Does anyone really know what the Supreme Court did last week?

The U.S. Supreme Court ruling on the Affordable Care Act is good news for suppliers of the type of medical information technology which helps hospitals maximize existing capacity.

That is, if the high court actually upheld the Act.  That is once again in dispute as a second round of critical analysis gets underway to determine what the court actually did rule. Writing in the New York Times’ Health Care BlogJeff Goldsmith didn’t see last week’s ruling as a win for the act.


“Instant analysts were quick to characterize last week’s Supreme Court decision as a ringing vindication of the Affordable Care Act and a big political victory for a struggling President Obama,” Goldsmith wrote in Robert’s “Flying Squirrel” Maneuver Takes Down the Affordable Care Act.

“On closer reading, the instant analysts were wrong. The Roberts Court actually punched a huge hole in the law, potentially reducing its historic coverage expansion by as much as a third.”

According to Goldsmith, “the Roberts Court found that requiring states to add between 15-20 million new low income folk to Medicaid rolls on penalty of withdrawing the state’s entire Medicaid funding was a coercive and thus unconstitutional abridgement of states’ rights.”

For the Court effectively to rewrite the statute to render the Medicaid expansion “optional” for states was an outcome no-one expected,” he wrote.

Even if that is the case, the law would still leave the doors to America’s hospitals open to the largest onslaught of potential patients in the nation’s history. Estimates of the number of uninsured range from 15 million to 40 million people.  Even when reduced by one third, those numbers will have an impact when added to the leading edge of the 70-million -strong Baby Boom Generation.

Resource optimization will be crucial to the success of hospitals which must deal with a large influx of new patients without benefit of adding new capacity. Reimbursement changes and a shift to disease prevention and more primary care may shift volume but capacity problems in hospitals are more complex than that.  There are fewer EDs, changing reimbursement models, lack of access to capital, an aging population, issues involving community access to primary care. These could take years or even decades to fix.

Meanwhile, hospitals must protect their missions by protecting their marginsand that will increasingly mean making the best use of existing capacity and resources. To manage what’s ahead without bleeding more red ink, they need to take advantage of new operational tools, such as real-time capacity management, which can optimize space, staff and equipment resources while easing overcrowding, reducing waste and increasing revenue.  The “real-time enterprise” of the industrial world, where activities and tasked are monitored and managed as they happen, may now experience a higher adoption rate in America’s hospitals because it achieves a key objective of Affordable Care Organizations (ACOs), to stabilize or reduce costs while improving patient care.


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