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By DAN REYNOLDS, senior editor of Risk & Insurance®

TAMPA, FLA.---The level of interest that healthcare risk managers have in the impact of healthcare reform could be gauged on the morning of Oct. 14, when the American Society for Healthcare Risk Management convened a session on the topic at its annual conference, held this year in Tampa, Fla.

"We are very excited about this, and we think we are leading in many ways," Zimmerman said at the conclusion of the Oct. 14 session.

The impact of the Patient Protection and Affordable Care Act and the Healthcare & Education Reconciliation Act of 2010 on healthcare delivery, quality and compliance is vast, and the task force in Tampa had only an hour to run through the topic.

ASHRM plans to keep a sharp eye on healthcare reform as it plays out over these next couple years, according to Kathy Shostek, an ASHRM board member and a senior risk management analyst with the Plymouth Meeting, Pa.-based nonprofit ECRI Institute, a healthcare research organization.

"It is such a multiyear concern," Shostek said. "It is not just this year. There are many, many years of health reform to come."

SAFETY A SHOW STOPPER

One reform-related presentation that got the crowd in Tampa vocal was by Dan Groszkruger, another ASHRM board member who is an attorney and a risk manager with the Stanford University Medical Center. His presentation centered on the quality and safety provisions of reform and the various research and compliance departments and organizations that will be created to implement it. One goal of reform is to get 32 million more Americans covered. Another is to create more efficient and better quality of care, and it is here where risk managers will want to pay particular attention.

Remember the chatter about "death panels"? That was a way of discussing the Comparative Effectiveness Research provision of Sections 6301-6302 of the act as amended by Section 10602. According to Groszkruger, the act calls for the creation of a nonprofit, nongovernmental agency that will award millions of dollars to evaluate and compare metrics including healthcare interventions, care management, medical devices and pharmaceuticals.

Groszkruger's problem with some of the language in the act concerns its vagueness. By Jan. 1, 2011, the act requires that the U.S. Department of Health and Human Services give to Congress a National Strategy for Quality Improvement, which is supposed to address concepts such as outcomes, "patient-centeredness" and efficiency.

Other ideas that are not in the law but are said to be part of this developing national strategy include the concepts of "person-centeredness," eliminating disparities and "aligning public and private" healthcare improvement efforts.

"It's all clear right? We can all pack up and go home," Groszkruger said, referring sardonically to the questions those terms are sure to elicit.

The language of reform as adopted may be cumbersome. But Zimmerman said that there are big opportunities for healthcare providers should the industry create the efficiencies and other improvements that the reforms call for.

"The benefit is positive," Zimmerman said. "If we can decrease readmissions, we can increase the amount of emergency room availability and the availability that we have for patient care and treatment."

If the laws work as intended, the outcome for patients improves, costs are reduced and services expand, Zimmerman said.

October 15, 2010

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