Many have asked, “now that the election is over and President Obama has been re-elected, how does this impact healthcare reform?” It is a good question, and the answer will impact our clinical system, our providers, and our patients.
Probably the biggest thing that will change is that the rhetoric about repealing the entire Affordable Care Act will stop. While I am sure there will be continued attempts to nibble away at portions of the Act, the basic tenets now should remain in place.
We have already seen the results of some increase nationally, in the insured patient population. The fact that we are moving toward more universal coverage, removing pre-existing condition restrictions, and providing insurance to children until later ages, all seem to be positive steps that I expect to continue.
I believe that there are two basic changes that are occurring in healthcare, that will continue to accelerate. These are:
- the idea that better quality healthcare must be delivered at a lesser cost
- the movement towards population management and away from the provision of episodic pieces of care on a fee for service basis
These two ideas will continue to drive the pressure towards reduced reimbursement for hospitals and providers. They will continue the push towards more transparent and public reporting about outcomes. They will continue to drive the consolidation of hospitals, health systems, and providers. I am certain we will see continued pressure for small hospitals to be acquired, changed, and consolidated. There will be more pressure for physicians to become hospital employees, or for their groups to be purchased and/or affiliated with larger healthcare systems.
The new reimbursement models will create potentially new strange alliances. Physicians and hospitals, providers and insurers, will all have to find new ways to provide more population care, better quality care, and to split the available healthcare dollar. It seems certain now that healthcare exchanges will flourish.
For an academic medical center like ours, there is continued concern regarding elimination of DSH, which is the payment from the federal government to institutions like ours for the care of the uninsured and under-insured. We also remain concerned about the ability to provide primary care in our community to an ever-growing population of insured patients. The training programs simply don’t exist to turn out enough primary care providers. There are few provisions for increasing the pool of primary care physicians. Despite an increasing number of medical school graduates in coming years from newly established medical schools, the positions for post-graduate training remain fixed and/or are shrinking in the new healthcare reimbursement environment.
It is clear with President Obama’s re-election that healthcare reform is here to stay. I expect many of the proposed changes to accelerate over the next few years, providing us with new challenges and opportunities. We will need to rethink how we deliver care, ensure efficient and effective high quality care, and find new partners. Regardless of the outcome of the recent election, challenging times lay ahead.