Some practices that had been waiting on the sidelines to see whether the Affordable Care Act (ACA) survived Supreme Court review could sign up for care delivery models now that the court upheld the law 5-4.
“Why bother participating if they were going to strike certain things down?” says David Zetter, Zetter Healthcare Management Consultants, Mechanicsburg, Pa.
But the ruling doesn’t clarify how some provisions will be funded, Zetter says. “We’ve got two years until many of the provisions go into place. They haven’t been paid for yet,” he said. “It’s no different in my opinion than it was before – it’s still a wait and see.”
The ruling also doesn’t shed light on the potentially game-changing value-based modifier. “The government is starting to gather data – we’re at the infancy,” he said.
Zetter's comments come after the 5-4 Supreme Court decision that upheld the Patient Protection and Affordable Care Act.The individual mandate, which guarantees health insurance to virtually every U.S. citizen, has been held constitutional as a tax levied by the federal government.
The uncertainty of the health reform law’s future kept many physicians from taking advantage of programs such as accountable care organizations (ACOs) and shared savings programs, says Don Fisher, President and Chief Executive Officer of the American Medical Group Association (AMGA) in Alexandria, Va., with a member base mainly comprised of large physician groups and health care systems.
Now, there’s nothing holding providers back and there will be a rapid consolidation effort between physician practices, hospitals and health care systems to create integrated, quality-based care for patients, Fisher believes. It’s a step in the right direction.
The court also has upheld an expansion of Medicaid coverage which is set to add millions of low-income Americans to the rolls. However, the court has limited the federal government’s ability to impose penalties on non-compliant states, according to SCOTUSblog.
All other features of the law are retained, including:
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accountable care organizations (ACOs) and other care-transition programs;
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payments for preventive services, such as annual wellness visits (AWVs);
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the home health and hospice face-to-face encounter requirements.
Now if Congress would only remove the uncertainty of the sustainable growth rate, Fisher says.
For more, sign up for a free, subscriber-only live chat featuring Michael Cook from 3:30 to 4 p.m. Friday, June 29. More information on the live chat and Supreme Court ruling will be on the PBN blog and http://daily.decisionhealth.com.