Who Will be the Winners and Losers in Health Reform?

No Change or Too Tough To Call

1. Medical attorneys. The Obama Administration has declined to put a cap on medical malpractice awards.
2. Testing laboratories. While redundant testing and tests that reveal clinically irrelevant information may decline, labs may get a boost with an increase in genetic testing especially when it may be predictive of a patient's sensitivity to a certain drug.  Pathologists also seek greater involvement in clinical decision-making to guide physicians in appropriateness of tests.
3. General acute care hospitals.  While there may be fewer patients admitted for certain procedures that are not deemed effective, and thus not worthy of payment, with a public option, more patients will get appropriate acute care.  Ideally, if health reform works, fewer people will have their illnesses go undiagnosed. Elimination or reduction of disproportionate share money that now goes to hospitals could hurt.
4. Academic medicine. Hospitals that now serve as both medical teaching and research facilities as well as provide an important safety net for their communities may see both good and bad from health reform. Funding for research may increase, but payment for certain expensive technologies not necessarily more effective than other methods may suffer.

Possible Losers

1. Health plans. The creation of a public option may create enormous competition for health plans, which may be forced to greatly lower their costs to continue to appeal to employers and individuals. Price competition will be intense. Even if there isn't a public plan, there will be more regulation and transparency in the health insurance market.
2. Specialty physicians. While more people will have insurance coverage and will receive specialty care they previously could not afford, fees for specialists may get cut and difference given to primary care.
3. Pharma. Pharmaceutical companies heavily vested in high-priced medications will see competition and price cuts. The U.S. also may authorize importation of prescription drugs to further reduce costs.

Almost Certainly Losers

1. Imaging.  The implementation of new formula that in effect reduces payment for certain kinds of imaging is almost certain to take effect. There may also be an elimination of a loophole that now allows physicians to self-refer patients to imaging services in which they have an ownership stake.
2. Biologics. Congress is working to allow the Food and Drug Administration to approve generic copies of expensive biologics, such as Avastin, Genentech's cancer drug, which costs $50,000 per year. This would be certain to drive down costs.
3. Physician-owned specialty hospitals. Proposals in both the House and Senate would outlaw any physician-owned hospital that is not yet operating and would restrict expansion of those existing facilities. Lawmakers have concerns that physician self-referral may be causing overutilization.
4. Durable medical equipment. Medicare payments for common home medical equipment devices have been cut by 9.5%. More cuts are expected.
5. Home health agencies and providers of home healthcare. These sectors may take a financial hit.
6. Skilled nursing homes. Nursing homes may take a financial hit. If a hospital is not reimbursed for care to a patient who has to be readmitted within 30 days, hospitals may keep patients longer. Also reimbursement to nursing facilities may be cut.