Health executives say reform will go on

The Morning Call reports:

“As the U.S. Supreme Court works behind closed doors to determine the fate of the Obama administration’s signature health care reform law, area health care business leaders say at least parts of the law will survive no matter what the court says.

That’s because even if the Patient Protection and Affordable Care Act is found to be unconstitutional, it already has unleashed momentum for changes in the market and provided benefits that officials say they want to keep.

As Lehigh Valley Health Network President and CEO Ronald Swinfard said at a recent Board of Associates meeting, “The genie’s out of the bottle.”

Leaders representing hospitals, the health insurance industry and local business say they are committed to at least some of the aims of the law even if the court strikes it down. In the meantime, they said, the Affordable Care Act is the law of the land, so it’s full steam ahead.

“The Affordable Care Act has many component parts, and it’s likely that even if the court rules that sections of the law are unconstitutional, other sections of the law will remain in effect or be reinstated through other congressional action,” said Grand View Hospital CEO Stuart H. Fine. “However, we won’t know that with certainty for at least a few more months.”

The biggest uncertainty right now is whether the Supreme Court upholds the law, finds it unconstitutional or invalidates only part of it. A ruling is expected in June.

Businesses and the federal and state governments have been implementing many of the reforms under the law, which Fine called a “grand, complicated and in many ways undefined experiment.” Those developments include Medicare and Medicaid payment reforms, development of insurance exchanges for consumers, buying up private practices to improve coordination of care, and developing electronic medical records systems.

Changing the payment system from the current fee-for-service model to one that rewards quality care is a major aim of the law that will continue regardless of the court’s ruling, they say. “We need to get paid for value,” Swinfard said.

At Good Shepherd Rehabilitation Network, President and CEO Sally Gammon said they’re hoping that the cooperation forced by the law will bring about smoother integration of different levels of care.

The existing system requires separate licenses and regulations for inpatient rehabilitation hospitals, long-term acute care and skilled nursing facilities, which makes care for many of Good Shepherd’s patients more complex and costly, she said. A test of a more integrated “continuing care” program is required under the law, Gammon said, and if the test goes forward, it would show that such a model would streamline care.

Sacred Heart Hospital already excels in coordinating care, said Vice President for Marketing Valerie Downing. But it’s behind in setting up an electronic medical records system, a requirement under the law that will reduce costs and errors.

“Right now, we do not have a uniform electronic medical records system,” Downing said. “We need to invest a great deal of capital in those electronic medical records. That’s going to happen regardless” of the court’s decision.

Blue Mountain Health System, which runs Palmerton and Gnaden Huetten Memorial hospitals, recently spent $14 million upgrading electronic medical records and computerized physician order entry systems, said Lisa Johnson, vice president of public affairs and marketing.

For consumers, it would be difficult to give up benefits that the law now provides. “I think employers will keep the age 26 rule,” said Tom Croyle, president of the Lehigh Valley Business Coalition on Health Care. The law now allows parents to include coverage for their adult children to the age of 26.

If the health care executives like the aims of the law, they’re not always keen on how it is to be implemented. Swinfard, for instance, said few hospitals have fully embraced Accountable Care Organizations, a payment and delivery system reform model pushed in the law. LVH, he said, so far has committed only to a pilot Accountable Care Organization program. The rules for establishing them, Swinfard said, are expensive and “quite complex.”

That’s a frequent complaint about other aspects of the law.

Vincent J. Hudson, chief operating officer at OAA Orthopaedics, said the law is making health insurance “excruciatingly challenging to comprehend,” with countless plan options, each with its own rules and prices.

In addition, the consolidation of providers driven by the law could push up costs by reducing competition, he said.

“We would rather [health care reform] simplify the process rather than add to the unknown,” Hudson said. “Contingency planning on the unknown remains next to impossible.”

During his Board of Associates presentation, Swinfard said the worst outcome would be a weakened law. “It’s a little dicey now,” he said as he flashed on-screen a picture of Supreme Court Justice Antonin Scalia, who is believed to be opposed to the law.

A decision to invalidate some elements and leave others would make a mess of an already complicated environment, said Sam Marshall, president and CEO of the Insurance Federation of Pennsylvania.

If the law’s individual mandate — the provision requiring most people to get insurance — is found unconstitutional, insurers would be hurt because people would be able to wait until they are sick to get coverage that an insurer would have to provide.

“A lot of other market reforms only work if there is a mandate,” Marshall said. “If the mandate fails, a lot of those things would or should also fail.”

He noted there won’t be much time to adjust if the court partially dismantles the law, which would take full effect in about 20 months.

“As much as Jan. 1, 2014, seems an eternity away, it’s actually very, very soon,” Marshall said. “It’s a year and a half. To get the regulatory apparatus in place and then to get the insurers in compliance with that and to get the marketplace educated and aware of what those changes are, that’s a huge, huge challenge.”

But they’re challenges that the health care executives said their businesses are ready to face.

“The bottom line is that we have a mission to fulfill,” said Grand View’s Fine. “Regardless of the politics and the drama that surrounds this issue, we need to remain focused on caring for our community as best we can.””