Federal health legislation stresses prevention

Editor's Note: This is the second story in a two-part series about the U.S. Patient Protection and Affordable Care Act, commonly known as "Obamacare." The first part was published last Saturday.

The biggest change being wrought by Obamacare, the health care reform package revamping many aspects of American medicine, may be its Jan. 1, 2015, shift from a fee-based to a quality-based system.

Starting at that time, references say, "Physicians' payments from federally funded programs such as Medicare will be modified to be based on the quality of care, not the volume."

That will mean changes like getting people to "take ownership" of their health by working more closely with doctors to avoid illnesses and diseases, better timed discharges to cut the number of readmissions to hospitals and building accountable care organizations, or ACOs, where doctors and hospitals collaborate to develop better practices, among other measures.

Hospitals like Nevada Regional Medical Center and Mercy Hospital in Fort Scott and groups like the Missouri and Kansas hospital associations have two and a half years to get ready, but they have been making preparations since Obamacare passed in 2010 and are working with more certainty now that it has been ruled constitutional by the U.S. Supreme Court.

Another benefit promised by Obamacare advocates is to enhance the ability of rural hospitals to recruit physicians. "We put a lot of time and money into recruiting doctors, but it's a hard thing to do," said NRMC Community Relations Director Aimee Meyer.

"We think it will give doctors incentives to move to rural areas by helping with financial incentives like student loan forgiveness."

Missouri Hospital Association Media Relations Vice President Dave Dillon of Jefferson City said his state has two ACOs in operation, increasing federal funding, with Heartland Health in St. Joseph, a member of the Mayo Clinic Care Network, and the non-profit BJC HealthCare's 13 hospitals and numerous community locations in St. Louis, mid-Missouri and Southern Illinois.

Kansas has no ACOs as yet, but its Kansas Healthcare Collaborative and Hospital Engagement Network, or "HEN," have similar goals, said Kansas Hospital Association Public Relations Vice President Cindy Samuelson of Topeka.

Dillon said Obamacare's emphasis on preventative medicine is heartening, "because when someone is uninsured and isn't managing their health, they may be using the emergency room as their primary care.

"Then they're using the most costly venue to get that care and receiving it at a time when their health has been compromised, like a diabetic going into a coma."

While the Supreme Court's June 28 ruling settled many questions, others remain.

Medical professionals are watching state and federal elections to see which positions win validation: the ones backing Obamacare or those advocating the law's congressional repeal and states' rejection of the expansion of Medicaid and insurance exchanges where companies could be compared and coverage purchased.

"We're eager to see what happens in November to determine if we are moving toward one direction or the other," Samuelson said. "But we will be quality-based and trying to go forward, no matter what."

Dillon said Missouri "still has a large uninsured population.

"The uninsured need a health insurance exchange, but the lawmakers may not accept the expansion of Medicaid," he said. "If they don't do that, it will be very bad for hospitals because the federal DISH (disproportionate share) payments are being cut anyway."