Revenue predictions for providers with reform implementation

Health reform no longer is up in the air. With last week's Supreme Court decision that the Patient Protection and Affordable Care Act is constitutional, it's "game on" for health reform, according to a report from PwC's Health Research Institute. But there will be winners and losers in the field.

"The pressure for innovative ways to provide higher-quality, more affordable healthcare continues," Kelly Barnes, Leader of PwC's U.S. Health Industries Practice, said in a statement. "Healthcare organizations that have been sitting on the sidelines will now have to get in the game and play catch-up."

PwC predicts the following revenue trends for these provider types:

Good news:
- Average hospital: The typical hospital with a payer mix comparable to the national average will see new revenues from better coverage, which could offset reduced Medicare reimbursements, including Disproportionate Share Hospital cuts.
- Suburban hospital: The satellite facility that has few uninsured and higher-than-average private and Medicare patients could benefit from the new coverage of the otherwise uninsured. The hospital also can build its brand image and attract the newly insured.
- Integrated health system: The health system associated with provider-owned health plans will be in the best position to take advantage of new payment models, including accountable care and bundling.

Bad news:
- Safety-net hospitals: The big hospital in a low-income area will benefit from the newly insured but still will have to serve the remaining uninsured, particularly in states that choose to opt-out of Medicaid expansion.

- Academic medical center: The teaching hospital that sees the seriously ill with a diverse payer mix are likely to see the Medicare cuts offset by increases of newly insured patients, as well as additional funding.
- Physician: Some primary care providers will see temporary increases in Medicaid rates, but others may see more uninsured, especially in states that opt out of Medicaid expansion. They will see benefits of preventative service coverage and initiatives for more nonphysician providers. However, specialists on Medicare primarily will see slightly decreased reimbursements.
- Long-term and home care: Long-term care, skilled nursing facilities, home health and rehabilitation providers could be negatively affected with Medicare cuts and might partner with acute care providers and payers in population health initiatives.

The Supreme Court verdict means it's "crunch time" for providers, according to PwC. With the high court decision, providers have at least a clearer direction.

"[I]mplementation deadlines that once seemed far off now are rapidly approaching, putting fresh pressure on health organizations to devise innovative ways of delivering high-quality, affordable care," the report states.

Hospitals, for example, are reaffirmed to continue to provide preventative services and efforts to curb readmissions.

PwC, however, noted the ACA still could be repealed, as Republican lawmakers have committed to do so.

For more information:
- here's the PwC statement and video statement
 see the PwC summary and report (.pdf)

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