Reactions to the Ruling

Covenant Health – Tony Spezia, CEO

We believe people should have access to care and are in favor of providing extended coverage… Everyone involved agreed insurance reforms were needed – the disagreement was about how to provide coverage. There is the issue of Medicaid expansion. States can’t be forced to extend coverage – and that piece jeopardizes one of the tenets of the bill … There is concern about an unfunded mandate on states. There are additional concerns among hospitals and physicians about whether we can afford to see a huge growth in state Medicaid programs with the way reimbursements are currently. There are also a lot of people who are ignored by the law – such as illegal immigrants – who still come into our emergency rooms seeking care.

Integrated Solutions Health Network, an affiliate of Mountain States Health Alliance – Rob Slattery, President and CEO

The Supreme Court decision validates the visions and strategies we have embarked upon. We know that we can’t continue to do the same things that have gotten us to this point in healthcare. We share a vision of how the healthcare landscape will change – how we can work together to provide greater value and to promote health and wellness across the communities we serve.

Summit Medical Group and Summit Health Solutions – Tim Young, CEO

The Supreme Court ruling came as a surprise to us. We thought the individual mandate would not be upheld, and we had prepared for several outcomes. The reform legislation is complex, and while it is imperfect, it is a step in the right direction. We are beginning to see alignment of incentives with improved quality, increased satisfaction and savings.

Wellmont Health System – Denny DeNarvaez, President and CEO

Although there are many details yet to be confirmed, Wellmont Health System believes the court’s action is an important step toward meaningful health reform … Any healthcare reform must balance cost-reduction pressures on hospitals and physicians with increased insurance coverage. With basic health coverage for all upheld in this decision, hospitals are in a better position to absorb billions of dollars in cuts that will be required of them to make reform a reality … The end result of this healthcare reform debate will undoubtedly affect how we as hospitals provide health care. It is incumbent upon us, then, to ensure that change is a positive one, not just for the healthcare industry but for the patients we serve.

Chattanooga - Hamilton County Medical Society –John McCarley, MD, President

The Society has no formal plans as yet, but basically, our response is in line with that of the TMA.

I am very concerned about the Independent Payment Advisory Board.  It needs to be eliminated.  It is wrong to allow unelected officials to make payment cuts to physicians as the only means of eliminating Medicare expenditures, especially when physician payment increases have been a little better than stagnant for over 10 years. 

I am profoundly disappointed that there was nothing done to formally eliminate the Sustainable Growth Rate formula for determining provider reimbursement in the Medicare program.

Medical liability reform should have been streamlined for the states if not mandated for the nation. 

Also, I remain skeptical that the ACO model will actually realize any income benefit to primary care physicians after taking into account the tremendous administrative burden of such a program.  There is not much incentive for new MD’s to go into primary care, particularly if they are staring down the barrel of an average medical school loan debt of over $150,000 after graduation.  The lack of any incentive for citizens to improve their own habits (e.g., diet, exercise, avoidance of tobacco, etc.) and preventative care is egregious.  A lot was done to get people insured, but a great opportunity has been wasted in terms of meaningful improvement of health and healthcare delivery for our citizens. 

On a positive note, the elimination of pre-existing conditions for insurance coverage, as well as the added option of coverage of adult dependents until age 26 on parents’ health insurance were good ideas.  I would suspect that added revenue of the latter will help to partially offset the expense of the former. 

Moving Forward in East Tennessee

Two healthcare systems in our region – Mountain States Health Alliance and Summit Medical Group – have created approved Accountable Care Organizations, or ACOs. ACOs are part of the Medicare Shared Savings program, authorized by the Affordable Care Act, and are designed to perform as collaborations between groups of physicians, hospitals and other health care providers that work as a team to give high quality, coordinated care to Medicare patients. The program is designed to reward organizations that prove success in delivering high quality care, achieving patient satisfaction and saving money. In total, there are five ACOs in Tennessee.

Integrated Solutions Health Network, an affiliate of Mountain States Health Alliance – Rob Slattery, President and CEO

ACOs are new care collaboratives that bring in a higher level of accountability and focus on care delivery.  We are looking at people – not just looking at patients or services. We are looking for ways to keep populations healthy and to share savings.

Summit Medical Group and Summit Health Solutions – Tim Young, CEO

We have been building the infrastructure for Summit Health Solutions [Summit Medical Group’s ACO] for the past two years in anticipation of the Affordable Care Act. We are the largest ACO approved in Tennessee with more than 35,000 Medicare lives. We will work with area specialists to reduce duplication of services and create savings through care management and coordination, quality reporting and improved customer satisfaction. [Covenant Health and Tennova Healthcare have signed participating agreements to work with Summit Health Solutions.]

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