Some observers say that last week's Supreme Court decision upholding most of the healthcare reform law won't really have much of an effect on health IT. The healthcare industry, these pundits point out, was already moving down the tracks to accountable care, patient-centered medical homes, and value-based reimbursement. Moreover, the main financial driver of health IT adoption is the HITECH Act's incentives for Meaningful Use of electronic health records.
This argument is partly true, but it isn't the whole truth. Let's start with Meaningful Use. Although the HITECH Act was passed before the Patient Protection and Affordable Care Act (ACA) as part of the 2009 stimulus law, the framers of the Meaningful Use regulations have made it abundantly clear that they're trying to use the incentives to steer the healthcare industry in the same direction that the ACA wants it to go: toward a high-quality, safe and efficient healthcare system.
The same is true of Medicare's shared-savings programs for accountable care organizations, the bundled-payment pilot, the value-based reimbursement program for hospitals, the Medicare penalties for excessive readmissions, the Beacon Community experiments, and the grassroots quality improvement programs made possible by nearly $1 billion in grants from the Center for Medicare and Medicaid Innovation (CMMI). All of this--and much more--would have been lost or amputated if the Supreme Court had thrown out the entire reform law.
The private sector is undeniably on board with the reform program--although not necessarily with Obamacare. Employers, insurers, and the majority of providers agree that the current rate of cost growth can't continue. Many health plans are helping healthcare systems and physician groups gear up to do population health management, and some already are contracting with accountable care organizations. There also are incentives for primary care practices that achieve recognition as patient-centered medical homes. So this part of reform would have continued even if the Supreme Court had destroyed Obamacare.
But despite the pace of change and the widespread interest in ACOs, only a small percentage of hospitals and physicians are involved in them today. Moreover, there still isn't solid evidence that ACOs, as currently conceived, will achieve their objectives. Having Medicare and Medicaid continue on a parallel track will not only provide more financial resources for reform experiments like ACOs, but will also create a critical mass of business to help providers move beyond fee for service.
Meanwhile, let's not forget about the state insurance exchanges and the Medicaid expansion authorized by the ACA. Barring a Republican sweep in November, there's general agreement that the insurance exchanges--which have so far gained traction in only about 15 states--will now go ahead, with or without state participation. These exchanges will require an enormous amount of health IT work in order to function and to communicate with other state and federal agencies that have the data they will need.
The Medicaid expansion is no longer guaranteed, because the Supreme Court ruled that the federal government can't penalize states that refuse to expand Medicaid by withholding the federal share of their existing Medicaid budgets. But Sara Rosenbaum, a professor of health policy at George Washington University, told Kaiser Health News that most states will support the expansion--which has been estimated to cover up to 16 million people--because of pressure from providers and communities. This huge influx of new Medicaid recipients will require states to upgrade their information systems, generating still more demand for health IT.
In all, the importance of the Supreme Court decision to health IT cannot be overstated. Thanks to Chief Justice John Roberts and the four liberal justices on the court, the reform train will keep rolling, full steam ahead. - Ken