In a 5-4 vote yesterday, the Supreme Court upheld the Patient Protection and Affordable Care Act (pdf) as constitutional, although the Medicaid expansion provision was limited but not invalidated. Here, five surgery center industry leaders share their thoughts on the Supreme Court's decision, as well as how the ruling will affect the healthcare industry, the surgery center industry and the upcoming presidential election.
Chuck Peck, MD, of Health Inventures: This is a good thing for patients and our country. Our national embarrassment of 50 million uninsured is finally over. The subsidizing of non-emergent care in hospital EDs by the insured and the government should ease. Those who have been shut out of the medical care system, including ASCs, will now have access. This should help reverse the declining case volume trend in some parts of the country.
The upholding of the individual mandate will help flatten the insurance premium curve by spreading risk more evenly through the inclusion of both the healthy and the sick. The market had decades to correct the problems – it didn’t happen and would not have happened in the future. Our industry should embrace this historic decision and welcome those who have needed care but who could not afford it.
Tom Mallon of Regent Surgical Health: If I were to just look at my own pocketbook, the Affordable Care Act has been very good for our business. We are working with hospitals that have resisted investing in surgery centers for decades. Now they know they need the low-cost, high-quality venue for surgical care. And they need to partner with their medical staff to align interests for ACOs and bundled pricing that are coming quickly, ACA or no.
My regret is the country currently borrows 40 percent of each dollar it spends. The Affordable Care Act is estimated to cost $1 trillion of new taxes and expenses. The taxes mostly occur over 10 years, and the expenses mostly occur over six years. In addition, a new long term care program was to add $70 million, or 7 percent of the cost. It has been deemed as unsustainable and underpriced. Nothing has been passed to take its place. So if the estimates are correct (a big if…), we have at least a $70 billion problem, with much higher annual costs than the fees and taxes estimated in the years after 2020.
All this is to say that with gridlock in Washington, Republicans making a no-tax pledge, Democrats spending money we don't have and using new legislation and regulations to freezing business in most sectors from making investments, we are in a terrible situation. It is hard to see how we come out the other side because our problems are all self-induced. Too many promises, too little money. The elections and next year are critical to our future welfare.
Richard DeHart, Rob Carrera and Scott Thomas of Pinnacle III:
My initial reaction after receiving today's decision regarding the Supreme Court upholding the 2012 ACA, is the huge impact it will have towards a national single payor system. Individual healthcare coverage mandates will be implemented by 2014. The good news is, this is an election year and this ruling will have substantial consequences on the presidential and congressional elections.
The potential impact on the ASC industry is vast, mainly as it relates to additional volume and adjusted payor reimbursements. The question still remains; “who pays for this additional coverage and at what cost”? ASC’s are in an excellent position due to their cost environment compared to its competitors. We expect case volumes to grow substantially as the payors continue to shift away from the high cost providers. But the realization is that there will be setbacks in reimbursement, so it’s back to the old adage “do more with less. This is the challenge each ASC facility will face and efficiencies will “rule the game”.
The primary care industry will take the brunt of this legislation. Currently strapped with capacity constraints, high patient demands and low reimbursement, the impact of additional low paying volume will not be favorable. There will be a positive impact for medical extenders i.e. Nurse Practitioners and Physician Assistants, because the scarcity of Primary Care Physicians will not be sustainable to the new demands.
As with any major industry shift, there will be winners and losers. In this case, the efficient low cost providers will win out.
Chuck Peck, MD, of Health Inventures: This is a good thing for patients and our country. Our national embarrassment of 50 million uninsured is finally over. The subsidizing of non-emergent care in hospital EDs by the insured and the government should ease. Those who have been shut out of the medical care system, including ASCs, will now have access. This should help reverse the declining case volume trend in some parts of the country.
The upholding of the individual mandate will help flatten the insurance premium curve by spreading risk more evenly through the inclusion of both the healthy and the sick. The market had decades to correct the problems – it didn’t happen and would not have happened in the future. Our industry should embrace this historic decision and welcome those who have needed care but who could not afford it.
Tom Mallon of Regent Surgical Health: If I were to just look at my own pocketbook, the Affordable Care Act has been very good for our business. We are working with hospitals that have resisted investing in surgery centers for decades. Now they know they need the low-cost, high-quality venue for surgical care. And they need to partner with their medical staff to align interests for ACOs and bundled pricing that are coming quickly, ACA or no.
My regret is the country currently borrows 40 percent of each dollar it spends. The Affordable Care Act is estimated to cost $1 trillion of new taxes and expenses. The taxes mostly occur over 10 years, and the expenses mostly occur over six years. In addition, a new long term care program was to add $70 million, or 7 percent of the cost. It has been deemed as unsustainable and underpriced. Nothing has been passed to take its place. So if the estimates are correct (a big if…), we have at least a $70 billion problem, with much higher annual costs than the fees and taxes estimated in the years after 2020.
All this is to say that with gridlock in Washington, Republicans making a no-tax pledge, Democrats spending money we don't have and using new legislation and regulations to freezing business in most sectors from making investments, we are in a terrible situation. It is hard to see how we come out the other side because our problems are all self-induced. Too many promises, too little money. The elections and next year are critical to our future welfare.
Richard DeHart, Rob Carrera and Scott Thomas of Pinnacle III:
My initial reaction after receiving today's decision regarding the Supreme Court upholding the 2012 ACA, is the huge impact it will have towards a national single payor system. Individual healthcare coverage mandates will be implemented by 2014. The good news is, this is an election year and this ruling will have substantial consequences on the presidential and congressional elections.
The potential impact on the ASC industry is vast, mainly as it relates to additional volume and adjusted payor reimbursements. The question still remains; “who pays for this additional coverage and at what cost”? ASC’s are in an excellent position due to their cost environment compared to its competitors. We expect case volumes to grow substantially as the payors continue to shift away from the high cost providers. But the realization is that there will be setbacks in reimbursement, so it’s back to the old adage “do more with less. This is the challenge each ASC facility will face and efficiencies will “rule the game”.
The primary care industry will take the brunt of this legislation. Currently strapped with capacity constraints, high patient demands and low reimbursement, the impact of additional low paying volume will not be favorable. There will be a positive impact for medical extenders i.e. Nurse Practitioners and Physician Assistants, because the scarcity of Primary Care Physicians will not be sustainable to the new demands.
As with any major industry shift, there will be winners and losers. In this case, the efficient low cost providers will win out.
More Articles on the PPACA:
Surgery Center of Oklahoma's Dr. Keith Smith: Would an Overturn of PPACA Matter?
Single-Payor Healthcare: An Analysis of Potential Benefits and Challenges
Report: PPACA Would Reduce Physician Shortage in Rural Communities