ACOs and other lower-profile provisions that enjoy more bipartisan support, in fact, could ultimately play key roles in reshaping healthcare delivery. Many of these reform efforts have been launched as pilots or demonstration projects. Salt Lake City–based healthcare consulting firm Leavitt Partners tallied nearly 500 ACOs through the end of July 2013—more than double the total in June 2012.
Other ACA provisions are levying fines based on excessive hospital acquired conditions or readmissions, and adjusting reimbursements based on e-prescribing, the Physician Quality Reporting System (PQRS), meaningful use of electronic health records, and other mandates. “There’s this broad theme out there of trying to get away from fee-for-service with various models, accountable care organizations, and other experiments, to see if they will lower cost and improve quality,” Dr. Laing says.
Hovering over all the change is the specter of more paperwork and bureaucracy, but Dr. O’Malley sees plenty of potential for increased efficiency. “I think increased emphasis on teamwork and delegation of tasks that don’t require a physician’s level of training is something that’s going to get a lot more attention moving forward,” she says. “It’s something that can help us function more effectively and efficiently so that we can make the providers that we do have go further and meet the population’s healthcare needs.”
Bryn Nelson is a freelance medical writer based in Seattle.
ACA by the Numbers
Sometimes, numbers do tell a story. The ACA has no shortage of them, and amid the densely packed provisions, regulations, pilots, demonstrations, fines, and other elements, a few numbers provide a glimpse of the intense wrangling that created both winners and losers in the healthcare reform effort.
One of the biggest numbers is also the mostly hotly contested: whether the ACA will blow a hole in the nation’s deficit or lead to a trillion dollars or more in savings over the first two decades. In March 2010, the Congressional Budget Office predicted the latter, with savings of $143 billion through 2019 and a hazier guess of savings equivalent to 0.5% of gross domestic product through the 2020s (equal to $1 trillion or more).3
The problem? “That calculation reflects an assumption that the provisions of the legislation are enacted and remain unchanged throughout the next two decades, which is often not the case for major legislation,” the CBO wrote at the time. That prediction, at least, was spot on.
Amid the ongoing political back and forth, one point is often overlooked: although still unsustainably high, per-capita healthcare spending is now increasing at the lowest rate in decades. Robert Berenson, MD, an institute fellow at the Washington, D.C.–based Urban Institute, a nonpartisan think tank focused on social and economic policy, notes that the trend (starting in 2006) predated the recession. Likewise, it is occurring in Medicare, where most beneficiaries have first-dollar coverage. Instead of being a side effect of the sluggish economy, Dr. Berenson believes fundamental change is occurring on the provider side, and that the additional focus on reform may be making a difference.
