With new leaders in D.C., health care providers in limbo

By Delen Goldberg

Monday, Nov. 22, 2010 | 2 a.m.

Health care providers are in a state of paralysis.

Doctors, hospitals, insurers and other medical professionals know they have to adhere to provisions outlined in the health care reform bill Congress passed in March. But with newly elected representatives and senators heading to Washington, many who have vowed to do away with health care mandates, the medical industry is hesitant to spend millions of dollars to redefine the way it does business for a law that could look very different very soon.

“Clearly Congress is going to be a different animal and have a different take on this than the Congress of a year ago had,” said Larry Matheis, executive director of the Nevada State Medical Association. “It’s hard to know exactly where we’re going to be in January or a year from January.”

As a result, health care providers “are moving ahead only on those things that are critical,” Matheis said. “Most doctors have put on hold what they are going to do about the parts of the act that begin to kick in next year and the year after.”

The health care bill requires practitioners to overhaul almost every aspect of how they do business. Providers have to redesign billing systems to allow for bundled payments that cover a continuum of care rather than individual procedures. Insurance companies face a bevy of new standards and regulations. Doctors and hospitals expect to serve significantly more patients — about 32 million more nationwide — and a larger Medicaid population. Everyone in the medical field will have to implement electronic records systems.

“It’s not just about installing technology,” said Dave Roberts, of Healthcare Information Management and Systems Society, a nonprofit health care information technology group. “It’s a completely different way of delivering health care.”

Because the changes are expensive, providers are loath to make them while Republicans, who will control the House in January, continue to promise widespread overhaul of the bill. Worse, health care practitioners say they don’t know what changes to make because the government hasn’t written specific regulations yet.

“We don’t even know what the laws are,” said Dr. Tony Alamo, of the Alamo Medical Clinic in Henderson. “That’s the limbo we’re in. It was done so abruptly, so quickly, they’re still working on the regulatory process now.”

Alamo believes the reformers’ intentions were good, but he bristles at how the bill was implemented and written, calling it a politically motivated “law of unintended consequences” that will hurt doctors and patients. Alamo hopes a lull will give politicians time to rethink the provisions and improve the law.

“What occurred on Nov. 2 was an eye opener for those who were part of the ‘Obamacare’ push to realize that the public didn’t want this,” Alamo said. “Because of that, I think that even the Democrats are going to walk a little slower and ask more questions.”

Repealing “Obamacare” was a signature Republican campaign platform and many politicians attribute their victories to that promise. With 2012 elections in sight, they know it’s important to deliver.

Rep. John Boehner, the incoming House speaker, recently vowed to “do everything we can to try to repeal it.” Nevada Rep. Joe Heck, a moderate, said there are parts of the bill that need rescinding and revising.

Senate Majority Leader Harry Reid, fresh off the Democrats’ bruising election cycle, allowed that he’s “ready for some tweaking” of the bill. President Barack Obama said he was open to changes. But both maintained they would fight repeal.

A Democratic Senate, along with a president who sees health care reform as his biggest success, will make it nearly impossible for the GOP to repeal the bill. But Republicans do have the power to stall progress and have threatened to do so by holding up funding needed to push reform provisions through.

“The fear is death by 1,000 cuts,” Roberts said.

Most likely, the GOP will use its power to force Democrats to change portions of the bill opponents find most odious.

The consensus among experts is that movement will be slow, and debates, oversight hearings and political posturing will delay the federal government from finalizing and specifying regulations providers need to move forward. The medical community will remain in a holding pattern.

“If there’s not going to be resolution of this until the 2012 elections, I think our system and the doctors are going to get increasingly frustrated,” Matheis said. “And they are going to increasingly try to insulate their practices” by putting off reforms.