Quiet Inevitability

Republicans may be about to piss themselves in sheer happiness over the thought of SCOTUS striking down the entire Affordable Care Act this summer, but health insurance providers and hospitals are moving ahead with implementation of the law's provisions because hey, it makes good business sense.   Take the example of Maimonides Medical Center in New York City:

“Quite frankly, if everything goes perfectly and everything is upheld, there’s a lot of confusion and a lot of uncertainty here,” said Dominick Stanzione, the hospital’s chief operating officer. “We also have an election coming up.” 

The cuts, on the other hand, seem inexorable, and not only because Medicaid and Medicare budgets are strapped. The policy thrust in health care financing, private as well as public, is to abandon reimbursements to hospitals according to the number of days patients spend in a bed, in favor of models that use a fixed sum per patient or set of patients over time, regardless of where care is delivered or how little it costs. 

Maimonides’s own successes have helped sell policy makers on the idea. Its collaboration with a state psychiatric hospital a few years ago, for example, put medical-mental health teams in storefront offices to manage the care of low-income patients with serious mental illness. Such patients, who are eligible for both Medicaid and Medicare, are among the health system’s most expensive and tend to have the worst outcomes. The program cut hospitalizations in half and reduced emergency-room use by 30 percent. 

“When the State Health Department people saw our data, the little dollar signs danced in their heads,” Ms. Brier said. 

Hospitals are operating under the assumption that not only that the provisions in the law will be implemented, but that the health care industry will simply move to adopt the provisions regardless of what SCOTUS says because it's good for their bottom line.

Imagine that.