Health reform may be a mixed blessing


By most accounts, health reform is likely to be a financial blessing, with far fewer patients coming through the emergency department needlessly and far fewer incurring uncollectible debts. To some extent, that's true, but there's lots of "gotchas" involved.

For one thing, if health reform follows the Massachusetts model, many of the uninsured will end up with high-deductible plans. While that's nice for covering catastrophic injuries, there may be a whopping $5,000 hole in your ability to collect. Multiply that by high rates of newly-insured patients, and we're talking real money.

Another issue is that under a government-sponsored plan, which very well might be a component of reform, the feds are likely to pay rates similar to what providers get from Medicare and Medicaid. That's not exactly reassuring.

Then, consider the challenge to your operations. With new insurance structures being put in place--including a potential government-sponsored plan--there's going to be a learning curve involved, and there are always costs associated with these adjustments. You may have to add staff, and you'll probably have to spend on training for existing team members.

And what about dealing with the inflow of new patients? That can be costly too. While the newly-insured may not be hitting your ED as often, they're still going to need services they probably weren't accessing in the past. Both outpatient and inpatient operations are likely to face issues in managing demand.

Finally, don't think the new inflow of money will come without its own price tag, most likely new regulations. Dealing with CMS is hard enough as it is; add yet another layer of bureaucracy from a "public option" and you're likely to be tied in knots for a while. You may even find that your rate of returned claims shoots through the roof for a time. It definitely reduces the value of those patients, somewhat.

Don't get me wrong: it's definitely a good thing when uninsured folks get some form of coverage. But at this stage, it's not a cause for wild celebrations in the CFO suite. - Anne

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