Blog

Recently, while listening to many “talking heads” discuss the Supreme Court’s consideration of the Affordable Care Act (ACA), I was overcome with the image of our Nation’s medical providers and medical billers rowing a Trireme, an ancient ship, bending their backs and straining their arms pulling their oars below decks to the steady drumbeat of “bill-collect-post” …”bill-collect-post” while listening to the scuffling from the wheelhouse just above their heads as the multiple captains vie for control, “Give me the wheel!” and “No, it is mine. I am in charge!” and “Turn that way!” and “No, turn this way!”

I would like to set my oar aside for a few minutes and explain my view of what may come about from the disagreement among our skippers and how it may affect the process of medical provider compensation and how the care process is documented.

First, it is quite clear that Electronic Health Records are here to stay, their adoption fueled with extra helpings of grog, soon to be replaced with the use of the lash, always in view. We owe the EHR state-of-affairs to the American Recovery and Reinvestment Act of 2009 (ARRA) and The Health Information Technology for Economic and Clinical Health (HITECH) Act, not the ACA and the Court could invalidate all of the ACA and that would do nothing to the EHR process underway.

The effect on the nascent trend to care provided through an Accountable Care Organizations (ACO) is more complicated and I have to call in an expert. Bill Finerfrock, writing for the Healthcare Billing and Management Association, has done an excellent job summarizing the decision points before the Court and their consequence. A copy of his brief and clearly explained piece, “3 Days in March”, is reproduced below or can be found at http://www.hbma.org/news/government-news/action-grams/n_3-days-in-march-.... I want to draw your attention to the fourth section of 3 Days and the issue of severability.

If the Court decides that the individual mandate is unconstitutional, it will then need to determine whether any other provisions should be “severed” or removed from the law. The choice the Court may make could be to invalidate the entire law (as the States argued) including the ACO provisions or just the guaranteed issue provision and the community rating provision (as the Government argued) leaving the ACO provisions intact. But, even if the Court invalidates all of the ACA, the progress toward ACO’s will likely continue as Government involvement is not necessary or critical to reform the delivery system. Private insurers are beginning their payment reform efforts and as we discussed EHR’s which play a critical role in the ACO trend will be unaffected.

This is our view as of today and until a new skipper grabs the wheel. I hear the drums and have to get back to my oar. Happy rowing!

Bill's article follows:

We will be attending the HBMA Spring Conference in New Orleans, April 19 - 21. You can find us at Booth 304. We look forward to seeing our old and new friends and potential partners. If you would like to meet with us there just send an email to info@nationalprovider.net. You can find more about this important conference at http://www.hbma.org/meeting_calendar/details.php?event=814