When the Supreme Court hears Florida v. HHS, which contests  President Obama’s Patient Protection and Affordable Care Act (PPACA) known as health care reform, the U.S. Supreme Court is set to issue one of the most important decisions in its history.

If PPACA is repealed it will be interesting to see if it is repealed in whole or in part.  The Supreme Court of the United States (SCOTUS) may excise the individual mandate requiring health insurance coverage, or it could strike it down entirely.  There is an excellent discussion regarding a case that both sides are expected to use known as Wickard v. Filburn on Forbes and other cases entitled “The 10 Cases You Must Know To Understand The Obamacare Case“  Widely read conservative Hoover institution has a post today referring to ACA as “An Unconstitutional Misadventure” however it only addresses the individual mandate component of PPACA.  Let’s look at some of the proposed benefits in terms of efficiencies.  The biggest danger may be that popular press only review the impact of the Affordable Care Act in its simplest form, without reviewing several efficiencies that are embedded.

Note: our intent is to provide a non-partisan view of the HIT impacts, which are separate from the highly politicized consumer impacts.

You have no doubt read that the biggest resistance to PPACA is in response to consumers being required to buy health insurance.  The Constitutionality of this provision regarding the Commerce Clause of the Constitution is being heard because some believe that it over-regulates consumers for the apparent national good.

Many don’t realize that other legislative measures such as The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 are separate from PPACA.

From a clinical data and efficiency perspective, the HITECH Act is focused on creating efficiencies:
• Meaningful Use of Electronic Medical Records ($27 billion plus in stimulus funds to wire up the hospitals and physicians in this country so that health records are electronic enabling efficiencies, analytics, etc. as well as standards for health care data interoperability which are desperately needed in health care to modernize it and remove paper.  Estimates are $77 billion in cost savings over time for EMRs.)
• Health Care (Payment) Reform (using comparative effectiveness research [“…compare the effectiveness of different treatments for the same illness…”] to apply what the industry calls ‘quality measures’ to change physician payments from per procedure [FFS or fee for service] to pay for performance).  In essence this means that if a physician or hospital meets certain benchmarks of quality and patient population health they can receive more reimbursements for Medicare patients, and health insurance companies who support these health care providers can receive incentives as well.
• Health Information Exchanges (ability to share information across multiple physicians, hospitals, and geographies, realizing efficiencies and enabling some of the provisions of payment reform), although HIEs are impacted by PPACA because Health *INSURANCE* exchanges are viewed as the mechanism by which consumers will purchase insurance. HIEs that exchange information about population health may have actuarial impact and pricing impact on the policies offered by Health INSURANCE Exchanges.

There is less uncertainly about a mandate that is separate from PPACA.   We  provide services to clients who must transition to a new medical coding standard called ICD-10. ICD-10 is a HIPAA mandate. Although CMS has delayed ICD-10 it is appears certain that this mandate will go forward.

The World Health Organization (WHO) sets this standard, and it was mandated prior to Obama’s election by Health and Human Services (HHS) Centers for Medicare and Medicaid (CMS) that it had to be used in this country.  But CMS just announced a postponement in this mandate from October 1, 2013 to a future, yet to be specified date.
We’ve  taken on some ambitious speaking engagements this spring covering these areas. One where we’ll be presenting is the American Academy of Professional Coders (AAPC) in April is entitled, “How ICD-10 and Payment Reform impact Hospital Revenue Cycles.”

Follow the discussion on Twitter at http://www.twitter.com/marrigo using hash tags #PPACA and #SCOTUS as well as here on our blog.  Discussions available for health plans, hospitals and other providers at http://www.linkedin.com/groups?gid=1777488&trk=hb_side_g

Related Posts:

Patient Protection and Affordable Care Act (PPACA) Will Not Save Costs

Meaningful Use Assessment

ICD-10 Implementation Consulting Best Practices

ICD-10 Postponement Opens the Door to ICD-11?

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Last week we attended HIMSS12 the national conference of HIMSS in Las Vegas. The pace of adoption of electronic medical records is increasing, and Dr. Farzad Mostashari, Director of the Office of the National Coordinator (ONC) from Health and Human Services (HHS) made a breath taking statement in his key note that he expects more care to be delivered in 2013 by providers using an EMR than not.   Wow – did he just suggest over 50% adoption of Electronic Health Records?

Dr. Mostashari, Director of ONC at his HIMSS Keynote

Current data suggests that we have achieved perhaps 15% of U.S. Medicare and Medicaid providers achieving meaningful use attestation via a regional extension center and CMS web portal, with perhaps 30% in some stage of development of implementing an EMR.

We also attended a session given by the primary author of Stage 2 meaningful use, Travis Broome from CMS.  There are revisions in the attestation process, timing of incentives and also a carrot and stick for industry adoption of standards for supporting quality measures (a key driver of payment reform and the shift away from fee for service medicine) in EMRs whereby CMS can either sweeten incentives or reduce them.

Although $27 billion has been put forth by HHS and CMS for EMR adoption, the real prize will be in determining who has access to the data of the EMR and how interoperability will be facilitated.  Vendors who are either providing EMRs or integrating with them are attempting to both embrace the Clinical Document Architecture (CDA) as well as differentiate from their competition.

One of the key questions will be how the EMR provides a foundation with the Health Information Exchanges (HIEs) for comparative effectiveness data over the life span of  a patient (sometimes called the continuum of care) and whether CDA standards currently proposed will accomplish that.   Informatics people call this “longitudinal clinical data.”  We’ll be speaking this spring on these topics and analyzing in future reports whether Accountable Care Organization enablement is on track.  While the $billions in meaningful use incentives are getting the spotlight today, the shift from Fee for Service (FFS) to evidence based medicine represents a tectonic shift in the $3 trillion health care economy.  When blended with ICD-10, we have a perfect storm for innovation and redistribution of wealth in healthcare.  Although ICD-10 has likely been delayed and some providers are relieved, the interaction between CMS, ONC, and HIPAA standards creates some interesting opportunities in the next five to ten years.  ICD-10 will provide the underlying content of diagnosis and procedure codes that will populate the EMRs and HIEs.

Keep watching the interchange between CMS, who sets the standards for Meaningful Use (i.e adoption of EMRs) and ONC that sets the standards for interoperability.  And, look for vendors with vision that can capitalize on the standards while achieving commercial adoption to enable Accountable Care Organizations.

Related posts:

• Electronic Medical Records and Analytics
• ICD-10 Mandate postponement and talk of ICD-11

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