It may turn out that rather than repealing or modifying provisions of ACA, the greater struggle will be over money designated to fund certain programs outlined in Medicare payment revisions such as Accountable Care Organizations (ACOs) or the Center for Medicare Innovation.
"The real issue is whether or not the Republicans are going to use the power of the purse to de-fund or chose not to fund various agencies or programs that are not mandatory, but were simply authorized in the reform bill," Gilberg stated. This could prove problematic, however, in that they still have to find payment offsets for the provisions that the Congressional Budget Office determined would help to trim healthcare costs.
Organizations such as MGMA believe there is potential in programs such as ACOs, but are concerned about how many healthcare organizations will be able to make critical infrastructure investments required for participation. A recent MGMA study indicated that upwards of 75 percent of its members are scaling back capital expenditures for clinical and administrative systems in their practice.
"The struggle we have, which is really our advocacy priority, is to shore up the Medicare payment system before moving forward with some of the newer concepts," Gilberg said. "And the SGR is an impediment to any kind of reformed payment system."