By Patricia Simms
For WisBusiness.com
The business community should be optimistic about the effects of the unfolding Affordable Care Act on access to health care and the quality of outcomes but shouldn’t expect it to control costs, industry insiders said Wednesday in Middleton.
Keeping health care costs down will have to wait until the next round of health care reform. In fact, Lon Sprecher, president and CEO of Dean Health Plan, said costs are likely to increase over the next two to three years, at least on the administrative side.
“For both … health insurance companies and for the doctors and hospitals, I think costs will go up,” Sprecher said. “There will be a Round 2 of health care reform. And Round 2 will, of necessity, have to focus on the cost side.”
The panel, sponsored by Smith and Gesteland at the Deming Way campus of the Edgewood College Graduate School of Business, brought together Sprecher; Peter Christman, chief operating officer of the UW Medical Foundation; Londa Dewey, president of QTI Group of Companies; and Dr. Dave Rakel, director of the UW Integrative Medicine program.
Cost aside, the experts said the federal law will have many other effects:
* More people will be insured.
* Focus will shift to preventive care of healthy people rather than treating the sick.
* Payment will be based more on positive outcomes rather than the number of patients treated.
* The “donut hole” in Medicare drug coverage is going to shrink.
* Physician compensation may be decrease, and the discrepancy in salaries among medical specialists will shrink.
* Insurance companies will see a blossoming market in the sale of individual health plans.
In March 2010, Congress passed a sweeping health care bill pushed by President Obama. Last month, the law survived a legal test when the Supreme Court largely upheld most of it. More than two dozen Republican governors, including Wisconsin Gov. Scott Walker, are resisting implementation of the law until after the November elections.
Christman labeled the legislation “pretty good stuff, for the most part.”
“We are going to end up with a lot more people that are going to be insured whether that’s through the expansion of Medicaid or through the exchanges themselves and the ability of citizens to get health care where, in some cases, they were not able to get health care in the past,” Christman said. “The 45 to 50 million Americans who are uninsured — that number is going to shrink significantly.”
Rakel, who focuses on holistic and integrative medicine in his practice, said the current health care system relies on a complex set of codes that doctors have to use in order to be reimbursed. “I have to label you as broken” in order to get paid, he said. “This is the next step in helping us pay for what we really want.”
For example, he said, one condition identified in the code is “struck by a duck.” Another is “burns from water skis catching on fire.” In the new system, there will be more emphasis on preventive treatment, he said.
Christman said, “In the end, keeping people healthy is going to be much more important, in the long run, than taking care of sick people. It’s not that we won’t be doing that in the future, but improving the health of the population is going to be at least as important.”
Physician compensation may change as part of that shift, he said. “Your typical neurosurgeon makes a whole lot more money than your family practitioner. I expect those differentials are going to become less in the future.”
And, Sprecher said, instead of rewarding physicians for “clicks at the turnstile,” the new system will reward them for value — patient satisfaction and outcomes.
“The mantra of the future is ‘no outcomes, no money.’ If there are no outcomes or bad outcomes, or marginal outcomes, there will be less money flowing to the providers.”
The landscape is also going to change significantly for employers large and small. Dewey said businesses should reassess the benefits they offer to attract and retain good employees.
“Do an analysis of what employees really want,” Dewey said.
