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Is health care autonomy DOA? Maybe not.

There are plenty of us who want to see PPACA, commonly referred to as Obamacare, repealed. Realistically speaking, the first opportunity for this to happen will be in 2012, totally dependent on our getting a Republican President who will push the issue on repeal and enough people in Congress who will support that effort. I’m not trying to shoot down repeal. I just have my share of questions about whether the health care industry as a whole is in a position where it can sit around until 2012 on the outside chance that repeal will happen. Here are my reasons.

For years now, the health care industry as a whole has been using the higher reimbursement rates from private health insurance to offset losses from the lower reimbursement rates from Medicare and Medicaid as a means of remaining financially solvent while providing treatment to as many people as they possibly can. Simply by the very structure of PPACA, there will be a decrease in private insurance enrollment accompanied by what could be a massive increase in Medicaid enrollment. This will cause a shift in the balance that hits on the very point that has been used to maintain financial solvency.

A lot of health care providers approve of a nationalized health care system in theory because they agree that there are plenty of people in our country who are not in a position to afford the health care they genuinely need. But PPACA is constructed in a way that leads down the path to complete subsidization of the entire health care system and rationing of healthcare. This defeats the purpose of even attempting to develop a nationalized health care system. Health care providers know this. So do health care organizations. They aren’t willing to simply do nothing and have this become the reality. For the time being, they still have enough autonomy and financial resources that the health care industry could respond by restructuring its business model in a way that allows them to at least break even with the lowest of reimbursement rates, i.e. Medicaid, and in some cases, even make a profit. It looks like this is the new goal for the health care industry. By exercising its own autonomy NOW to bring this about, it is possible that the health care industry could reduce the necessity for health care rationing and prevent its own financial collapse.

Look around at what is going on in the health care industry right now. You can count on it that health care organizations are reevaluating every aspect of their operations. If they have a function that has been operating at a loss, it stands at risk of being cut from the system. Management methods could be changed. Job functions can be altered. All of these things play a part in finding a way to accomplish and achieve this goal.

In some cases, health care organizations may be able to use trends that have already developed to succeed in this goal. In this WSJ article, one of the trends that have been identified during the past few years is of physician’s selling out their practices to either hospitals or private insurance companies. What is stated in this article is that it is projected that by next year 60% of the doctors in our country will be salaried employees. It is possible that this type of trend could open a whole new world of opportunities to the health care industry that allows practical cost-cutting measures other than sacrificing quality of care or implementing rationing of care.

Here’s a hypothetical example. At the present time, overhead costs account for 60% of the costs incurred by private practice physicians. Very few private practices operate at 100% potential. When a hospital buys out a physician’s practice, all of these overhead costs and the responsibilities associated with those costs are transferred to the new owner. The hospital can choose to centralize some business operations, such as purchasing, HIT, Billing, etc., which reduces operating costs and prevents these private physicians from the expenditure of costs to meet regulations pertaining to EHR and ICD-10. Malpractice and liability insurance would be provided through a blanket policy with the hospital, which reduces the cost of these services to the physicians.

Suppose there are two practices that are not operating at 100% potential. Services could be consolidated into one facility which could eliminate a significant amount of the overhead costs associated with the second facility. To maximize the potential for operations from the first facility, the hospital could choose to have physicians perform regular office functions during normal business hours. During non-business hours, such as on the weekend, the facility could be used as a non-urgent care facility which could reduce demands for care at the local ER, thus reducing costs associated with these ER visits and reducing bottlenecks in service that might have been faced through the ER.

If the second facility structure is owned by the physician, the hospital could choose to put this facility to use as a center to provide routine health maintenance care, which is a big provision written into AAHCA, or standard follow-up care. By using NPs and PAs operating under the guidance of a MD, it is possible that the facility could break even with Medicaid reimbursement rates or even derive a profit. Or the facility could be transformed into a CAH, which is a “mini-hospital” consisting of less than 25 beds where acute inpatient services of less than 96 hours could be provided, preventing bottleneck of inpatient services at the larger hospital facility. Or the facility could become a satellite out-patient facility, preventing bottlenecks of services at the on-site out-patient facility located on the hospital campus. There are plenty of options on this one.

At any point where a bottleneck in services occurs, this can lead to rationing of health care. So every effort made to prevent these bottlenecks is to the benefit of the general public.

The health care industry is apparently at a point where it is willing to take on this kind of challenge. It really doesn’t have much choice on the matter. It’s going to be interesting to watch, because if the health care industry in our nation finds a way to derive a profit from the lowest reimbursement rates, this is going to make a serious dent in the whole socialistic, oppression-to-the-people-by-means-of-health-care plans some individuals in the current administration might have had.

Here are some things that we the people can do. We can become consciously aware of the costs associated with our own health care system and ask it of ourselves for the sake of our country to use those resources wisely.

Secondly, we can elect people into office in this country who will strive for repeal. If they can’t get repeal, then we need them to fight tooth and nail to implement objective, quantitative efficiency standards for every single solitary DHHS and CMS department even remotely associated with our health system to prevent the inefficiency of this government from being our downfall. No pun intended, but the inefficiency of our own government is killing us… and in this case, you can take it literally.

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