The Affordable Care Act, or “Obamacare,” was Barack Obama’s signature legislative accomplishment, and the House of Representatives just last week voted to repeal it. At its core, the ACA’s goal was to provide essential healthcare coverage to all Americans, and to prioritize quality of care through hospital reimbursements and a rating system that enforced a culture of accountability in the ways that healthcare organizations treated both staff and patients.
Since the move to repeal and replace narrowly passed in the House with a vote of 217 to 213, it is one step closer to becoming law—it now moves to the Senate. Should the repeal go through, it would mean a great many things for both high-volume healthcare systems and down-market providers, which would have to make major changes in talent strategy to adapt.
Major Hospital Systems will lose funding and cut jobs. In January, the major healthcare providers in northeast Ohio banded together to warn the next administration about the impact an ACA repeal would have on the regional economy. Cleveland Clinic, UHHospitals, and the Sisters of Charity Health System publicly agreed that “Statewide, an analysis for the American Hospital Association warns of Ohio hospital losses totaling $15 billion between 2018 and 2026.”
Since healthcare is the largest source of employment in Ohio, the cuts would mean the loss of thousands of jobs, and a dramatic reduction in essential healthcare services. Since a single vacancy in nursing can cost around $33k, hospitals will need to prioritize retention when considering talent strategy.
At the most basic level, the loss of thousands of healthcare jobs would put significant pressure on healthcare organizations nationwide. With fewer healthcare providers, there would be an increase in the need to turn over patients, and by extension, less emphasis on quality of care. The metrics used to measure wait times, value of treatment, and patient satisfaction would take a backseat role to addressing patient volumes. The importance of measuring outcome-based goals would diminish as hospitals are forced to do more with less.
The ACA’s rewards and penalties would have a major impact on quality of care. While HCAHPS was established apart from the Affordable Care Act in 2002, the establishment of the Value Based Care Initiative was what “weaponized” that metric. Hospital and health systems made sweeping changes to their talent strategies to prioritize quality of care and preventative care practices in order to maximize Medicare and Medicaid reimbursements.
A repeal would threaten those reimbursements, to the tune of “168.5 billion dollars between 2018 and 2026” according to a report filed by Rick Pollack, AHA president and CEO, and Chip Kahn, FAH president and CEO. The quality of care standards for hospitals would essentially move from top priority to last, unless the new healthcare legislation accounts for them in the way it processes hospital reimbursements.
With HCAHPS scores and Joint Commission Reviews meaning less to hospital leadership, it will cause a shift in what metrics and organizational priorities will be reflected in both the hiring practices and performance reviews that are conducted.
With smaller hospitals and health systems threatened, there will be a higher concentration of specialized healthcare talent, and greater demand for their services. With repeal and replacement legislation signifying a “death knell” for smaller healthcare providers, the best practitioners will seek out larger healthcare systems or privatize their offerings. With a larger pool of specialized caregivers, the competition for top talent will scale up dramatically—as will the demand for their services.
In order to retain the quality of top-level specialists and staff, healthcare organizations will have to innovate with their own talent strategies. Hospitals will be forced to be accountable for the career tracks of their best performers, and will need to provide the most competitive and comprehensive pay and bonus plans to keep quality of care consistent. With PeopleFluent’s focus on “Outcome Based Goals,” it’s easier than ever to identify, prioritize, and take action on improving performance metrics in healthcare.
With the threat of “safety net hospitals” losing upwards of “$40 billion dollars” in rural communities, this may be the very thing that puts them under. Since the ACA extended Medicaid coverage to tens of thousands of uninsured patients in smaller communities, these same hospitals may not continue to have the resources to keep the best front-line staff and physicians around.
With focus shifted away from HCAHPS, nursing staff could potentially become free to focus entirely on patient care. In my own conversations with healthcare HR leadership, I've learned that there isn't a strong focus on the temperaments of nurses and administrative staff. If consumer assessments of area hospitals continue to focus on the attitudes and manners of the healthcare professionals that interact directly with patients, there is a chance that a perceived ‘bad attitude’ would mean more to a hospital’s funding than a patient who was treated and discharged without readmission.
No matter what happens, the ACA’s replacement would invariably need to focus on how healthcare organizations receive funding; the core argument is whether Value Based Care is an essential pillar of the single-payer health system, and how the ensuing re-prioritization will impact the talent strategies that hospitals implement. With less funding and a higher demand for top-performing healthcare professionals, one thing is certain—the quality of care will change, and we will need to be ready for it.