What the Supreme Court Ruling on Reform Will Mean

Almost simultaneously, I broke my foot and my six-week-old granddaughter developed an acute bronchial infection that resulted in both of us going to a hospital. I was attending a wedding in Indianapolis, so I presented at Indiana University’s Methodist Hospital Emergency Department. Maya lives in Singapore, so she was admitted to KK Women’s and Children’s Hospital. Both Methodist and KK are outstanding teaching and research facilities with international reputations. KK has 830 specialized beds, and Methodist, while licensed for over 1,000, operates at about the same capacity as KK.

 My drama consisted of five hours, lots of pain medication, x-rays and a walking cast with orders to see my own orthopedist for follow-up treatment. Maya’s was much more serious and included five days in the “High Dependency” section with gaggles of newly-minted medical doctors looking over her test results and many times a nurse ratio of 1:1. Five days as opposed to five hours.

 As it turned out, IU charged approximately $200 more than it cost for Maya’s entire hospital stay. I’m not talking about after insurance. I’m talking what was actually paid by insurance and co-pays. And no offense to IU – they charged exactly what you would have seen from most urban US healthcare providers. Singapore is not an inexpensive city. A glass of good Sauvignon Blanc at the Marriott cost me $28 after a long day at the hospital!

 The United States spends a higher portion of its Gross Domestic Product (GDP) than any other country on healthcare, and we seem to get so much less. When the World Health Organization (WHO) ranked 191 countries on the quality of their healthcare, the US came in at 37th. Singapore ranked sixth.

 None of what I am saying is news. The reason we have the Patient Protection and Affordable Care Act, or what is known as healthcare reform, is because the healthcare system in the US is broken. In 2010, we spent $2.6 trillion on healthcare, or 17.5% of the GDP. France, with the WHO’s number one rated healthcare system, spends 11% of their GDP on their healthcare. It is projected that US expenditures will increase to 20% by 2020 if drastic changes are not made. We cannot have economic recovery unless we get healthcare spending under control.

 Knowing this, the Obama administration recently asked the US Supreme Court to rule on the constitutionality of the Patient Protection and Affordable Care Act. At question is whether or not it lies within Congress’ powers to require individuals to obtain health insurance or pay a penalty. Three appellate courts have split sharply, so how the high court will rule is completely in question. The decision is expected by the end of June 2012, more than two years after healthcare reform became law.

 If one section of the law is ruled unconstitutional, all 450 sections will be thrown out. Healthcare reform generally calls for the United States to provide better care for less, to expand prevention and wellness programs, and to extend insurance coverage. But how all that is accomplished is greatly dictated by the way the government pays for healthcare. Physical Therapists became one of the most highly sought professionals when healthcare became law because all of a sudden therapy caps were lifted, they could write their own orders, and it was projected by the Office of Management and Budget (OMB) that they would drive $189,200 to the bottom line annually.

 After the passage of healthcare reform, new for-profit healthcare companies popped up and existing companies morphed into ones that provided services well funded within healthcare reform. Demand grew for professionals providing home and long-term care and rehabilitation for joint replacement. Doctors quickly found that with the demand for Electronic Medical Records (EMR) and funding for episodic care (as opposed to individual services), they wanted to become employees of healthcare systems. All of a sudden, health systems were recruiting lots of physicians.

 The question now becomes whether we continue to recruit like healthcare reform will remain the law, or whether we wait and see if the Supreme Court overturns the legislation.

 Waiting for a final ruling may ultimately be very difficult for Healthcare Human Resource professionals. The timeline for implementation of mandated projects like ICD-10 compliance will continue to tick by, but we won’t know the rules of the game until the end of June. I am afraid that for the next nine months, Senior Management will sit on the initiatives fueled by healthcare reform, and, when the ruling is made one way or the other, they’ll call HR in a panic. (Hire ten of those, hold those, and how’s retention?)

 This uncertainty, coupled with the dragging economy, promises to keep healthcare recruitment something akin to a three-ring circus. You’ll be getting four hundred applications for an accountant and only unqualified ones for that Nurse Practitioner position.

 My advice is to continue to use this time to develop your best lean, mean recruiting machine, recruit as if the law will be upheld because we need it as a nation, and then improve processes. Begin to rely heavily on social and emerging media (which is so much less expensive), develop those standard operating procedures for the hiring managers, re-write the job descriptions, find your metrics and use them wisely, and attempt to put some control in your world. It doesn’t matter how the Supreme Court rules – healthcare recruitment will need organization and strong professionals at the wheel.

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Thomas Delorme
Written by Thomas Delorme

VP, Digital Products & Strategy

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