There's plenty of uncertainty surrounding the health care reform law passed by Congress earlier this year. Only time will tell how some aspects of the law play out, and much skepticism remains over whether cost-cutting measures spelled out in the bill will be honored — or reversed — by a future Congress.

But one relatively small part of the bill will be felt at hospitals across Western Pennsylvania, including Butler Memorial Hospital. Changes to a formula that determines Medicare reimbursement payments to hospitals will change in a way that reverses years of underpayments to hospitals in this region.

It's expected that hospitals in Western Pennsylvania will share in an estimated $67 million a year in additional Medicare reimbursement funding.

But while that change is positive, it will just allow the region to begin catching up after more than a decade of declining reimbursements caused by the old hospital-reported wage formula for Medicare reimbursements.

It's been estimated that declines in the region's wage index used in the reimbursement formula has cost area hospitals about $300 million over the past eight years.

Changing the formula in a way that brings an additional $67 million a year will, after five years, just bring reimbursements to area hospitals up to the level they should have been receiving without the lower payments related to the old wage index formula.

Over the longer term, if the new formula is maintained, area hospitals could see some financial gains, relative to hospitals in other parts of the state and nation.

The old system, using wage reports from hospitals, resulted in two different hospitals being paid different amounts for the same procedure. Hospitals in Western Pennsylvania saw their wage-based reimbursements decline more than payments to hospitals in any other area of the country, except in Muncie, Ind.

Starting in 2012, the reimbursement formula will use figures from the Bureau of Labor Statistics, which is expected to boost payments to hospitals across Western Pennsylvania.

The idea of cost-based reimbursements makes sense, because cost differentials are recognized as a reality. But in addition to creating inequities for hospitals in this area, the approach can be viewed as having an inflationary, and perverse, impact on health care costs — hospitals were rewarded for having higher costs. What incentives would a hospital have to hold down its costs, when its government reimbursements go up as its operating costs go up?

Beyond the formula-based inequities, there were political inequities that occurred when some members of Congress were able to link or group certain hospitals to high-wage hospitals hundreds of miles away, earning suburban or rural hospitals the higher urban reimbursements.

Fixing the Medicare reimbursement system is good for Butler Memorial and hospitals across the region. But the health care reform law also contains some bad news, or potentially bad news, for hospitals in the bill's plans to reduce overall Medicare spending by $500 billion over the next decade.

To pay for the cost of taxpayer-subsidized insurance for many of the 30 million previously uninsured Americans addressed in the health care reform bill, Congress mandated huge cost savings to come from Medicare.

The cost-cutting plans in health care reform worry Butler Health Systems Chief Executive Officer Ken DeFurio, who fears the lowering of reimbursement rates across the board will hurt BMH's bottom line.

The health care bill's 2,500 pages no doubt include changes few people know about. And even for those changes that are clearly spelled out, it is often difficult to foresee the impact years into the future.

Still, there is some good news in the just-passed health care reform law for Butler Memorial and other hospitals in Western Pennsylvania if the flawed wage index Medicare reimbursement system is fixed and made more fair.

But the ultimate impact of the health care reform law on BMH is still impossible to determine.

Congress put most of the emphasis on expanding coverage and restricting the most abusive practices of health insurance companies. The result is that little was done to address the fact that America spends, on a per-capita basis, nearly twice the amount spent on health care in other advanced nations.

Making Medicare reimbursement more fair is an overdue change, and one that will benefit Butler Memorial Hospital. It's less clear how other changes will impact BMH, but the hospital's recognition for quality care and progressive efforts to reduce hospital-acquired infections might pay dividends as health care reform shifts toward paying for results rather than number of procedures and costs.