Doctor, Did You Wash Your Hands?™ was created to explore healthcare transformation with the advent of the ACA.
Now that it will be likely be nullified we need to figure out what that might mean and what will happen.
Foundations of the ACA for providers included: Population Health management and Investment in ambulatory care centers; preparation for Pay for Value replacing fee-for-service reimbursement; Medicaid expansion; and a steep and fast trajectory in employing physicians particularly primary care physicians and hospitalists. And much more!
This triggered consolidation of hospitals into becoming regional hospital systems quickly transitioning into integrated health care delivery systems, then to mega systems focusing on geographic reach, then to super-size systems which have started or taken over medical schools, now functioning like insurance companies and investment banks.
Billions of dollars were invested nationally to build and support this newly created infrastructure, often paid for by issuing bonds, using lines of credit and perhaps even dipping into endowment funds.
Months ago I suggested “stress tests” for super-sized hospital systems. Now we will find out if there are contingency plans or a “bubble.” Will we have an orderly unwinding or “toxic derivatives”? What will be the impact if 20 million people lose insurance and providers lose the payments associated with them?
So I am starting over by studying Nullification 101 and may be back if I have any insights.
DOCTOR appreciates our valued readers. It’s a challenge being an “orphan” blog so we will take a break and look for a host organization or web site. Please send any comments or suggestions to firstname.lastname@example.org
Thanx! for being my treasured readers.
Jonathan M. Metsch, Dr.P.H.
Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai
Adjunct Professor, Management, Zicklin School of Business, Baruch College, C.U.N.Y.
Adjunct Professor, Rutgers School of Public Affairs and Administration & Rutgers School of Public Health