However, the ACA also could flood hospitals with new, high-use patients, which could tax already overburdened physicians and hospital staff. In addition, hospitals also could receive less money for the same services in the short term: The government has outlined plans to cut reimbursement rates for patients on Medicare.

Hospital administrators and employees are worried, with good reason.

Amid the uncertainty in the industry, one thread remains clear: Hospitals will, in the future, exist in a world where they are rewarded more for the quality of care than for the volume of patients they treat. As this transition occurs, hospitals must live in two worlds — one where they still earn money per procedure and another that views the treatment of patients in a more holistic way, with successful outcomes the most important measure of a hospital’s performance.

“We have to understand that today, we are still paid for volume,” said Kevin Locke, managing partner of CPA firm Dixon Hughes Goodman, who helps clients navigate ACA-related reimbursement issues. “As we migrate from that system to one that pays for value, we have to stay financially solvent. It’s figuring out that puzzle in the middle.”