The Patient Protection and Affordable Care Act, dubbed "Obamacare," was signed into law by President Obama in March 2010 and large pieces of the law are now being implemented.
So what does implementation of Obamacare mean for Park City's largest health care provider? Robert Allen, Park City Medical Center's CEO, recently discussed health care reform with The Park Record and explained how the medical center is preparing for further health care reform implementation and what it is expecting to see in the near future.
Obamacare has been making national headlines the past two weeks because state health insurance exchanges were just opened for the so-called "individual mandate" that goes into effect Jan. 1 and requires individuals who cannot obtain health insurance through an employer to purchase individual coverage from their state's exchange, if they are able to afford it. If they can afford it and forego obtaining insurance, they will be required to pay a tax penalty. For those who do not make enough money to be able to afford to purchase coverage on the exchanges, there are subsidies available.
While there are ongoing debates about the economic effects of Obamacare, most expect the law to result in more Americans having health insurance. A key question, then, is what effect that will have on health care providers like Park City Medical Center.
"We anticipate probably an increase at the hospital in those front-end, wellness service things that we do," Allen said. "Our LiveWell center, our health and wellness center here at the hospital, we anticipate doing more services for people in the up-front assessment side and monitoring things as basic as mammographies and colonoscopies."
Greater access to preventative care services comes with a cost, Allen said, "It will probably impact the volumes here at Park City Medical Center as well as other hospitals across the country providing those diagnostics."
Allen is hoping, however, that the greater traffic on the preventative side will decrease care for individuals in need of urgent, and more expensive, care. "We do think, in time, we'll see a shrinking in the utilization on the back-end side. We hope that's a driver of more health and wellness on the front. That's our mission, so that would be a good thing."
"Interestingly, we've seen that impact since 2008," Allen said about the front-end/back-end dynamic. "We've seen a shift in the marketplace in how people make health care decisions, based on the economy. That shifted in people's lives as we went into the Great Recession, and that has not all come back.
"Typically, what's happened in a recession time period, is people will put off the preventative or elective items they could do, and they'll put that off for a year or 18 months. And what happens then is we see an increase in ER visits because those things that were minor start to build and become where they're not minor anymore and people then have to suddenly go get care for something."
Allen is wary of "unintended consequences" of the health care law. He is concerned with "compression of payments" to hospitals, which are already depressed because of the current budget situation in Washington, D.C. "We're in the sequestration now, our Medicare reimbursement is down two percent. That was just part of that budget deal that led us up to where we are right now," he said.
Another potential unintended consequence is whether more physicians may decide to not accept Medicare or Medicaid coverage, driving more patients to health care providers like Park City Medical Center. Allen is also on the lookout for whether a significant number of businesses decide to pay a tax penalty rather than providing coverage for their employees (the employer mandate is not set to take effect until January 2015), forcing more people than expected into the individual market.
Allen warns that Obamacare isn't a cure-all for health care insurance in the United States, but that it can still have a positive effect. "Along with more people covered, we also will still see people who are uninsured," Allen said. "We're going to see there's still projections of millions of people across the country who ultimately won't have health insurance, but for those who have new access and choose to take that access, it will be a positive thing for them."
"The ultimate goal is going to be: How do we use the framework here to deliver better care, to better manage the cost of care, and to really focus people on the front-end of personal decision-making to get the outcomes for their health and wellness, the lifestyle they want," Allen said, returning again to the hospital's focus on preventative care. "That will reduce the cost of care and frankly it improves people's lifestyles. The health and wellness component of this, I think is the core of where we want to leverage for the benefit of our community."