Supreme Court Upholds Health Reform Law

In a 5-4 ruling, the U.S. Supreme Court allowed healthcare reform to proceed largely unchanged, including the requirement that all Americans buy health insurance.

Besides waiving co-insurance for such services as screening colonoscopy in an effort to increase access to preventive services, the ruling has no immediate impact on the way that surgical facilities do business, observers say, but it does leave the door open for changes in the way the industry operates.

"On Monday and a month from now, nothing legally is going to change about the operation of surgery centers," says John Fanburg, chair of the health law practice at Brach Eichler in Roseland, N.J.

"What they'll need to think about is, as the market consolidates, are they going to be winners or losers? If they can't get in-network anymore, will patients still come?" asks Mr. Fanburg. They may seek out more aggressive managed care contracts, alignments with other ASCs, hospitals or corporate partners, or participation in accountable care organizations.

The Supreme Court's ruling did, however, put the brakes on a provision requiring states to expand their Medicaid programs, which observers saw as a major source of increased patient coverage when the Affordable Care Act became law in 2010.

For William Prentice, CEO of the ASC Association, the political ramifications of the ruling (that is, mobilized opposition seeking to repeal the law) will be apparent before the healthcare ramifications, which may include an increase in covered patients seeking care, consolidation squeezing the market, or both. "Fundamentally, it's not going to change anything we've been working on," he says, namely demonstrating that ASCs deliver low-cost, high-value care.

"The decision means that hospitals now have much-needed clarity to continue on their path toward transformation," said Rich Umbdenstock, president and CEO of the American Hospital Association. "But transforming the delivery of health care will take much more than the strike of a gavel or stroke of a pen. It calls for the entire healthcare community to continue to work together, along with patients and purchasers, to implement better coordinated, high-quality care."

David Bernard