Healthcare Explosion...So What Next?

Posted by Ron Decker on 07/09/2012

Following the aftermath of the SCOTUS’ ruling on the Patient Protection and Affordable Care Act

Well, it’s been almost two weeks, and the boom heard around the world is in our rear view mirror. The Boom? The gavel dropping on the SCOTUS’ decision on the constitutionality of President Obama’s pet project, “Health Care Reform”, that some said will define his Presidential legacy. In the aftermath of a nuclear explosion, you have waves of devastation; impact, heat and radiation fallout.  History will most likely judge the Supreme Court’s decision in much of the same way as a nuclear explosion.

Impact – I was fortunate or unfortunate, depending on your point of view, to have watched for a few hours the various media pundits, talking heads and politicians brave enough to comment in the moments immediately following “the explosion”.  As if the complexity of the “But we have to pass the bill so you can find out what is in it… ”, said the Speaker of the House bill wasn’t enough; the decision of the Justice’s was equally unsettling with four of the Justice’s stating in their comments that the entire bill was unconstitutional.  However, the swing vote, or knockout blow that upheld the law was strategically delivered by the Bush appointed conservative Judge Roberts.

In my contemplating and reviewing the decision, speculations and political spinning in the moments following the Court’s ruling, the visual that came to mind was one of the freakish futuristic warriors in today’s militaristic video games.  You know, the ones that allow your alter-ego to morph into hulking warriors fighting evil, brandished with 50 caliber automatic weapons secured to one arm, laser guided missiles launched by voice command from their shoulder and a 54 inch massive double edged sword on the other arm all being used in a cohesive and seemingly inexhaustible attack on their enemy…

On June 28th, 2012, Justice Roberts did battle playing the part of the warrior.   He sliced up the conservatives with his deciding vote declaring that the ACA was constitutional.  He fired a .50 caliber round at the President’s pitch to the people that “this bill isn’t a tax”!  Simultaneously, the Bush Appointee detonated what appears to have been a laser guided nuclear missile at the Democrat’s November election efforts.  With the elections closing in and even more dismal jobs numbers released recently, combined with the thought of more people qualifying for health care funded through a new entitlement program, his decision is a defining moment in our nation’s history.


Politicians – “if you can’t stand the heat”, you’ll be voted out of the, uh, office.  Please understand, I’m not a political analyst, but in the time remaining before the elections, there are going to be an incredible amount of details that shed light on the holes that the Supreme Court ruling has revealed in this entitlement expanding law.  There will be politicians who find themselves on the end of an agitated, finger pointing constituent that the elected official “thought” the constituent was on his side, only to discover that the indignant finger pointer just realized they don’t qualify for a tax credit for a government sponsored plan.  While a “legal” alien neighbor making more money does.  Or because a State doesn’t accept the Medicaid expansion, a hole will exist that some making less than 100% of poverty will fall into because the authors of the bill never planned for Medicaid not expanding.

If the last administration’s attempt at addressing health care financing reforms yielded the terminology “the donut hole”, this administration could have their attempt at reforms being referred to as “the Swiss cheese model”.  The unintended consequences of these situations are mind boggling.

States – As referenced above, the States are going to be reviewing their constitutions, political layout and current budgetary environments to determine the direction that they deem most beneficial regarding the provisions and responsibilities that come with accepting the matching Federal dollars in the form of golden handcuffs.

Obviously, with many states in dire straits from a fiscal perspective, in order to expand coverage they will be forced to accept the matching dollars just to stay solvent.  Additionally, the implications from a state perspective could prove incredibly unique when considering the potential of over half the states have indicated they are evaluating rejecting or plan to reject what they deem to be a massive overreach of the Federal government on both governance and taxation.  If you take that a step further, imagine a state that chooses to not take the Federal dollars who borders a state that does accept the additional matching funds.  What happens socially, culturally or demographically in that environment?

Hospitals – Hospitals are vulnerable in many ways under this new plan.  Facing difficult economic conditions, especially those facilities whose mix of patients includes a higher uninsured/underinsured population, the American Hospital Association supported the bill.  Now AHA’s constituents will be forecasting what life will be like in a scenario that is based on the individual states actions and its acceptance of the Feds additional funding and bureaucracy.

Regardless of the outcome of the State’s actions, Hospitals don’t have an option with regard to the day to day.  They treat patients, operate hospitals on shrinking margins; and are forced to somehow strategically plan for the status quo or a significant change in both revenues and increases in patients.  The bottom line is hospitals are anxious based on a recent Modern Healthcare article titled:   “States draw battle lines Hospitals wary as GOP governors vow to fight Medicaid expansion


Today we know the Supreme Court’s decision on the Constitutionality of the Patient Protection and Affordable Care Act.  Some of what we don’t know is:

  • Of the over 2000 pages in the bill, how many new programs will the Secretary of Health and Human Services create under the direction of the Law?
  • It is estimated that, so far, the law has been translated into over 200,000 pages of regulation and policy, if few took the time to read 2000 pages of the bill, who is watching over the regulations being inked in the 200,000 policy pages?
  • If we assume that the real objective of this reform was to stop the current unsustainable utilization model and transition to a quality and improved outcomes model, while increasing the access to the uninsured population in the US, why do the rules for the Health Insurance Exchanges (the provision in the law for fairness, transparency and easy access to health care under PPACA) seem ambiguous and fluid?
  • In March, the Department of Health and Human Services released the Final Rule on Health Insurance Exchanges.  In an April 2012 article in Health IT, “Insurance exchange rule unveiled”, Senior Editor Mary Mosquera quotes HHS Secretary Kathleen Sebelius, “More competition will drive down costs and exchanges will give individuals and small businesses the same purchasing power big businesses have today”.  Why then in the article does it state that; Exchanges will be operational by October 2014, States consider cost as the biggest barrier for planning Exchanges, Exchanges will coordinate with Medicaid and finally, “The federal government will put in place an exchange for states that choose not to establish one or will not have one operational by 2014.”?

An important fundamental thought that must stay in the forefront of the discussion is simple in principle, but somehow has been lost in the bureaucratic dialogue.  Patient and Provider, this should be the driving force or the focus in the debate.  No matter where the patient is seen, no matter who finances or pays for the services, the one overriding theme should be to improve the communication between the patient and the provider for the purpose of improving the patient outcome and experience.  This has been and should be in the future the core of providing quality patient centered health care.

However, both parties, Patient and Provider, must understand that change is eminent and that the future “will be” different.  The days of providing care, collecting co-insurance, uploading claims, posting payments, storing ERA’s/EOB’s, and having staff assist/educate patients will be giving way to a new era for the prosperous health care practice.  The practices of the future will contain words like; Coordination of Care, E-Clinical Template, Bundled Payments, Unit Measuring, esMD, Power Mobility Devices, Carve Out Claims Processing, Health Information Handler, and Interoperability. It will also use traditionally non-clinical terminology like; data-mining, Business Intelligence, SaaS, Petabyte, MANET and other Information Technology jargon standard with business today.

This final thought or summary to my post was much more difficult to write.  It is both a closing and an opening.  Most health care Professionals will agree that the “radiation” or fall out of this bill will be massive.  I hope I am wrong, but I believe that in 20 years those of us who have managed healthcare organizations through this time may conclude that PPACA was the largest US entitlement program ever.  As the Justices discovered, this law is multi-faceted, just like health care.  The debate on this subject was unfortunately done in seven second sound bites, by media types, special interest groups, uneducated politicians who were paraded out in town hall meetings to be the messengers, at a minimum, and maybe more accurately the martyrs for a “greater good, Affordable Health Care for all” campaign.

Like health care, radiation used by the knowledgeable and trained expert can yield great results.  However, when exploded in an uncontrolled environment, radiation will cause irreparable damage.  Just because the issue is complicated, doesn’t mean we can sit on the sideline.  Take time to read, educate ourselves and then communicate our position, continuously.


© 2011 – Ron M Decker

Ron Decker’s Blog – rmdmusing

Twitter -  RonMDecker

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