If the Affordable Care Act is overturned by the Supreme Court in a ruling expected any day and some say there's at least an even chance that could happen -- we'll all be overwhelmed by the messy details of reassembling healthcare reform.
Among those details are care coordination/payment reform programs under way by the federal government in partnership with hundreds of provider groups across the country. Those range from incentive programs on primary care delivery to accountable care organizations designed to provide a wide range of care for Medicare beneficiaries.
We'll see plenty of political wrangling over what stays and what goes from the 2010 ACA, but my money is on both parties embracing features of these programs. For Democrats, there's improved oversight of healthcare quality for millions of Americans. For Republicans, there's the transfer of financial control to the private sector -- the integrated delivery systems, hospitals and physician offices that will assume responsibility for living within our financial means.
And, really, who wouldn't support giving physicians more control over our care? Ask anybody who the good guys are in healthcare, and you won't hear many answers for health plans, and just a very few for hospitals. (And maybe none for the government). Physicians, despite their growing and vocal frustration with the system, remain trusted.
Many of the tenets of medical homes and ACOs involve putting the physician and his or her patient at the center of care, not the insurer, the employer or the government. That means control over not only prescription drugs and CT scans, but also the financial details of a patient's care. For years, doctors and their staffs tried to avoid money matters, but two big forces are at work in 2012: more patients those uninsured and insured are paying for care out of their pockets; and health plans are saying, Go ahead, provide care for this diabetic patient. Keep him compliant and at the same time, save the system some money. If all of that works, the doctor may get a little richer in the process.
Whatever the ruling by the court, the coordination and payment reform efforts are unlikely to slow. The biggest roadblock may be erected not by politicians but by doctors unprepared for the lean, mean caring machine that the system now demands their offices be.
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