With the ACA seeing to it that millions of patients are insured, it should be an unmitigated blessing for hospitals. But the truth is, there's a fair amount of confusion out there as to just what the net benefits to hospitals will be, and what hospitals can do to make sure they get the best of the situation.
Here's a few examples of the dilemmas hospitals face when they consider their strategy for dealing with health system changes related to the ACA.
1. To pay or not to pay?
Looked at one way, it makes a lot of sense for hospitals to pay premiums for patients who can't afford them. (And make no mistake, there are millions of middle-class consumers who make "too much" to get a subsidy, yet haven't got enough cash to pay the premiums.) In theory, paying for thrifty exchange policies but only saves money over leaving patients uninsured, it's a tangible demonstration of community benefit which can do good things for charity hospitals. But with HHS discouraging the practice, it's understandable if hospitals don't dare pursue this strategy. It's a tricky issue.
2. The staffing dilemma
In theory, hospitals should anticipate that newly-insured patients should bump up the bottom line now they can pay for services. In these circumstances, it makes sense to staff up in preparation for the new business they can anticipate. The problem is that with many patients only able to afford high-deductible policies, hospitals' financial exposure is still high. (After all, a patient who can barely afford the premiums on his high-deductible policy probably can't afford to pay the first $2,500 -- or even more -- for his care each year.) So hospitals are left to muddle along, make the best demand forecast they can and hope for the best.
3. Capital investment
Hospitals are already up the eyebrows with infrastructure investment demands, such as the need to prepare for ICD-10 and meet Meaningful Use Stage 2 standards with their EMR. But should they also invest in additional health IT tools and other infrastructure designed to support a new flow of patients equipped with health insurance? As with the staffing issue, it's very hard to predict what impact patients enrolled in the ACA policies will actually have. Hospitals will have to grapple with this issue as well, despite having far too little information on how the ACA will hit home financially.
Would you like to see more healthcare news and analysis like this in your inbox on a daily basis? Subscribe to our Healthcare Dive email newsletter! You may also want to see our look at four reasons why health IT networks won't bloom in 2014.