Reform Without Results
Philip Betbeze, for HealthLeaders Media , December 13, 2010
About This Survey
The Healthcare Leaders Reform Readiness study was conducted by the HealthLeaders Media Intelligence Unit. It is part of a series of monthly Thought Leadership studies. In October 2010, an online survey was sent to the HealthLeaders Media Council and select members of the HealthLeaders Media audience. Respondents work in a variety of settings, including hospitals, physician organizations, health plans, insurers, government, education, and academic. A total of 289 completed surveys are included in the analysis. The margin of error for a sample size of 289 is +/- 5.8 percentage points. A detailed report and analysis can be found online after December 15, at www.healthleadersmedia.com/intelligence/.
Nearly half (43%) of healthcare leaders oppose the Patient Protection and Affordable Care Act, but now that it’s passed, only 34% want it repealed, as many newly elected Republican legislators have promised to try to accomplish. However, fully 71% of respondents to a survey for the HealthLeaders Media Intelligence Report Healthcare Leaders on Reform Readiness say they would repeal portions of the bill. As for the problem areas, many respondents take issue with the elimination of lifetime caps on health benefits, while others don’t think the bill goes far enough to cover all. The health insurance mandate rules are called unconstitutional by some respondents. Others say tort reform should have been included. Still others think the phasing-in nature of the law is inappropriate. They want all of the law enacted immediately.
But perhaps support for a full repeal is thin because many forward-thinking leaders already have started making changes in their organizations that will help them achieve the benchmarks the new legislation will require of them. However, it seems there is pessimism about the achievability of the goals of the law, which include care that is more widely available, safer, more coordinated, and cheaper.
For instance, more than half of healthcare leaders who answered the HealthLeaders Media Reform Readiness survey say neither the quality nor the efficiency of the nation’s healthcare will get any better after the provisions in healthcare reform have been enacted. That’s a stinging slap to advocates who claim that the law will not only increase insurance coverage dramatically, but also lead to higher quality and more affordable healthcare. When survey participants were asked to rate how these reform goals would fare in their own organizations, scores were slightly worse, with fully 60% saying quality and efficiency will either deteriorate or remain the same in their own organization by 2017, by which time most of the provisions of the law will have been implemented.
Why is there such pessimism about the law as it is currently written?
Dan Wolterman, president and CEO of Memorial Hermann Health System in Houston and lead editorial advisor for this intelligence report, says it’s because the law is flawed and needs revisions. However, he does say that the PPACA offers a platform to begin a necessary realignment of the stakeholders in the provision of quality healthcare.
“We’ve put the down payment on a movement toward a new healthcare system for this country,” he says.
However, he’s concerned, as are many other senior healthcare executives who completed the survey, that the law as written pays disproportionate attention to access—in other words, insuring the uninsured.
“The pay-or-play provisions on both the employer and individual are set much too low,” he explains. “Incentives are strong to opt out. I don’t believe in the intermediate term that the number of uninsured will go down. In fact, we run a very good chance that they will go up as employers opt out. Penalties were set artificially low intentionally.”
Most survey respondents express concern that the access problem can’t be fixed without massive change in the delivery system, addressing such concerns as fee-for-service financial incentives that have been left in place during the transition period.
While 29% say the law will cause deterioration of their organization’s efficiency in delivering healthcare services, and another 21% expect a deterioration of their organization’s quality, a clear majority—58%—expect that their organization’s financial strength will deteriorate because of the PPACA That presents an apparent discrepancy, but Wolterman says it really means a majority of healthcare leaders are saying that they’re going to continue to provide high-quality care and improve patient safety and customer service and satisfaction, but that the math for reimbursement doesn’t work.
“The federal government is cutting their reimbursement and disproportionate-share funding,” Wolterman says. “If you improve your quality, your reimbursement per unit of service will go down and your bottom line will go down as well, which is why I don’t think the answers to these questions are contradictory.”
One element of the law that receives mixed support is the establishment of an independent payment advisory board under the executive branch, which will largely take payment rate-setting out of Congress’s hands. While 37% of the respondents oppose this part of the act, 32% support it. Count Wolterman as a member of the opposition.
“If you read the fine print in the law, this is not an impartial group, it’s not accountable to Congress, and it fundamentally changes how Medicare rates and budgets have been done,” he says. “Although they can override the board’s decision, they would have to substitute other cuts to take the place of anything they override. Not a lot of people in our industry understand that implication.”
Philip Betbeze is a senior leadership editor with HealthLeaders Media. He can be reached at pbetbeze@healthleadersmedia.com.
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