There’s an old saying: be careful what you wish for. This month, I will have been in healthcare management for 31 years. During that period I have seen us pass from the days of payments based on UCR (usual, customary and reasonable) to the participating provider fee for service model, the comings and goings of HMOs, medical management companies rising and falling, and a myriad of other delivery system changes. Now we have the Accountable Care Act (ACA), or “Obamacare”, as the Act has been become known, and there are many who are wishing for its demise.  

While its goal of making quality, affordable healthcare available to all is hard to fault, the Act itself is fraught with problems ranging from its complexity to its legality. The Supreme Court is now considering four issues:

1.       Whether the Anti-Injunction Act bars challenges to the requirement for individuals to obtain insurance (the individual mandate) until the mandate is implemented in 2014

2.       The constitutionality of the individual mandate

3.       Whether the individual mandate, if found constitutional, is severable from the rest of the ACA

4.       The constitutionality of the Medicaid eligibility expansion to a new segment of the population.

If the Supreme Court strikes down any one of these provisions, it will have a significant impact on the whole Act. While plenty of experts are predicting which way the Court will rule, the fact is, we won’t know until sometime this summer. That means plans for Insurance Exchanges, Healthcare Co-ops, and the other methods on the drawing board for implementation of the Act must move forward in a fog of uncertainty.

The issue now is: what happens if the Act goes away? Do we go back to the “good old days” of four years ago? And were the “good old days” really that good? We still had the SGR issues, there were concerns about Medicare insolvency, more control of the healthcare delivery process by payers through benefit management programs and wide variations in the availability of diagnostic services.

So if the Act goes away, what takes its place? We probably will be dealing with some or all of the following:

1. Medicare funding will continue to dry up if we maintain the current fee for service model.

2. Wide variations in access to care will continue.

3. Payers will continue to be forced to reduce payments because their customers, industry purchasers of benefit plans, will demand it, as their costs will be too high.

4. Reporting on the cost of healthcare to payers and patients will expand. 

5. There will continue to be efforts to find some national guidelines for care.

In essence, if the ACA goes away, we still face the same issues. So how will we deal with this?

We continue to implement more technology (EMR’s, better links to transmit patient information, more accurate testing, etc.) to save money. We try to control costs by purchasing more efficiently. That means standardizing and negotiating prices, something that we have not done well historically.

We try to improve quality to control costs. This means finding ways to measure quality and being willing to address issues. Providers will need to work together to find ways to improve quality and accessibility so we can accomplish all of the above.

So, while the ACA is the plan many of us love to hate, we still have to deal with the same issues no matter what happens. Ultimately, we have to avoid throwing the baby out with the bath water. We must be the drivers of improvement, which will require us to deal with uncomfortable subjects (quality, utilization rates, etc.).

I was recently on a call with a national medical specialty organization discussing the availability of cost and quality information when some on the call expressed concern over presenting the information because the information is “sensitive.” That’s despite the fact that in 2013 Medicare will make the same information available to the general public through its Physician Compare website. The information in question is based on claims and documentation data submitted by providers and has some inherent problems based on things such as patient demographics, coding expertise and other reporting issues. Wouldn’t we be better served by improving that information instead of arguing about the sensitivity?

The reality is we have to find ways to work together. Forget the ACA, health plans, payers and other influencers. Providers have to figure this out themselves or accept what is handed to them.