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If PPACA is repealed it will be interesting to see if it is repealed in whole or in part.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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ICD-10 will drive initiatives such as bundling

as a component of health care payment reform. Therefore reimbursement, and case management and other areas must be viewed in a broader landscape. HIPAA mandates and health care reform impact one another.

In the Wall Street Journal’s “Study Raises Questions About ‘Bundling’ To Pay Doctors” notes,  There is “… concern that paying fees to medical providers for each service may lead to unnecessary care. But there’s no easy way to replace the massively complicated fee-for-service system. One of the suggestions for new-style payment is ‘bundling’…,”  Fee-for-service payment is blamed for many of the problems observed in the US health care system.

Bundling payment for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement, is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients both when they are in the hospital and after they are discharged. Such initiatives can help improve health, improve the quality of care, and lower costs.”

ICD-10 will re-define medical concepts, DRG reimbursement, case management and other areas that must be factored into the bundling equation.

ICD-10 is not one of the factors mentioned in the article, however adoption of bundling and the transition to ICD-10 will be co-mingled.  No benefit will come from bundling, we predict, until after ICD-10 is implemented.  ICD-10 transitions, the ICD-10 vendor assessment, and the ICD-10 assessment should factor bundling payments in for health care providers.

Related concepts and posts:

ICD-10 reimbursement, revenue cycle

ICD-10 and medical policy management

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