Archive for October, 2011

Employer Sponsored Health Coverage – What Changes Are Coming?

Under provisions of the Patient Protection and Affordable Care Act (the “Affordable Care Act”), beginning in 2014, many employers that currently offer health insurance may no longer do so. The Affordable Care Act does not require employers to offer health insurance coverage. Instead, it penalizes large employers that do not offer minimum essential coverage or coverage that is not considered affordable

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Will the ACO Final Rule Actually Motivate Provider Integration?

On October 20, 2011, the Federal Government issued the Accountable Care Organization (”ACO”) final rule. The Government received approximately 1300 comments about the proposed rule objecting to overly administrative burdens, high costs and reporting requirements that exceeded the capacity of current providers. The new rule attempted to address some of these concerns.

Specifically, the new rule reduced the number of quality metrics that the providers must report on from 65 to 33. The quality metrics will focus upon the patient-care giver experience, preventative health, care coordination and patient safety and caring for at-risk populations. Specifically, patients will be surveyed on their actual experience with their caregiver. The patient’s experience will drive whether or not the provider met the quality indicator. If a patient had a bad experience and providers did not achieve at least 30% satisfactory results on those quality indicators, providers will not be …

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The Rational Non-Implementation of the CLASS Act

The Obama Administration has elected not the implement the CLASS Act portion of the Affordable Care Act. The CLASS act established a national, voluntary insurance program for purchasing community living assistance services and supports (CLASS). It was a long term care insurance program. Individuals who might have elected to buy into the program would have paid a premium for five years before becoming legible for benefits. Following the five-year vesting period, the program will provide individuals with functional limitations a cash benefit of not less than an average of $50 per day to purchase nonmedical services and supports necessary to maintain community residence. Premiums were to be paid through voluntary payroll deductions: all working adults will be automatically enrolled in the program, unless they choose to opt-out.

The title of this piece is a take off on a 1990 article by Mark Pauly entitled “The Rational Nonpurchase of Long-term-Care Insurance” published the …

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Physician Assistants and Healthcare Reform

As the culture of Healthcare changes around us each and every day, Physician’s Assistants are becoming a very important and popular player in the game. PAs can assist medical providers meet many of the goals of Reform, including patient centered, efficient, collaborative care. However, their most important attribute may be that their care is significantly cheaper to provide, than the care of a licensed Medical Doctor.

PAs, whom work independently of Doctors, are able to make clinical decisions and handle most routine cases. They also act as a door keeper of sorts, insuring that the Doctors spend the most time with the patients who need the most attention. They are especially important in closing a large gap in the Primary Care Market.

Many States, including Georgia, are working on legislation to make the powers of PAs and their affiliate Nurse Practioners (NP) clearer and more easily defined. Georgia recently enacted House Bill 303. This Bill makes it easier for a PA …

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Flight to Quality: The Banking Crisis and Healthcare

Moody’s continuing negative outlook for the entire sector of healthcare certainly plays a part in the “flight to quality.”  We’ve discussed previously that the largest lenders in healthcare have moved up stream, providing ample capital and solutions to the highest investment grade providers.  This is certainly beneficial to these larger, or financially strongest hospitals and systems because it has caused a rate compression of unprecedented levels.  That means the spread over the lenders cost of funds is deeply reduced from normal, target spreads.  This results in lower profit for the lenders for these loans, but the trade off is the greater security of the largest and most stable credits in the sector.   What about the rest of the sector and what are some creative approaches to solve current capital needs?

The rest of the sector is largely left underserved.  The community hospitals or smaller systems either un-rated or non-investment grade are turning largely …

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The Adaptability of Research and it’s Presentation to the Public

With the various sources of information available today we really have multiple choices of the decision that we make. Let me clarify. There is probably a significant amount of data available on most subject matter to support an answer of yes or no to the same question. Just take your pick. This is occurring with multiple arguments concerning research (whether business, medicine, politics, etc) throughout this country and  the world. There was a recent report that vitamins are not good for you. So should we stop taking vitamins? Not yet. Wait a few weeks and there may be another report that will make you want to take them again.

Without going into the proper guidelines and ethics for developing and reviewing research projects, there should be a general premise from which all research should originate; the researcher should attempt to be unbias. We all see the reports of bias research done by so called independents that help verify a company’s product. There are also tons …

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The Case for Metrics in Improving Access

So often hospitals think of growth in terms of dollars and sense.  When a hospital administrator evaluates opportunities to expand their services, the metric that frequently carries the most weight in deciding whether to commit funding to a project is a financial one, like return on investment.  

This isn’t necessarily wrong.  Even for nonprofit systems that are seen as the stalwarts of their community and provide millions of dollars in charity care year-over-year, the old truism “margins = mission” is still relevant.  In order to fulfill even the most high-minded mission, hospital leadership must be financially responsible and take caution in committing funds to any venture that may lose money, as it will inevitably hold larger consequences for the entire system (whether in terms of credit ratings, solvency issues, community perceptions, etc).  

However, as frequently reported in the press, we know that there still exists a substantial need for better and more …

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ObamaCare: More Unintended Consequences

Since its passage, President Obama’s federal health reform has resulted in a series of unintended consequences. Just last week, the Kaiser Family Foundation released a study which indicates that ObamaCare has caused annual family health insurance premiums to increase at a rate three times higher than in 2010.

ObamaCare has created way too many unintended consequences. 

Remember the ObamaCare provision which guaranteed issue of health insurance for children?  It was intended to ensure that kids who were sick or had pre-existing conditions could obtain health coverage. However, the unintended consequence?  Many health insurers made the business decision to no longer offer so-called “children only” health insurance policies and thousands of children no longer have access to coverage in their state.

Remember how federal health reform was supposed to reduce overall costs? When ObamaCare was passed by Congress and signed by President Obama, the price tag was just over $800 …

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Recent Consumer Healthcare Data Supports Self-Service, Education & Empowerment Mantra

For regular readers of this blog, you know a common theme has been the rise of the “self-service” consumer and that awareness and education leads to empowering consumers into action, of course, aided by technology. I’ve referenced many examples to support each of these theories separately, as well as how they work together for the betterment of consumers and our healthcare system.

Today I’d like to share some recent data collected from our SoloHealth Station™ healthcare kiosks currently in investigatorial testing phases in retail locations across America.

The SoloHealth Station is a self-service interactive healthcare kiosk offering vision, blood pressure, weight, and body mass index screenings; an overall health assessment and recommendations; and access to a database of local doctors. The bilingual kiosks provide free health screenings in a matter of minutes.

The kiosks were designed to make consumers’ access to essential, core health screenings free and …

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