Will November bring health reform repeal?

With the November election only weeks away, the GOP has vowed to overthrow the Affordable Care Act, which the U.S. Supreme Court upheld in June. However, a complete repeal of health reform isn't likely, according to hospital leaders.

The federal government isn't likely to undo provisions already in motion, including initiatives that hospitals have acted on already, such as accountable care and health IT programs. Healthcare executives told FierceHealthcare, although they are watching, they are un-phased by the recent Supreme Court decision or the impeding presidential election.

"Regardless of how the Supreme Court ruled, there needs to be a fundamental change in healthcare delivery in the United States," William Cors, chief medical quality officer of Pocono Health System in East Stroudsburg, Pa., said.  "Whether it is repealed or not is quite irrelevant, as the fundamental issues of cost, quality and value remain."

Accountable care continues

Mandated under the Affordable Care Act, accountable care has hospitals steaming ahead toward the patient-centered approach.

"My organization's mission and vision and strategic initiatives have not been affected by health reform," Dartmouth-Hitchcock Director of Clinical Services Sheila Johnson said. The CMS Pioneer ACO Program based in Lebanon, N.H., has a long history of patient-centered care in the medical home model that evolved into an ACO, Johnson explained. "Organizational priorities will not be affected if health reform is repealed, which I do not believe will happen."

Likewise, providers are continuing to coordinate care across the continuum.

"We are focusing more on care coordination and population-based healthcare delivery," said Gaurov Dayal, chief medical officer at SSM Health Care in St. Louis. "Much of healthcare will take place outside of the hospital, and we are laying the foundation down to deliver outpatient-based care to large populations in a high quality, yet cost-effective manner," said Dayal, who supports the upheld reform law. 

Health IT makes progress

With care coordination at heart, many providers are continuing make progress on health IT initiatives, although for some, faster than others.

Johnson noted that Dartmouth-Hitchcock has close relationships with Medicare and commercial payers and has a robust electronic health record platform--Epic, Centricity and AllScripts.

But for smaller organizations, building a comprehensive, effective EHR system will be challenging, even under pressure from the ICD-10 changeover.

"Decreasing reimbursements for primary care while continuing to require unfunded new initiatives such as transition to ICD-10 and EHR adoption will continue to squeeze the primary care practice," said Jeremy Tucker, medical director of MedStar St. Mary's Hospital in Leonardtown, Md.

Jesse Pines, director of the Center for Health Care Quality and associate professor of emergency medicine and health policy at George Washington University in Washington, D.C., pointed out that the administrative burden of EHRs might compel practices to join the ranks of larger organizations.

"For small practices, buying an expensive EHR may not be possible, so what we are likely to see is more consolidation as physicians will need to join larger groups of physicians to purchase and maintain expensive EHRs," Pines said.  

Regardless of the tumorous times of regulatory change, duty to patient care requires hospitals to change their structures and processes.

"Even if ACOs flop, there is a need to move a pay-for-value system as opposed to strictly a pay-for-volume system," Cors said. "This means having good real-time information available to all caregivers across a spectrum of care; that is, a functional electronic health record."

Implementation of the healthcare law hinges on the November election, which could change congressional control and switch up the White House's commander-in-chief. Depending on the outcome of the election, Congress also could remain divided with a gridlock stalling reform.

Still, providers seem to have chartered their own course. Although motivated by government regulation, hospitals and other care providers have moved forward in the interest of patient care.

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