Hospital Impact: With ACA repeal imminent, time for healthcare leaders to consult their ‘True North’

When faced with a new reality, will organizations follow their True North or capitalize on opportunity? (Getty/ipopba)

As defined by Bill George in a previous Huffington Post blog post, “True North" is:

“your orienting point—your fixed point in a spinning world—that helps you stay on track as a leader. It is derived from your most deeply held beliefs, values and the principles you lead by. It is your internal compass, unique to you, representing who you are at your deepest level.”

There is probably no better time to exercise True North than if the current Republican healthcare bill is passed as is. Also consider that cuts to the Environmental Protection Agency, the Department of Housing and Urban Development (HUD) and other agencies also have an impact on the health of older adults. When faced with a new reality, will organizations follow their True North or capitalize on opportunity?

ACOs, value-based care, bundled payments

It’s no secret that the Center for Medicare and Medicaid Innovation (CMMI) has been in the crosshairs of Congress. Eliminating the Affordable Care Act could mean axing the CMMI, which was established under the law and given $10 billion in funding through fiscal 2019.

Its purpose is to test “innovative payment and service delivery models to reduce program expenditures … while preserving or enhancing the quality of care.” Consider that the Centers for Medicare & Medicaid Services just held up some new bundled payment initiatives for “further evaluation,” and you can sense a trend for less regulation.

The majority of hospital-delivered healthcare is still fee-for-service. Without mandates, will the healthcare system voluntarily keep moving toward value or will it be easy to slide back into a fee-for-service, let’s-pile-it-on mentality?

Will physicians still have all-important end-of-life discussions with patients? Will the Medicare Wellness Visit continue? These are important programs. If they are not paid for, will health providers still offer them, knowing they help keep people healthier and costs down?

The uninsured and the poor

Every scenario suggests there will be more people uninsured (24 million according to the Congressional Budget Office) if the American Health Care Act passes as is. And costs will be sure to rise, pricing people out of the insurance market. Caps on Medicaid funding will further restrict access. The emergency department will once again become the primary care office for people.

In an opinion piece for the New York Times, Theresa Brown writes:

“So, while some uninsured patients will forgo care after repeal of the ACA, others, especially the seriously injured and mortally ill, will secure the care they need even if they can’t pay for it, even if they know they will never be able to pay for it. And in the end, all of us pay for that care through higher insurance premiums, increased hospital costs and overtreatment of the (paying) insured.”

We all pay ultimately when we don’t take care of our fellow man. When hospitals go out of business, as some will surely do, jobs disappear. How can hospitals try to continue down the medical home, value-based purchasing route when they are also hemorrhaging in the ED?

I am on the board of a Community Health Clinic, and we foresee many more people needing our care. In turn, we will need more funding. We rely on grants and charitable giving. Will states fill the shortfalls through other means even as Medicaid is being cut? Will citizens look to their souls and their pocketbooks and fund care for those most in need?

Affordable housing for seniors

Medicaid is the No. 1 source of payment for nursing homes. One can only imagine the devastation that will be caused if this safety net is not there. It is the last hope for many. Surely, nursing home costs will rise and more of the share will be passed on to residents and families. This is easy to dismiss when it does not impact you directly, but percentages suggest that this issue will impact a majority of Americans in the not-too-distant future.

Affordable housing for seniors will be damaged if cuts are made to HUD. This will put more families to the test.

True North or travesty?

Rep. Joseph Kennedy III, the grandson of the late Robert F. Kennedy, called the Republican-crafted ACA replacement an "act of malice," according to the Boston Globe.

Here is some of what he said:

"There is no mercy in a system that makes healthcare a luxury. There is no mercy in a country that turns its back on those in most need of protection—the elderly, the poor, the sick and the suffering. There is no mercy in a cold shoulder to the mentally ill. … This is not an act of mercy. It's an act of malice.”

We are truly at the testing point of our moral and ethical convictions. It’s probably apparent that I stand with Joe. But I have selfish reasons, too. My healthcare premiums are $2,000 a month with a $7,300 deductible. I want to see competition, but I don’t foresee it. I want to see drug prices negotiated, but I don’t foresee it.

Following a political promise without fully understanding the implications is bad. Politicians do not fully embrace the implications. After all, they have platinum health insurance. But it is clear through town halls and polling that Americans are starting to understand the real implications.

It will be a travesty to pass a law to fulfill a promise. It will take courage and True North on the part of healthcare leaders to stand up for what is right.

Anthony Cirillo is president of The Aging Experience. He helps organizations craft experiences and seize opportunities in the mature marketplace, and helps family caregivers thrive and individuals make educated aging decisions. A consultant and professional speaker, Anthony is also an executive board member of the Dementia Action Alliance.