Ready or Not, Reform Under Way

This article appears in the December 2011 issue of HealthLeaders magazine.

As a topic, healthcare reform is almost too big to fully evaluate. There’s a reason the legislation runs 900 pages. Further, most of the provisions in the Patient Protection and Affordable Care Act won’t reach maturity until 2017. And it’s not even certain that the law will survive that long, what with many Republican candidates vowing to repeal it if they are elected.

But healthcare leaders have to worry about what is, not what might be, and right now, PPACA is the law of the land. Whether or not the law is ultimately repealed, many of the drastic changes taking place in healthcare today regarding strategy, composition of assets, and even the business model are already under way. Going back to the way things used to be simply is not an option.

The pace of change is one reason, according to the HealthLeaders Media Intelligence Report Reform’s Impact: Staff and Service Cuts Expected. As the title suggests, healthcare senior executives who completed our Reform Readiness Survey expect to cut staff and services under the legislation. That is certainly not the outcome lawmakers who backed the plan say they expected, but the reality is that the law will increase complexity and overhead, so such responses make sense.  

The good news is that most healthcare leaders, despite barely more than half supporting the law, believe it will lead to healthcare quality levels that are better (41%) or at least at the same level (23%) as they are today, for a total of 64%. What’s surprising is that only 40% believe the act will result in better access to healthcare services. Many pundits beg to differ. They insist that access will be the only element of healthcare PPACA will improve, because it ensures some level of healthcare coverage for many of the currently uninsured. Also disconnected from the access question are leaders’ responses to the question of utilization. Fully 72% believe the law will lead to increased utilization of health services. How does that happen when access is tighter?

Marty Manning, president of Advocate Physician Partners, the captive physician practice within Chicago’s Advocate Health Care, says it might reflect the pent-up demand of the previously uninsured as they gain access to the healthcare system. Indeed, while inpatient care and reimbursement is expected to decrease, outpatient care will grow as more of the previously uninsured are steered toward accessing care in locations other than the emergency room, which was the only place they could previously be guaranteed access to healthcare services.