1. ACOs will soon be defined. Hospitals holding off on accountable care organizations until CMS releases its proposed ACO regulations don’t have long to wait. “The proposed regulations are due in the next few weeks,” Mr. Kahn says. “We’ll see what more they have in mind.” He adds: “Hospitals haven’t been sure just what an ACO is. When the regulations are out, they will be able to determine whether they want to participate.”
2. Expect more experiments. While CMS moves forward with ACOs, its Center for Medicare and Medicaid Innovation, which just opened its doors, will be testing out a variety of other models to reduce healthcare costs and improve quality. “These new models may or may not be scalable, but it does begin the process,” Mr. Kahn says.
3. Don Berwick has one more year. While the federation supported the recess appointment of Don Berwick, MD, as Medicare administrator this summer, but Mr. Kahn doesn’t think the controversial administrator will last. As a recess appointment, Dr. Berwick cannot serve much past 2011. “I don’t think he can be approved by the Senate,” Mr. Kahn says.
4. Deficit panel will be mostly ignored. President Obama’s deficit commission recently called for sweeping reductions in hospital payments, but Mr. Kahn doubts they will be implemented. “The deficit commission didn’t get the message about health reform,” he says. Hospitals already agreed to $155 billion in cuts in the next 10 years to help support the reforms. The report, simply a draft proposal, must still be approved by the full commission and then needs to get through Congress. “I have my doubts that is going to happen,” Mr. Kahn says.
5. No regrets about backing reforms. The federation was an early supporter of healthcare reform. Even with mounting GOP opposition, Mr. Kahn, formerly a Republican political operative, has not regrets about that stand. “We support health reform because we think it will be helpful for hospitals,” he says.
6. Reform will stay in place. With President Obama ready with a veto pen, there won’t a repeal of health reform in the next two years. In that period, “the risks of any further reductions in hospital payments are probably limited,” Mr. Kahn says.
7. Too early to tell about a repeal. Republicans are determined to repeal reform and President Obama has been weakened by the midterm elections, but it is too early to tell if the GOP will win back the White House in 2012 and overturn reforms. “We would have to get a little closer to that before I would have an opinion,” Mr. Kahn says.
8. Expect some Medicaid reductions. As states draft their 2011 budgets, they are considering big cuts in Medicaid. Their problems only get worse next June, when extra federal funding for Medicaid end. But Mr. Kahn says the degree of the problem varies by state and, in any case, the healthcare reform law requires states to maintain a minimum level of eligibility.
9. Expect more uninsured. Viewing the sluggish economy, numbers of uninsured are not about to fall and may even get higher in 2011, Mr. Kahn says. They might well high until coverage expands in 2014. “This is not going to get any better until 2014,” he says.
10. More hospital consolidation likely. For-profit companies are completing blockbuster takeovers of systems in Detroit and Boston, and there could be many more consolidations to come, carried out by for not-for-profits as well as for-profits. “I think this trend could continue,” Mr. Kahn says. “There are more available options for hospitals, such as investments to grow IT, if they are part of growing systems.”
Learn more about the Federation of American Hospitals.
Read more about Chip Kahn and the Federation of American Hospitals:
– Federation of American Hospitals Answers 10 Questions on ACOs Posed by Antitrust Enforcers
– Leading Hospital Organizations Back CMS Nominee, as Senate Hearings Near
