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Interventionalists Speak Out on Supreme Court's Decision to Uphold ACA
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On June 28, the Supreme Court ruled in favor of the Affordable Care Act, voting 5-4 that the mandate is constitutional and essentially upholding it in its entirety. Following this news, Cardiology Today Intervention talked with three of its board members to get their thoughts on what the Affordable Care Act (ACA) will mean for clinical practice.
Deepak L. Bhatt
It is very difficult to predict what effect the ACA will have on cardiology and on interventional cardiology. The mandate for everyone to have insurance will likely lead to increased demand for medical services across the board. On the other hand, downward pressure on reimbursement will likely continue. So, practices could be busier, but take in substantially less revenue and this could strain their ability to provide top-notch care. Accountable care organizations (ACOs) will become popular, at least for the next few years, and this will favor large, integrated health care systems. Most solo practitioners and small group practices are unlikely to be able to survive without allying or merging with much larger health care entities. These trends have already started and will likely accelerate. How these changes affect patient care remains to be seen, but it will be important for cardiologists to stay abreast of upcoming rapid changes in health care and do what they can to maintain high-quality care, protect patients' interests and speak out if they don't feel that patients are being well-served.
– Deepak L. Bhatt, MD, MPH
Cardiology Today Intervention Chief Medical Editor
Disclosure: Dr. Bhatt reports no relevant financial disclosures.
David J. Cohen
I believe that the ACA will be good for patients and therefore good for cardiology. Many patients who are uninsured or underinsured currently do not seek medical attention until it is “too late” — at which point they often present with a critical condition, such as an MI or a serious HF exacerbation. By mandating insurance coverage for all Americans, the ACA will allow these patients to follow-up more regularly with their cardiologist, which should improve their health in the long run. This should also allow us, as cardiologists, to practice evidence-based medicine in a more unrestricted fashion than is currently possible. As one of the most evidence-based areas of medicine, cardiology should benefit from these changes.
– David J. Cohen, MD
Cardiology Today Intervention Editorial Board member
Disclosure: Dr. Cohen reports no relevant financial disclosures.
Kenneth Rosenfield
The interventional cardiology community embraces the concepts encompassed within the ACA: access to high-quality health care for all individuals (regardless of socioeconomic status or pre-existing conditions), focus on prevention and quality improvement, and patient-centeredness. The Supreme Court’s reaffirmation of the ACA will reinvigorate us to continue pursuing and build on our multiple initiatives aimed at improving quality of care and CV health of our patients — not only by reducing mortality and morbidity, but also by improving quality of life for our patients, a major focus this year for SCAI. I am proud of how the interventional cardiology community has enthusiastically taken on the challenge of increasing value in health care. We have been leading the charge to improve quality and reduce waste by actively scrutinizing ourselves with rigorous peer review and support of facility/operator accreditation, embracing transparency with public reporting of outcomes, critically assessing the appropriateness of our practices by implementing “Appropriate Use Criteria,” and providing tools to enable quality improvement (SCAI QIT toolkit). We look forward to building on the improved access to care that the ACA provides, and ensuring that the right patients get the right treatment, every time.
Finally, the importance of enabling the individual patient to engage in a shared decision-making process with his/her physician and to determine what is the most appropriate treatment for that particular person cannot be understated and this must be preserved and even enhanced with more informed patients. As we work to make the health care system more affordable and sustainable, we must preserve the best of American health care, including the tremendous advances we have made in CV care over the past 20 years.
– Kenneth Rosenfield, MD
Cardiology Today Intervention Editorial Board member
Disclosure: Dr. Rosenfield is a member of inaugural class of the Masters in Health Care Delivery Science Program at Dartmouth College.