There is no doubt that the current “conversation buzz” certainly has healthcare reform as one of the hot topics heading the list. The debate on the nature of how the healthcare system in the United States needs to be reshaped appears to be a contentious one. The many variables affecting how to approach such a major undertaking, the key priorities, and how it will be paid for seem to be key focal points, with no agreement as to what the ultimate financial impact may be to providers, consumers, employers, taxpayers, government, etc. With new projections that the Federal deficit will increase to over $9 trillion during the next 10 years, containing the AGR in healthcare expenditures continues to be a critical element of the Congressional charge in implementing reform.

The America’s Affordable Health Choices Act (H.R. 3200), developed jointly by the Ways and Means, Energy and Commerce, and Education and Labor Committees, is designed to achieve President Obama’s goals of strengthening employer-provided care, while fixing what is deemed to be broken. The Act would ensure that at least 97 percent of Americans will be covered by a health care plan that is both affordable and offers quality, standard benefits by 2019, and is also intended to control the growth of health care costs.

Summaries of the Act generally point to the following key provisions:

• Coverage and Choice
• Affordability of health coverage for all Americans
• Shared Responsibility
• Controlling costs
• Prevention and Wellness
• Workforce Investments

Medicare and Medicaid payments and payment mechanisms will for sure be adjusted, realigned, and refined in the future, with billions of dollars in reimbursement cuts expected affecting various provider types. CMS and other governmental agencies will devote more effort in fighting fraud and abuse, and MedPAC may be empowered to regulate versus just recommend. A public health plan negotiation power afforded to the government promulgated by Pete Stark that may get scrapped due to opposition is one of many issues of disagreement.

It is also noted that three reform approaches have been touted. Although far from being finalized, they will likely play an important role in the future and are a) reducing readmission rates, b) bundling payment for certain spells of illness or episodes of care, and c) establishing accountable care organizations or ACOs. The New England Journal of Medicine, in a recent report, estimates that 20% of Medicare patients were rehospitalized within 30 days of discharge costing the program $7.4 billion on an annual basis. Payment bundling is projected to save $26 billion over the next 10 years–but this initiative is not expected to commence until FY 2016. The concept of ACOs would essentially reward groups of providers that meet defined quality standards by sharing cost savings generated for the Medicare program. However, the model has not yet been defined and although targeted for 2012, it could take longer to implement.

The three main objectives that keep cropping up in defining the President’s and Congressional reform initiatives are lowering costs in the long-run, improving quality, and guarantying every American access to high-quality, affordable health care. Most would not argue that these objectives are critical and crucial points to rectify and improve the U.S. healthcare system. Many would argue as to how to best effectuate such chang–it will be an interesting healthcare evolution in the months and years to come.

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