The ACA challenges ahead

The healthcare reform law is already driving big changes in the ways hospitals deliver care and get paid for it. In a matter of months, the law will extend health coverage to millions of Americans through the new insurance exchanges and broader Medicaid eligibility.

Much work remains for federal officials striving to make sure that coverage is available—and for state officials still deciding how and whether they'll help.

Amid this climate of change and uncertainty, Modern Healthcare asked CEOs attending the recent congress of the American College of Healthcare Executives to describe their most pressing concerns about the Patient Protection and Affordable Care Act. There answers included exasperation over “political” concerns, uncertainties related to undecided state governors and questions about the future costs of some of these reforms.

Here are some of their edited responses.

Sister Carol Keehan, president and CEO, Catholic Health Association:

“I think right now the most pressing question is, let's get every state in this nation to accept expanded Medicaid. I mean, the great horror of having worked so hard to get coverage for the millions of uninsured, to have it there, to have it a hundred percent covered, to have such clear indications of the good it could do and to have people say, 'No, I am not going to do it' for political reasons, or whatever reason—I can't think of any good reason.

“So, our first goal right now is get everybody to accept Medicaid expansion, and we are working right behind that on ways to get people signed up for exchanges and Medicaid expansion.”

Bill Leaver, president and CEO, Iowa Health System, Des Moines:

“In Iowa (where most of our facilities are), the governor is still debating whether to expand Medicaid. We are working with his administration around how to restructure Medicaid; more around an ACO-type concept. We would like to get all of our payers aligned—Medicare, Medicaid, and Wellmark Blue Cross and Blue Shield is the largest commercial insurer—around the same payment methodology.

“We would like Medicaid to be there. And I think they are very open to doing that, but the big question is whether they will expand Medicaid as the law offers that opportunity.”

Rulon Stacey, president, University of Colorado Health, Aurora:

“I think the drive toward population health is going to be a challenge for us and every organization. We are going to have the data systems … in place by the end of the year, but that is just the beginning. And I don't know that those implementing the Affordable Care Act have gotten their minds around fully what it is going to look like when the exchanges are in place. When those people who have access to the exchanges and then have access to the system, how much is that going to cost?

“I don't believe that there is any scenario that has greater reimbursement for us. But sometimes I hear people talking as though the answer is we are going to get everybody in the system and then we are going to be able to pay for everybody's healthcare. I don't know that they've come to grips with that and I think that unknown presents for us challenges, because there is no more money in this for anybody.

“We have got to make sure that we get through identifying what it is that they are trying to get through—the pay-for-performance issues, all those other things—and then make sure that our system is leading the charge and being vigilant about quality of care and driving costs down and bringing those two together.”