Our early prediction on the Supreme Court health care decision has become conventional wisdom. But we can see things going a slightly 

different way.

Back when people were saying -- was it really only a few weeks ago? -- that the Affordable Care Act was a shoo-in to pass Supreme Court muster, we thought the individual mandate (otherwise known as the "heart" of the ACA) would be struck down, leaving the Act to wither.

We felt this way for two reasons: 1.) The Court leans conservative, and though this doesn't affect every decision it makes, it tends to affect the big ones; and 2.) The Court is strongly influenced by the doctrine of Originalism, and the Act's classification of health insurance as interstate commerce is not something the Justices are likely to relate to the vision of the Founders.

We said last week that we expected the Supreme Court to strike down the Individual Mandate in its health care reform hearings.Tuesday's session confirmed our suspicions.

The individual mandate is the feature of the Affordable Care Act that requires nearly all citizens have some sort of coverage -- either government programs such as Medicaid or, if they don't qualify for that, private insurance provided via exchanges or on the market. 

The Court is not inclined to recuse itself.

Monday's Supreme Court hearing, beginning the mega-case that will decide the fate of the Affordable Care Act (ACA), included "hard-nosed questions" from the Justices, said Modern Healthcare, but few clues as to which way the judges were inclined.

The latest MedPAC report urges repeal of the SGR -- of course. What will Congress do with that?

 In its March 2012 report, MedPAC recommended a series of payment adjustments, including a 1% increase in payment rates for hospital inpatient and outpatient services. (They found the Medicare profit margins for hospitals improved between 2008 and 2010 -- but remain negative at −4.5%.)

They also recommended Congress "reduce payment rates for evaluation and management office visits provided in hospital outpatient departments so that total payment rates for these visits are the same whether the service is provided in an outpatient department or a physician office."

But the deadline (this past Jan. 1) remains the same. Back in November, you'll recall, CMS gave a break to practices who weren't ready to implement the new ASC X12 Version 5010 standards for HIPAA transaction security. They didn't push back the actual deadline -- but they did say they "would not initiate enforcement action until March 31, 2012." 

Now here we are, mid-March, and 5010 has remained a sore point, with practice advocates calling for another extension.