5 ways to help hospitals implement reform ASAP
As the Presidential campaign finally moves toward election day, it is becoming clear that the Affordable Care Act will remain the law of the land. Whether Mitt Romney comes from behind to defeat President Obama, relevant polling data shows the Democrats will at least maintain their majority in the Senate and may even retake the House. This renders any GOP vows to "repeal and replace" the ACA as little more than noise.
I've been discussing with a variety of industry observers what should take place between now and Jan. 1, 2014, when the most critical components of the ACA are implemented--primarily Medicaid expansion and the use of the health insurance exchanges for non-indigent individuals to purchase coverage.
Anthony Wright, the executive director of Health Access, and one of California's highest-profile consumer activists, told me of the need to meet a "day one challenge." That is to ensure as many people are enrolled in Medicaid and in private health insurance plans by early 2014 as early as possible. Otherwise, a ramp-up that takes years will leave billions of dollars on the table that could go toward patient care.
Obviously, a quick ramp-up will help the ongoing financial health of hospitals. Medicare reimbursements are shrinking in the form of penalties for readmissions and will be cut in many other ways as well. If hospitals continue to have their emergency rooms flooded with uninsured patients well into 2014 and beyond because of enrollment lags, their erosion of margins will continue.
So here are five things hospitals can do to speed up the implementation of the Affordable Care Act:
1. Expand your staff of social workers
As I've said before, hospital social workers are not only great liaisons between patients, families and medical staff, but they are also crucial when it comes to performing benefits eligibility on behalf of patients and their families. The more people they can enroll or pre-enroll in Medicaid, CHIP or private insurance in the months leading into 2014, the better off your institution will be. If you can't afford to hire more social workers, there are a variety of firms that will perform on-site outreach on your behalf.
2. Report on ACO progress
Few people outside of the healthcare business community know about accountable care organizations. However, the more data that is reported on their performance, the more attention they will receive--and the more likely this particular facet of the ACA won't be spun as cuts to the Medicare program. Patient testimonials, cost savings and other salient facts should be made part of hospital media kits and contacts with journalists.
3. Report on readmission reductions
Few politicians whose support of the ACA has been painted as a desire to gut Medicare have asked a town hall meeting crowd this burning question: "How many of you want to go right back into the hospital after you're discharged? Raise your hands." Now is the time for hospitals to begin discussing this key bit of data in marketing materials. Your patients want you to continue serving the community--but they want to spend as little time as possible within your walls. Make known that you're getting patients in and out with as little trouble as possible, and that the ACA is partly responsible, and you will get more buy-in for the initiative.
4. Help market the exchanges
Believe it or not, but the open enrollment period for health plans offered via health insurance exchanges is less than a year away (Oct. 1, 2013). Most exchanges are still trying to figure out not only how they will function, but also what name they will be called. If your community benefits division has a grant available to assist in marketing, this is the time to dole it out. If not, consider advertising the exchange on your own. Posters in the ER would make a terrific first step.
5. Lobby, lobby, lobby!
Even though the ACA's implementation is far more likely than not, there are still forces that will try and make every ongoing effort to defund and defang it. This should not happen. The more trips to the state capital and Capitol Hill made by your local and state hospital associations to stop this, the better off you'll be. - Ron (@FierceHealth)