What will be the impact on hospitals now that the U.S. Supreme Court has upheld the constitutionality of most of the Patient Protection and Affordable Care Act?
Will the Republicans' July 11 threat to repeal the law—unlikely as it may seem—hold back providers' plans to implement pieces of the law? Should organizations wait to see if the party's nominee, Mitt Romney, pushes out President Obama in November? And if Romney is president, should they be prepared for several more seasons of debates and new versions of more bills?
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There is still uncertainty around healthcare reform, leaving hospital leaders to apply Hamlet's torturous contemplation: To be, or not to be?
It kind of depends on who's answering the question.
Many C-suite executives issued statements in the days straddling the decision saying that they expect the Supreme Court's decision, along with the political theater expected in the next four months, to have little to no effect on their operations because, they say, their hospitals were already marching to the beat of inevitable system change.
That means reducing cost, improving communication through electronic medical record systems, aligning physicians, and working at every level to improve quality of care and patient experience.
That's the opinion of Rulon Stacey, immediate past president of the American College of Healthcare Executives and now president of the newly formed University of Colorado Health, which includes some 1,500 beds in five hospitals from Fort Collins to Colorado Springs.
"We've been dealing with these kinds of public policy tug-of-wars now for such a long time, and you can't make meaningful strategic decisions on a public policy that is so volatile," he said on Friday. "You just can't do that. So the trick then becomes to identify things you know are happening independent of the policy debates."
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Like finding as many creative ways to reduce costs. "All organizations are being more judicious about how we spend money today than we were five years ago," Stacey says. "I don't know of any hospital that is banking their future on the fact that reimbursement in the future is going to go up. So yes, our job is going to be to decrease costs and increase quality simultaneously."
For Stacey, that has meant forging joint operating agreements between Poudre Valley Hospital, the Medical Center of the Rockies, the University of Colorado Hospital, and in the works, Memorial Health System in Colorado Springs, to become University of Colorado Health. The venture enables a massive electronic medical record system linking patients and providers along the Front Range of the Rocky Mountains.
And it even means a 200-bed expansion at University of Colorado Hospital.
"Regardless of what happens, we know there's going to be a demand for those services," Stacey says.
However, Blair Childs, vice president for public affairs for Premier Inc., a purchasing and quality collaborative with 2,500 hospitals, has a different view. He believes the Supreme Court's decision changes the landscape for hospitals.
Between March of 2010 when PPACA was passed and signed, and the time the Supreme Court decided to review the lawsuits filed by the states and others, hospitals were working toward goals of reducing costs and quality improvements and joining some of the models and programs the law offered, Childs recalls.
They had little doubt about which direction they should steer their organizations. "There was a flurry of activity," he says.
Then, almost overnight, hospital leaders began to slow down. "There was this thinking, 'Oh my gosh, the Supreme Court is going to take this up,' and 'Oh my gosh, they might actually strike this down'"—a sense that gained traction after oral arguments in March, Childs says.
"We've been hearing from our members that a lot of folks were tapping their foot on the brake for the last six months for all practical purposes," he says, such as holding back on applying for demonstration projects.
"I can give you many examples of organizations that did not proceed with an MSSP application or bundled payment application because of that," he says. "They began second-guessing their investments, or perhaps hedging a little bit more."
The Supreme Court's role in healthcare became decisive. "If the whole thing had been struck down, it could have thrown things into a deep level of disarray," Childs says.
Given the partisan threats and the tensions building to the November election, there is still uncertainty over healthcare reform, he says. "But this is the one very big question mark that is now out of the way. There's a sense that this direction is constitutional."
Although the election could change that direction again, hospital leaders participating in Premier don't think it will be very significant, Childs says. In the event of a repeal, "people realize that part of the replacement would be around the same things, payment reforms that were Republican ideas initially."
So, to the extent that people were hesitating, “they will put their feet back on the accelerator," he says, adding that this will happen soon, before the election.
The November election will provide further clarification for hospital leaders.
"If, after the election, there's evidence to suggest that the law as written today is going to be the law enacted in 2013, I think you could start to make some strategic decisions after the election. But right now, who knows what's going to happen and whether this law is going to stay in place?" Stacey says.
"This thing has been dragging on and dragging on," Stacey says. "But now, everybody has come to the conclusion that you just can't wait anymore. We have to start going on the themes of the things that we know are going to happen."