FEATURE EDITORIAL
Heritage Publishing, Inc. © 2012
Q&A WITH HUGH GREENE, FLORIDA HOSPITAL ASSOCIATION CHAIR
the longest, and they can’t understand. They think, you can get me in and out in a hurry; I don’t have much wrong with me. But, in a true emergency room, they’re the least priority. So every time that ambulance rolls in, they’re in the back of the line.
I’m very hesitant to tell anybody, “You’re going to come to our
emergency room and get in and out in 30 minutes,” if they’ve just got a cut finger or something. I think it’s an interesting marketing thing that people are doing, but I don’t want to create unrealistic expectations.
How will the changes outlined in the Patient Protection and Affordability Care Act (PPACA) impact physicians, hospitals and patients in Florida?
Health care reform impacts everything. It’s transformational.
The law is so complicated. It has a lot of stuff in it, and I’ve argued all along it has a lot of good stuff in it. The good part for physicians and hospitals is, when you move 32 million of the 50 million uninsured from being completely uninsured to having some level of coverage, that’s really a positive thing.
Now on the other hand, what is occurring in part of the law,
are simply big reductions. There’s a $500 million cut in Medicare payments contained with this law, but it’s somewhat offset by the uninsured having the ability to pay something.
There are a whole series of things that affect the insurance
industry, specifically, and there are major delivery system reforms contained in the law that changes, potentially, the way hospitals and physicians are compensated going forward.
You’ve heard many things like bundle payment contained in
the law. The goal of bundle payment is to avoid hospital readmissions. Any time anybody does anything to anybody, if they’ve got insurance, we get paid. We’re paid by encounter– volume. So the more you do, the more you make. The law says, maybe the incentives are not correctly aligned here.
A patient that’s admitted with congestive heart failure that’s
discharged and then returns to the hospital six days later and is readmitted—guess what—we get paid again. If they get discharged a second time and get readmitted, we get paid again. Every time they come, we get paid. So, there’s really no incentive in the system, historically, for doctors and hospitals to try and manage care more effectively. I mean it’s not like we’re trying to readmit them, but we just aren’t particularly incentivized.
If you suddenly get paid a bundle payment for a 30-day
episode, and by the way, if they’re readmitted you don’t get paid any more, that changes the whole nature of what we do. Then we start assigning case managers, following up with patients at home, etc. We’re incentivized to keep them out of what’s the most expensive aspect of the health care delivery system—the emergency rooms and hospitals. So, I actually think that change of incentivization is a positive thing.
Critics would say, “Are we moving toward national health
care?” We really are not moving toward more government control. The law, as it’s currently put forth, actually solidifies the private employer insurance model in this country. It’s not socialized medicine in the traditional government sense. People keep wanting to turn it into that. When people do that to me, I say, “Have you read this thing?” That’s not what it does. But, it certainly is giving government a more active role—in terms of how Medicare’s going to pay in the future, particularly.
2012-2013 The Greater Daytona Healthcare GuideTM My point is—even though it takes us down a very different
transformational path around health care delivery in this country, it has enough other things in it including expanding coverage that makes it, I think, in the long run, more palatable for those of us in the delivery system.
On the other hand, it’s not perfect. There was a lot of political
jockeying, so there are things about it that are just not good. But, generally, it’s not a bad start.
What’s your opinion about the Supreme Court hearing testimony on the Patient Protection and Affordable Care Act (PPACA)? Do you think aspects of the health care reform legislation are going to be overturned?
I don’t have the expertise from a legal standpoint to say
whether this thing is or is not constitutional, and so much of it seems to revolve around the political.
The more important question to ask is—what is the effect if it
is not deemed to be constitutional? And that has two parts. There really is a difference between the individual mandate being deemed unconstitutional—if they strike down that piece and allow the rest of the law—and the entire law being thrown out. Clearly the mandate is very important to the expanded coverage piece. So, most people believe that if you take away this mandate, it does significantly undermine the coverage expansion that’s so important in this law—that reportedly will result in about 30 million people becoming covered.
This is a conviction I have. We have so started down this path
now that I’m convinced if the health care reform law is repealed, we’re going to still see reform march forward. The commercial insurers have already begun implementing the very kinds of things that the government was talking about implementing. So, when I meet with [insurance companies], they’re talking about bundle payment; they’re talking about pay for performance.
I guess what I’m saying is, I think the train’s kind of left the station. 27
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