Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Measures Put in Place to Comply with Health Act Hang in Balance

Newspaper article Pittsburgh Post-Gazette (Pittsburgh, PA)

Measures Put in Place to Comply with Health Act Hang in Balance

Article excerpt

Often overlooked in the Supreme Court challenge to the health care law are changes that hospitals, doctors and insurers had been moving toward even before the law was passed in 2010.

Some of these could be halted if the court throws out the Affordable Care Act, or hobbled if the justices excise parts of it, experts say.

The changes include increasing the role of primary care, especially for low-income patients, forcing hospitals and doctors to work together closely, and reducing pay to hospitals if they don't meet patients' expectations or outcome benchmarks set by the government.

"We have to change, and we know that," said Ken Raske, president and chief executive of the Greater New York Hospital Association, which represents 250 hospitals and other medical facilities. "But it's easier if you're going to build the building to have the shovels and picks and the hammer and nails than trying to dig it out with your hands. That's what the [Affordable Care Act] is."

One of the concerns raised during the debate over the law was that expanding coverage would lead to a shortage of primary-care doctors. The law allocates more money to provide primary care to people, especially the poor. The theory is that seeking early care or preventive measures will help more people stay well enough to avoid expensive hospitalizations or develop chronic conditions.

The government has spent $1.9 billion to build and expand community health centers and $512 million to train more health care workers, including primary-care doctors, physician assistants and nurse practitioners, according to the Kaiser Family Foundation.

Also at stake are some new methods to pay doctors and hospitals to reward good and efficient medical care, and ongoing efforts to come up with different reimbursement models. Many of these changes are being implemented by the Centers for Medicare & Medicaid Services. These include 65 collaborations among hospitals and doctors, which are working as "accountable care organizations." Freed from antitrust laws, they can earn bonuses from Medicare if they provide care more cheaply without sacrificing quality. …

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