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Reform Now Past the Point of No Return

 |  By Philip Betbeze  
   January 06, 2012

Most of the provisions of the much-discussed, and much feared, Patient Protection and Affordable Care Act, won't take place until 2017. But making the changes necessary to compete in a drastically altered reimbursement and service environment is far from as simple as flipping a switch in 2017.

In fact, here in the first week of 2012, if hospitals and health systems have not yet begun the work of making significant changes to just about everything they do—including patient care protocols—they are already significantly behind the change curve.

Indeed, this is true for just about any entity that provides healthcare services and depends at least partially on government reimbursement. But as you know, government is not the only entity pushing change.

As I discovered during my reporting for our most recent intelligence report, despite widespread opposition to some of the provisions in the PPACA, the majority of respondents to our survey suggested that it will improve healthcare quality.

Why? Put simply, because revenue and survival are at stake. Certainly some healthcare entities see their death warrants in the signed legislation. Staff and service cuts are sure to be a big part of it as well, and those are well under way.

So no matter which way the political winds blow—they're at hurricane force now and gathering strength—there's no going back. Even in the unlikely event that the PPACA is repealed or otherwise weakened by Republicans after the 2012 elections, private market forces have also recognized the problems with value and quality. And that's a significant factor forcing change.

So never mind the government, says Peter Brumleve, chief strategy officer at Scott & White Healthcare in Temple, TX, and an advisor for the intelligence report.

"Regardless of whether [the PPACA] gets repealed or funded, private market forces will still act in trying to fix the fundamental issues in healthcare," he says. "So we look at the act as a stalking horse for what we eventually have to do as a system."

So despite the uncertainty and even fear about the future, healthcare leaders are getting on with the process of transformation.

Interestingly, at least for me, is the belief held by a majority of our respondents that the new landscape will offer better access for the majority of people to healthcare services. Before it was passed, the key attribute of the PPACA, at least from supporters' viewpoints, was that it would provide health coverage to the majority of the uninsured. Healthcare leaders remain unconvinced.

In fact, only 40% of our respondents believe that PPACA will lead to better access to healthcare services. That's because they anticipate that a bitter irony of the law's legacy will be that many healthcare organizations simply won't be able to cope with what they see as the law's draconian effect on their bottom lines.

That means such entities, without the financial resources to reinvent themselves, eventually will go away. And they assume that no other entity will find it profitable to enter where those who went before them failed.

I've written about this funky possible outcome before. Such an outcome would indeed be disastrous, but it's far from certain. After all, what does coverage mean if you can't get access because the reimbursement for your coverage is so poor?

Of course, I'm just skimming the surface of the enlightening information we uncovered in the report. Take a look and see if it helps you determine the best strategic options for your organization, whether you lead a multi-site hospital system, a small physician practice, or even a home health agency.

Finally, the silos are breaking down, and healthcare is becoming more integrated. That's something to cheer about—at least for patient care. For healthcare leaders, how to get there without becoming a statistic is the real challenge.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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