Archive for the ‘Reform’ Category

The delivery of U.S. healthcare services is going through a profound change. Yet this change is occurring in the background and not apparent to the general public. The driving force behind this change is payment reform to healthcare providers for medical services delivered. The underpinning of this change is the reduction of cost in the delivery of healthcare services to make it more affordable. The initial step of payment reform has been the reimbursement models of Bundled Payments and Accountable Care Organizations. These new forms of reimbursement are forcing healthcare providers (hospitals, physicians and other care delivery services) to re-examine and redefine the delivery of services and working relationships. The changes being initiated are positive and took something extreme like payment reform to push organizations to look at how healthcare is delivered and make changes in the manner business is done. The outgrowth of these changes will be positive for our society by …

Continue reading The Direction of the U.S. Healthcare Services »

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

Continue reading Employer Sponsored Health Coverage – What Changes Are Coming? »

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 …

Continue reading ObamaCare: More Unintended Consequences »

Due to the significant capital required to operate an ACO, the IRS should allow investments in preferred stock by larger organizations to facilitate the participation of physicians as investors.

Continue reading Accountable Care Organizations – Is the IRS Impeding Needed Health Reform? »

As the summer heat subsides and the leaves are starting to brighten, the debate over healthcare reform in Washington only continues to heat up.  Last week, the Medicare Payment Advisory Commission (MedPAC) released a draft proposal that recommended to Congress to repeal the Sustainable Growth Rate (SGR), which had previously proposed to cut physician reimbursement by 30% as of January 1.  The SGR has been at the center of the debate over Medicare reimbursement since 2005 when the first cuts were recommended by MedPAC.

The conflict with the SGR has always been that it does not account for the rising costs of providing care, nor does it have any mechanism for inflationary adjustment.  As such, for the past few years, Medicare has been forced to recommend payment cuts to Congress, which were prevented only by legislative action to prevent the cuts from going into effect.

With the elimination of the SGR and the prevention of the 30% cuts, this means that there will be a …

Continue reading Impact of Repealing the Sustainable Growth Rate »

It was a different story only five years ago.  For most medical students finishing their residencies and many in the medical profession, primary care as a medical field represented the ugly stepchild of the family and the last to picked in gym class.  The jocks and cheerleaders (e.i., cardiologists and radiologists) were looked up by everyone in the playground and were the kings/queens of the school.  And when compared to specialists, primary care physicians (PCPs) were in fact generally paid less and subject to working longer hours with many days filled with fevers and strep throat.  

However, that is dramatically changing in our post-reform environment.  With headlines like “recruitment demand high for primary care doctors” dotting newspapers and blogsphere, the field of primary care has emerged as the new “it” profession in medicine.  According to a 2010-2011 study by Merritt Hawkins, family practice and general internal medicine physicians were the top two …

Continue reading Primary Care: The New King of the Schoolyard »

They say, “Perception is reality.”  If that is the case, the American Medical Association (AMA) is in serious trouble.

In a recent survey of physicians conducted by the Atlanta-based physician recruitment firm Jackson & Coker, doctors believe that the AMA no longer represents their views. A whopping 77 percent of physicians reject that premise that the AMA currently reflects their profession. Only 11 percent said the nation’s oldest doctors’ organization today stands for what they do. (To view the survey, go to: http://www.jacksoncoker.com/news/News.aspx?sc_cid=AMA)

When asked if they agreed with the AMA’s support of federal health reform, physicians said the organization sold out the nation’s medical profession.  The AMA’s high profile endorsement of ObamaCare has been questioned by AMA and non-AMA member physicians from every corner of the country.

So why did the AMA turn its back on the medical professional?

Many believe that the AMA is deeply conflicted. …

Continue reading Physicians Say the AMA No Longer Their Voice »

As a result of the enactment of the Patient Protection and Affordable Care Act, every charitable hospital must adopt a written financial assistance policy that identifies the specific eligibility criteria used by that hospital for providing free or discounted medical services to qualifying patients. In addition, a charitable hospital is prohibited from engaging in extraordinary collection actions before reasonable efforts have been made to determine whether a patient is eligible for assistance under the organization’s financial assistance policy. The Joint Committee on Taxation Technical Explanation indicates that “extraordinary” collection actions include “lawsuits, liens on residences, arrests, body attachments, or other similar collection practices.” The Technical Explanation indicates that “reasonable efforts” will include “notification by the hospital of its financial assistance policy upon admission and in written and oral communications with regard to …

Continue reading Identifying Charity Care – A Shared Responsibility »

Healthcare Reform is missing the mark to reduce a key driver of healthcare cost, chronic diseases. It does not contain a strategy or approach to control or reduce the costs associated with chronic diseases. A chronic disease is a medical condition that cannot be cured and usually lasts a lifetime. An example of a chronic disease is Diabetes. The CDC estimates that seventy five percent of U.S. healthcare costs can be attributed to chronic diseases and is responsible for seven out of ten deaths. There is also the associated cost of disability with chronic diseases that takes productive people out of the workforce. When this occurs, a financial burden is placed on their family and subsequently the U.S. healthcare system.

Healthcare reform under the stewardship of the current administration and Centers for Medicaid and Medicare Administration (CMS), are testing various healthcare delivery models and forms of payment such as an Accountable Care Organization (ACO) and Bundled …

Continue reading Healthcare Reform is missing the mark to reduce a key driver of healthcare costs »

By the stroke of President Obama’s pen on August 2, America averted its first-ever default and a major economic crisis by raising the debt limit.  And even if the country in the words of the Obama administration lifted “a cloud of uncertainty hanging over the economy,” plenty of economic uncertainty continues today.  Congress and the administration still need to agree on $1.5 trillion more in budget savings by year’s end.  The prime targets:  Medicare and Medicaid.  The “supercommittee” of 12 members of Congress can’t ignore such a huge part of the budget and will have to deal with healthcare costs.  More details can be read here.

If we look into a crystal ball, it would be a safe bet to argue that Medicaid will likely get the brunt of those cuts.  While nearly every major industry or interest group has some form of representation to lobby federal and state representatives (including Medicare), select organizations that may include some of …

Continue reading Making the Case for Medicaid »