reinvestment Act, so the program will remain in effect regardless of the ruling on the health reform law.

The ruling still will have a major impact on electronic health records, though, because it will have a major impact on the industry. Unfortunately, it's still uncertain what that impact will be.

For instance, if the court rules that the provision requiring individuals to buy health insurance--the "individual mandate"--is constitutional and upholds the entire law, then all of its provisions remain in tact. That means that 16 million previously uninsured people will join private insurance plans through health insurance exchanges being created by the states.

This will create some significant changes on physicians and hospitals that will be treating these newly insured people. While more people will have some insurance coverage, improving revenues, many more may reach out for care than before, increasing the burden on providers. Can an EHR help providers meet this increased burden, and ultimately spur more to adopt the technology? Or will providers focus instead on treating patients, and worry about EHRs later, if at all?

And the individual mandate is only one piece of the health reform law.

The ACA requires providers to interact with each other in new ways, which increases the need for providers to use EHRs for communication. The law launched pilot programs and other initiatives--such as the Medicare Shared Savings Program--encouraging the creation of accountable care organizations and the Center for Medicare and Medicaid Innovation (CMMI). These programs virtually require the use of EHRs; providers who don't have them are at a disadvantage. CMMI has gone so far to say that EHR users get preference when applying for some of these programs. Without these initiatives, will there be less incentive to use EHRs?

Moreover, the ACA has affected providers--and their use of EHRs--in other, more subtle ways by changing the fundamental structure of the industry. Reimbursement will be profoundly impacted, whichever way the ruling goes. Will EHRs help providers save money in light of these changes, or will they be seen as a drain on already dwindling revenues?  

The relationship between physicians and hospitals has been impacted by the ACA, even without the pilot programs aimed to increase coordination of care and interoperability. Physician employment by hospitals has risen sharply in the past two years, in large part over concerns about future reimbursement and the sustainability of small independent practices. Hospital-based physicians don't pay for their EHRs out of their own pocket. This will affect the EHR adoption rate. But if the law is struck down, does that mean that physicians will return to independent practice? Who knows?

And, should the ACA be struck down, how will the government react? Will the incentive program remain a priority, or will the U.S. Department of Health & Human Services turn its efforts more to reintroducing provisions of the Act and getting them passed by Congress? Will the agency lose its enthusiasm for EHRs, or redouble its efforts to get every provider to use one?

The upcoming ruling may not directly affect the incentive program, but it certainly will affect those who would purchase, sell and use EHRs.

I don't have a crystal ball, but rest assured, either way the ruling will shake up the industry. - Marla

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