The Alternative Press

While the nation continues to debate the pros and cons of today’s decision by the Supreme Court to uphold the national healthcare reform act, at the local level, many physicians believe it’s a positive step forward.

“I’m happy about what happened today,” said Dr. Robert W. Brenner, chief medical officer for Summit Medical Group. “We (Summit Medical Group) are not going to do anything different based on this decision. Although the overall healthcare reform act will affect our practice in the long run, we’re going to stay with our plan to reduce the cost of care while increasing quality. The value in healthcare is what’s most important. There’s no way our employers, our patients, or the healthcare system would tolerate climbing costs when healthcare is not improved.”

One of the highest-cost areas in healthcare, Brenner said, is around hospital admissions. Summit Medical Group has a team in place to handle discharges, oversee prescriptions and follow-up care, even monitor patients in long-term care facilities, all of which helps reduce re-admissions.

“By reducing re-admissions, healthcare providers are able to reduce costs and improve care,” he said. Having that team in place has helped Summit Medical Group reduce its readmission rate from 20 percent, which is the national standard, to about nine percent.

One of the main points of contention in the overhaul that was signed into law two years ago – that most Americans get health insurance or pay a fine – is what actually makes it all work, Brenner said.

“At the state level, if you get right down to it, the individual mandate makes sure the whole thing doesn’t collapse,” he said. “You can’t manage risk when it’s skewed in one direction. The individual mandate would push healthy young people who feel they can get away with not having health insurance, then when they need it, go to the ER and get ineffective and costly care.”

In the historic 5-4 vote, most of the Supreme Court justices said the individual mandate is constitutional as a tax.

Brenner said that personally, he believes it was a good decision based on tax implications as opposed to interstate commerce.

“A lot of the costs are with the uninsured, and those who have insurance and have a disease burden,” he said. “When you have that kind of population, you need to be able to manage them appropriately. It’s important that we cover people.”

In New Jersey, many of the insurance companies are prepared to put up a lower-cost product for those who will now be made to buy policies.

“It won’t be a Cadillac plan, but you’re covered,” Brenner explained. “Insurance companies have been preparing for this for a long time. People are going to be able to go to a website and look at insurance companies A, B and C, line them up and compare them. They will be able to get affordable insurance.”

What’s got so many people riled up, Brenner said, is that coverage is being mandated. The penalty is minimal, and although it does increase over time, there is a cap on how high it can go.

However, part of the overhaul raises the threshold for Medicaid. As it currently stands, Medicaid only covers low-income Americans and those with disabilities, and Medicare is for those 65 and older. That leaves an estimated 30 million Americans uninsured. Under the reform act, more people will qualify for Medicaid.

The Supreme Court had some problems with the expansion of Medicaid, but agreed the expansion could proceed as long as the federal government does not threaten to withhold states’ entire Medicaid allotment if they don’t take part in the law’s extension.

Brenner said a lot of physicians don’t accept Medicaid as the repayment is so low that they often can’t even recoup their costs, let alone make a profit. The reform would move the repayment closer to the levels of Medicare, which repays better.

“We’re the only nation in the developed world that has these kinds of gaps,” Brenner said. “That’s why our health outcomes are terrible. We have some of the most expensive healthcare and the worst outcomes. This is an attempt to fix it. In my personal opinion, this is what was needed. If we tore it all down and started all over again, I think we’d have been throwing the baby out with the bathwater. This is a better way to go.”