At the annual AMDIS Physician Symposium, the annual gathering of CMIOs and other medical informaticist executives, sponsored by the Association of Medical Directors of Information Systems (AMDIS), held in Ojai, Calif., reactions on Thursday to the Supreme Court’s ruling on the Affordable Care Act (ACA) were varied. For the most part, industry leaders were pleased with the result, even if some didn’t think any ruling from the court would have had an impact on what they generally all consider to be the inevitable work of "internal healthcare reform"--pushing the healthcare system towards improved patient safety and care quality, clinician effectiveness, efficiency, and cost-effectiveness, leveraging healthcare IT to move the industry forward.
For example, Troy McGuire, M.D., CMIO, Seattle Children’s Hospital, noted that his hospital is in a heavily managed care-penetrated market, while it also has typical indemnity coverage, as well as a lot of governmental payers. He was happy to see certain elements of the ACA stand.
“The fact things were upheld, like children’s coverage to age 26, preexisting conditions, supports the direction in which we believe we were moving as a country with healthcare reform,” Dr. McGuire told Healthcare Informatics. “What it will mean to us directly, I think we won’t know until we know what happens with the Medicaid expansion, and the move forward to continue in the direction that the act originally called for.”
Kshitij Saxena, M.D., medical director of medical informatics at Adventist Health, Lake Mary, Fla., said that overall, healthcare IT would not have been directly affected, regardless of the result. However, speaking on his own behalf and not for the official views of Adventist Health, he said he thinks an overhaul of healthcare is the right step in the direction of the future.
“It’s a victory for the American people and a victory for the American future. Probably 20 years down the road, America will look back and say, we are glad we did it,” Dr. Saxena said.
Washington, D.C.-based Vi Shaffer, vice president at the research and consulting firm, Gartner, said the result means “It’s back to business.” For providers, she said, that means figuring out how to operate on the new Medicare margins, and reinvent yourself for value-based purchasing while living in a fee-for-service world, and dealing with a chronic disease.
“I think IT switches in two ways" because of the ruling, Shaffer said. "Number one, you’ve got to get a lot more value from the EHR. Number two, a variety of really important IT investments; analytics; and patient-centric care management systems [are preserved]."
David Classen, M.D., associate professor of medicine at University of Utah, and chief medical informatics officer at Pascal Metrics in Washington, D.C., was said he was shocked by the outcome; he said he had anticipated that the individual mandate for purchasing health insurance would be overturned.
“Across the industry, most people were planning for that," Dr. Classen said. "Now that it wasn’t, it’s going to be much harder for this to be repealed. Many of us thought that if the mandate were repealed, the rest of the law might be repealed. I don’t think that now. So now, hospitals shouldn’t pull back from their plans, because of this is likely to move forward. That’s the bottom line,” he said.
Classen and other providers also had the opinion that regardless of the ruling, many in the industry were moving towards reform anyway. Colin Banas, M.D., CMIO of VCU Health System, Richmond, Va., said that his organization was going to have to have some flavor of reform no matter what the Supreme Court ruled.
“So without getting into the politics or constitutionality of it, we were going to have to move forward in our work, because healthcare in this country is unsustainable without bending the curve; and we remain committed to that,” Dr. Banas said.
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