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Meritus Health System president explains challenges of Affordable Care Act

He says act will focus more on outcomes and management of care than volume

February 13, 2013|By DON AINES | dona@herald-mail.com
  • Meritus Health System President Joseph P. Ross addresses the Hagerstown-Washington County Chamber of Commerce breakfast meeting Wednesday.
By Kevin G. Gilbert, Staff Photographer

Figuring out how to improve access, maintain quality and keep down the cost of health care are challenges facing hospitals as more provisions of the Patient Protection and Affordable Care Act go into effect, Meritus

Health System President Joseph P. Ross told those attending a Hagerstown-Washington County Chamber of Commerce breakfast Wednesday.

“Not all Americans enjoy access to health care and that drives long-term costs,” said Ross, who was named to head Meritus in 2011. Improving access through mandated coverage and treating conditions earlier could result in significant cost savings, he said.

“That principle is one of the drivers of the Affordable Care Act,” Ross said. As an example, he noted that treating Stage 4 breast cancer can cost $300,000 or more, compared to $50,000 for Stage 1.

Health care providers will see a shift in how they are reimbursed from what has been the standard fee-for-service model, Ross said. The act will focus more on outcomes and management of care than volume, he said.

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One way of better managing care and controlling costs could be an accountable care organization, or ACO, a group of health care providers whose Medicare payments are linked to how well it achieves quality care and outcomes resulting in cost savings, Ross said.

Several ACOs could be set up within each state, Ross said.

“It’s a macroeconomic model with incentives to more efficiently manage care,” Ross said. It could be particularly effective in managing the care and thus reducing costs for people with conditions such as asthma and congestive heart failure by reducing their hospitalizations, emergency room visits and other uses of the health care system, he said.

State health insurance exchanges will be part of the health care landscape beginning next year and Ross said even “the toughest-talking Republican governors” are deciding to set up exchanges rather than risk the loss of federal funding.

The exchanges are designed offer a choice of affordable health care plans to individuals and small companies, according to the U.S. Department of Health and Human Services.

“It works very well in Massachusetts,” although the exchange in that state also receives a substantial state subsidy, Ross said.

In answer to a question, Ross said he could not predict the effect the Affordable Care Act would have on insurance premiums paid by businesses, but said it could allow them to cap their risk by insuring employees through exchanges.

“Washington County’s got some health care issues ... We look a lot like America,” Ross said at one point.

Although the Affordable Care Act seeks to control costs, in part, by encouraging preventive medicine, Ross said there are social phenomena that “bend the cost curve in a very negative way.”

“The fastest-growing service line and the fastest-growing revenue stream is diabetes,” Ross said. Obesity also threatens the long-term well-being of a significant portion of the population, and mental illness is something that is often not treated until a person reaches a crisis point and ends up in an emergency room, he said.

There are also social pathologies such as teen pregnancy and generational poverty that affect health care costs, Ross said.

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