SUPREME COURT BACKS HEALTH CARE MANDATE : Hospitals, Insurers Are Ready; Industry Has Been Preparing for More Streamlined Care; SUPREME COURT HEALTH CARE RULING

Article excerpt

St. Louis - The green light for the Affordable Care Act will accelerate changes to the local health care system that have already begun ahead of a coming wave of newly insured patients and incentives to keep them healthy.

The law, largely affirmed by the U.S. Supreme Court on Thursday, means millions of Americans who don't have insurance will become covered by 2014.

It will also mean a stronger emphasis on preventive medical services. For example, hospitals will be able to earn incentives for improving patients' health instead of getting reimbursed by insurers only for procedures they perform.

To prepare for the changes, St. Louis-area hospitals have been adding outpatient clinics or buying up independent doctors' groups to better collaborate on patient care. The goal: to encourage better treatment of patients early on and reduce costly emergency room visits and admissions.

Most recently, St. Anthony's Medical Center in south St. Louis County absorbed Southwest Medical Center, a 15-doctor medical office on Watson Road. The Mercy hospital system is expected to announce today a merger with Patients First doctors' group in Washington, Mo.

Such moves are expected to help primary care doctors better coordinate with specialists.

"Hospitals and health systems will continue to integrate, which on balance should improve health care for all of us," said Mark Goran, a local health care attorney. "It should also reduce the cost because coordination should keep people out of the hospitals."

Steven Lipstein, president of BJC HealthCare, the region's largest hospital operator, said another benefit for hospitals will be a drop in uninsured patients who now use an emergency room for primary care.

"A great many of those patients, now they'll have (insurance) and hopefully will come to us sooner, when they're faced with either medical conditions or symptoms, so that we can help them avoid hospitalization," he said.

Local hospitals also are expected to see an impact on their bottom lines. Their debts could decrease, as fewer uninsured patients means fewer uncollectable bills.

"Patients entering the nation's hospitals will be much more likely to be carrying an insurance card," said William Smith, director of the health care practice at NSI, a Washington consulting firm.

Like other hospital systems, SSM Health Care, which operates seven hospitals in the region, had not waited for the Supreme Court's ruling to prepare. …