The healthcare reform bill passed narrowly by the House of Representatives yesterday will eventually expand health coverage to tens of millions of uninsured Americans, creating both "opportunity and risk" for the ambulatory surgery industry, according to Marian Lowe, executive director of the ASC Advocacy Committee.
By requiring most U.S. citizens and legal residents to have health insurance or face a tax penalty, Ms. Lowe notes that the legislation will eventually increase the number of people with some form of coverage, creating "significant business opportunities" for ASCs. However, one of the ways the legislation achieves this goal is by expanding the Medicaid rolls to 133% of the federal poverty level. "That's something providers will want to keep an eye on," she says.
Expanding the insurance rolls will most likely have a positive impact on hospitals that have not been able to collect on indigent care in the past. But with the coverage provisions not kicking in until 2014, neither hospitals nor ASCs are likely to see an immediate increase in insured patients, says Robert I. Field, JD, MPH, PhD, professor of health management and policy at Drexel University School of Public Health in Philadelphia, Pa.
The reform bill "will have no immediate effect on people under Medicare and people with employment-based insurance," says Dr. Field. He adds that healthcare facilities may see more 20-something patients who will be eligible to join their parents' policies in 6 months, but this age group is less likely have surgery.
Ms. Lowe points to 2 specific provisions in the bill that would have a direct impact on the ASC industry:
Beginning in 2011, the productivity adjustment will start being applied to Medicare payment rates for ASC services. A longtime MedPAC recommendation, the productivity adjustment means Congress will reduce the annual inflation update by a measure of economy-wide productivity gains. The 10-year rolling average is about 1.4%, so if the CPI update were 2, you'd end up with 0.6% increase, explains Ms. Lowe.
The bill waives co-insurance for Grade A and Grade B services, such as screening colonoscopy, in an effort to increase access to preventive services. Ms. Lowe says it's logical to assume that patients will be more willing to undergo such testing if there's no out-of-pocket expense associated with it.
The hospital industry, which ultimately supported the bill after early resistance, seems to have a cautious attitude towards the future. "Yes, everyone has concerns about aspects of the bill; no stakeholder — or legislator — got everything they wanted, so we will seek changes as the reform journey continues," said American Hospital Association President Rich Umbdenstock in a statement. "As with any reform of this magnitude, it will need to be closely monitored and further refined."
The association would not further elaborate on how the bill may affect hospitals and their surgery departments. "A lot remains to be seen in terms of the full impact of this bill," says Matt Fenwick, a spokesman for the association.
Once President Obama signs the bill, which he's expected to do as early as tomorrow, healthcare providers can expect a huge government outreach to put the program in place, says Dr. Field. "There's going to be a huge implementation effort," he predicts, similar to when Medicare was enacted.
Kent Steinriede and Irene Tsikitas
