Archive for the ‘Finance’ Category

So What If You Like Your Health Insurance Plan?

obamacareKyle Wingfield was one of the very first to be right. The AJC opinion page editor hit the nail directly on the head in his column on October 31, 2013 entitled, “Real-life Trade-offs Belie ‘If You Like Your Plan’ Claim.”

Most of us clearly remember President Obama saying, “If you like your health insurance plan, you can keep it.” Truth of matter is that it is simply not the case for millions of Americans and an estimated 400,000 Georigians.

Whether it is employers who have decided to get out of the health insurance business entirely or individual health insurance plans that some federal bureaucrat has determined does not pass ObamaCare’s muster, the reality is: If you like your health insurance plan, you may NOT be able keep it.

More reprehensible is the fact that we now know that the president knew what he was saying was not the truth while he was saying it.

So while the president has thrown everyone from Verizon to House Republicans under the bus for the …

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The Healthcare Reform Law that Inequitably Treats Healthcare Providers

A recent article published in Modern Healthcare[1] highlights how CMS interpreted a rule within the healthcare reform law that is putting healthcare providers at greater financial risk. To summarize, healthcare providers could incur unreimbursed costs for services delivered to a consumer that has discontinued paying their insurance premium. See below for a detailed description of this scenario.

It appears that the business of delivering healthcare to a community is becoming more financially challenging. When you consider the increasing number of patients looking for care, reimbursement rates declining, no limits on malpractice suits and increasing regulatory burdens, it should be no surprise that in the future we see more healthcare providers filing for bankruptcy, looking for a financial bailout, selling their business, delivering limited services or discontinuing operations.

Here is the scenario that puts healthcare providers at greater financial risk due to CMS’s …

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More Unintended Consequences of Federal Health Reform

health reformThe implementation of the Affordable Care Act also known as ObamaCare has caused some interesting responses and reactions within the medical community. Most of those reactions are the direct opposite of the stated goals of ObamaCare.

Let’s look at the goals of ObamaCare and how the healthcare system and healthcare professionals are responding to the increased role of the federal government in healthcare.

First, ObamaCare promised improved access to care for the nearly 50 million uninsured Americans. However, the reality is that more physicians are either leaving private practice, retiring early or getting out of medicine entirely. A national survey conducted this summer by the nation’s third largest healthcare staffing company, Jackson Healthcare, indicates that fewer doctors are in private practice — 52 percent in 2013 vs. 56 percent in 2012. The survey also found a significant shift with physicians leaving their own practice to become hospital employees – a 26 percent …

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Not-for-Profit Hospitals Must Prepare for Reimbursement Shift toward Quality over Quantity

Guest Blogger Donna Fincher, Marketing Manager at Diversified Account Systems of Georgia, Inc.

Hospitals and other healthcare providers have been measuring the value of their services based simply on the numbers of patients they treat for generations. Today incentive changes imbedded in the Patient Protection and Affordability Act are forcing hospitals and physicians to reevaluate their methods of measuring and proving the value of the care they provide.

Historically, full hospital beds and busy physician schedules drove the success of providers; however emerging trends in the industry are leaning toward higher reimbursement levels for better quality services. In short, both government and commercial payers are beginning to reward providers who see patients less often because their original treatment plan was better and more comprehensive resulting in fewer office visits and hospital stays for those patients.

Medicare has already implemented a strict readmissions policy with …

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Healthcare Payment Reform Redefines Healthcare IT Solution Requirements

Healthcare payment reform is a work in process. The Centers for Medicare and Medicaid Services (CMS) Innovation Center is rolling out various test projects to identify how to bend the curve of healthcare costs while improving quality outcomes. These projects are gravitating towards a common underlying reimbursement theme, a fixed payment for services covering the episode of care (ambulatory, acute, and post-acute services) with a linkage to quality outcomes. Present healthcare IT solutions do not meet the anticipated needs of the market for this new form of reimbursement. There are two key requirements a healthcare provider’s IT solution needs to provide:

  • Episode of care (ambulatory, acute and post-acute services) integrated platform supporting the data acquisition, measuring and monitoring of total services delivered
  • Financial accounting system to forecast, measure and manage the distribution of a fixed payment to various providers participating in the episode of …

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Transforming Healthcare One Medicare Patient at a Time

teamAs we ring in the New Year, many features of the Accountable Care Act (ObamaCare) will begin to take shape. State Benefit (Insurance) Exchanges will begin to unfold. The Medicare and Medicaid Innovation Center within HHS will continue to examine and support promising models of care delivery. Cost containment programs like Accountable Care Organizations (ACOs) will begin to reshape the way Medicare pays for healthcare services.

So what are Accountable Care Organizations (ACOs)?

ACOs are organizations created by either groups of doctors or hospitals that improve quality measures in five key areas that impact affect patient care:
• Patient (caregiver) experience and satisfaction;
• Care coordination;
• Patient safety;
• Preventive health; and
• At-risk population health management.

HHS wants to improve the quality of care Medicare patients receive. ACOs are seen as a way to drive improved care through better coordination of healthcare …

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The Affordable Care Act is solidified with the election – Healthcare providers will need to accelerate their plans for payment reform

The recent reelection of President Obama solidifies the future of the Patient Protection and Affordable Care Act (PPACA). A number of healthcare providers (hospitals, physicians, post-acute services, etc.) sat on the sidelines awaiting the outcome of the Presidential election to determine if they needed to start rethinking their business model and what changes are required. Now that we have the answer the PPACA is here to stay, healthcare providers are starting to reassess how they need to redefine their businesses and strategic business relationships.

An underlying principle that all healthcare providers will base their strategic planning against is that the demand for healthcare will rise and the level of reimbursement will decline.  Various payment models are being tested by CMS, and we can expect more variations over the next year or two. With the power of the PPACA, CMS can rapidly adopt a payment model that demonstrates effective results reducing costs and make it a …

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Filling in Healthcare’s Money Pit

The Atlanta Journal-Constitution ran a print article earlier this month entitled “Health care called a money pit,” bringing to mind the similarly titled movie of the mid-80s that detailed a couple’s near split over struggles with never-ending home renovations. Tom Hanks and Shelley Long certainly brought levity to the predicament of high-cost, low-quality construction that resulted in extremely unsatisfied customers. It’s no stretch to see parallels to healthcare’s current situation regarding cost, treatment, and patient outcomes and satisfaction.

The AJC story’s statistics regarding the $750 billion a year squandered by today’s health system won’t bring much of a smile to anyone’s face. The Institute of Medicine’s (IOM’s) one-year estimate of healthcare waste is “more than the Pentagon budget and more than enough to care for the uninsured,” and combines:

  • Unnecessary services worth $210 billion
  • Inefficient delivery of care worth $130 billion
  • Excess …

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Riskier Investment Strategies for Hospitals Could be Slippery Slope

According to a study recently published by the Commonfund Institute, not-for-profit hospitals throughout the United States are turning to riskier investment strategies in alternative assets as a means to make-up for the losses they incur from government reimbursement cuts.  The 2012 Commonfund Benchmarks Study® of Healthcare Organizations evaluated the investments and returns in FY 2011 of approximately 86 not-for-profit healthcare organizations, and compared them to previous benchmarks from the past three years.

The Study concluded that the participating healthcare organizations reported 0% returns on their investments in FY2011.  The Study went on to report that, “The flat returns followed net gains of 10.9% in FY2010 and 18.8% in FY2009 [...] Beyond the flat year-over-year return, the most important shift to emerge from the Study was in asset allocation, where healthcare organizations’ allocation to alternative investment strategies in their investable asset pools …

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Tax Implications of the ACA – Just Bad Timing Part II

The Affordable Care Act has many benefits. The costs of some of these benefits will not be known for a while.

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