By Leah Binder

Modern Healthcare - - Special Feature -

Em­ploy­ers are di­vided on the mer­its of health­care re­form, but they are unan­i­mous in ex­press­ing un­easi­ness about its busi­ness im­pli­ca­tions. Many pur­chasers have ab­sorbed hefty costs in com­ply­ing with re­form’s most im­me­di­ate pro­vi­sions.

Pur­chasers worry that if key qual­ity and cost­con­trol­ling pro­vi­sions in the leg­is­la­tion—pro­vi­sions that many pur­chasers sup­ported and some lob­bied for—fail to de­liver promised re­sults, the busi­ness com­mu­nity will be on the hook for more cost in­creases in the fu­ture.

Now in the wake of the midterm elec­tions, Congress may give the busi­ness com­mu­nity a new plat­form to air those con­cerns.

Why are pur­chasers so wor­ried? Af­ter all, Congress and Pres­i­dent Barack Obama ar­tic­u­lated as a core goal of the leg­is­la­tion “bend­ing the cost curve.” Yet pur­chasers know from years of ex­pe­ri­ence that the strate­gies in the leg­is­la­tion are far more chal­leng­ing to im­ple­ment than they seem, and if they don’t work as in­tended, it is not clear who will be held ac­count­able.

Taken to­gether, most of the cost and qual­ity strate­gies in the leg­is­la­tion rely on a sig­nif­i­cant ex­cess read­mis­sions. The law also calls for new fi­nanc­ing ar­range­ments that would at­tempt to side­line hos­pi­tals among the many providers pa­tients en­counter.

For in­stance, ac­count­able care or­ga­ni­za­tions would pre­sum­ably weight fi­nanc­ing in­cen­tives to­ward pri­mary care and other ser­vices that are less ex­pen­sive rather than hos­pi­tal care. And for those times when hos­pi­tals can’t be avoided, the law im­poses fi­nan­cial penal­ties on those that fail

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