SAN FRANCISCO—U.S. healthcare reform is imminent and forthcoming; however, it remains to be seen how these changes will impact the field of electrophysiology (EP), Richard I. Fogel, MD, of St. Vincent Medical Group in Indianapolis, said during a May 5 presentation at the annual Heart Rhythm Society (HRS) meeting.

Passage of the Patient Protection and Affordable Care Act (PPACA) has attempted to reform the health system to focus on patient, but at lower costs. Individual mandates within the act are attempting to work to madate health insurance for all U.S. citizens, but many argue that this is unconstitutional. 

Fogel noted that the U.S. Constitution says that “Congress does have the power to regulate commerce among the several states and make all laws necessary and proper for carrying into execution the foregoing powers." However, the big question remains as to whether it is constitutional for Congress to regulate activity and mandate Americans to purchase something to serve a greater national purpose.

Fogel said that this mandate would mean that an additional 30 million people would be insured. This would have a trickle down effect and patients would eventually move from primary care to being treated by specialists, including EPs. Fogel said that this move could have implications including cutting reimbursement for specialties to pay for the influx of primary care patients.

Fogel said that the movement towards health reform is still in progress, the creation of the Independent Payment Advisory Board (IPAB) (part of the PPACA) will be most controversial, but also most important.

The goal of the IPAB will be to decrease CMS expenses to pre-determined levels to keep the Medicare budget on track. The IPAB will hire 15 members. Fogel offered that this initiative is important, he said that he worries that there will be no opportunity for medical professionals to lobby for these budgetary changes  or provide oversight to the board.

“It’s an effective tool to control costs but whether it’s the right tool is a different issue,” said Fogel..

"If the IPAB finds no benefit to maintain NSR in atrial fibrillation patients (AFFIRM, RACE trials), what will happen to reimbursement for AF ablation?"

Additionally, Fogel touched unon the advantages and possibilities of integrating accountable care organizations (ACOs).

While Fogel said this shared-savings model will “encourage investment in infrastructure and redesigned care processes to achieve high healthcare quality and efficient services deliver,” he offered that the ACO may be good in theory but not be the right structure.

“The government will formalize ACOs as a legal entity and facilities will have to agree to a minimum of three years of participation.” Fogel questioned whether less costly, “better” care is really achievable in this three-year time period.

This ACO model will put a massive amount of pressure on the spending concept surrounding population disease management he said. For EP, will it be more cost-effective to treat a patient with supraventricular tachycardia with long-term pharmacological drugs or with curative ablation? “These are the questions we will need to start asking in the field of EP.”

Fogel concluded: “This is a very dynamic healthcare environment with a lot of unknowns and while I am not sure what the picture will look like in the next five years one thing is for certain, healthcare in the U.S. will be forever different.”