The following column was written by Nap Gary, COO of Regent Surgical Health.
Like Charles Barkley, who once asserted that he was misquoted in his autobiography, I wish to disclaim responsibility for the title of this article, even though I wrote it. Given the pace of change in this arena, the title should be "Where Are We This Minute?" but a single column just can't capture that. So I'll try to be accurate through last Tuesday (Jan. 25); after that, you're on your own.
As we all know, the Patient Protection and Affordable Care Act ("PPACA") was passed early in 2010 by a Democrat-controlled House and Senate in response to extraordinary encouragement from a very popular Democrat President. Popularity, though, is a fleeting thing, as the November elections showed. The Republicans regained control of the House and significantly eroded the Democrat majority in the Senate. In January 2011, the House passed a bill to abolish PPACA.
So what happens to PPACA next? In all likelihood, not much (at least in the near term, from a legislative standpoint). It's extremely unlikely that a sufficient number of Senate Democrats would cross the aisle to vote with Republicans to abolish PPACA, and even if they did, President Obama would almost certainly veto the measure. From a legislative standpoint, we're much more likely to see Republican-led efforts to chip away at components of the Act, particularly the Independent Payment Advisory Board and the individual mandate to purchase insurance.
Perhaps the more interesting assault on PPACA will come through the courts, where challenges to its constitutionality are percolating. In December 2010, a federal District Court in Virginia ruled that the individual mandate was unconstitutional, and then on January 31, 2011, a District Court in Florida did the same, but carried the analysis a significant step further. U.S. District Judge Roger Vinson ruled that because the individual mandate was not severable from the rest of the law, the entire law must be declared void. Ultimately, the issues being raised in the lawsuits challenging PPACA may be decided by the United States Supreme Court. Observers suggest that the Court is likely to uphold the constitutionality of the law by a 5-4 vote, with Justice Kennedy being the swing vote, but that remains to be seen.
More broadly, a Republican majority in the House, with its resulting changes in committee and subcommittee leadership, should be a positive thing for surgery centers. Opponents are at least less likely in the short term to succeed in enacting new healthcare legislation that is harmful to providers. There are also encouraging signs that MedPAC is beginning to view surgery centers on less of a silo basis- recognizing that cutting dollars to surgery centers doesn't necessarily mean savings for Medicare. The ASC Association and the ASC Advocacy Committee are working diligently to broadcast that message as well- to help policymakers understand that the alternative to surgery center reimbursement rates is HOPD rates, and a much higher overall cost to the government.
At the same time, regardless of the fate of PPACA, the reality is that the coming years will only see more pressure to reduce payments to healthcare providers. It's crucial that we continue to educate and advocate- to make lawmakers understand that ambulatory surgery centers offer a cost-effective, high-quality alternative to hospital outpatient departments. I urge you to consider contributing to ASCPAC — the industry's political action committee — to support these efforts. You can access information about ASCPAC at www.ascassociation.org or by calling (703) 836-8808.
Learn more about Regent Surgical Health.
Read more from Regent Surgical Health:
- Team Work: How to Form a Successful Partnership
- 4 Ways to Benefit From Your Surgery Center's Natural Advantages
- Becoming and Remaining Engaged: Critical to Success of Physician Partners