Archive for the ‘Uncategorized’ Category

Last week CMS and the IRS came out with proposed rules on exemptions to the health insurance mandate. As you know, PPACA requires individuals to purchase health insurance that meets certain minimum criteria. These regulations create hardship exemptions which exempt individuals from paying the fines.
There are three main exemptions: 1) if it is determined that the coverage available through the health insurance exchange in an individual’s state is unaffordable, the individual would not be subject to a fine 2) individuals which would be eligible for Medicaid, but for their state’s refusal to accept Federal funding to expand Medicaid, are not subject to a fine and 3) individuals who are not required to a file a Federal return are also exempt.
Therefore, the Congressional Budget office estimates that only 2% of the population will actually pay the penalty. This means there will still be a lot of individuals without insurance who are not subject to the fines. At the same time, it …

Continue reading Will the Health Insurance Mandate really change anything for Hospitals? »

By Bart Foster, CEO & Founder of SoloHealth

@Bart_Foster

Money is a powerful motivator. Look no further than the sports world for validation. The PGA’s FedEx Cup encourages golfers to earn “points” towards participation in playoffs that offer a big season-ending payoff. Tennis has a similar format with the U.S. Open Series where performance in a series of events equates to a huge prize purse. Both instances use hefty prize money to help ensure the top performers participate and at high levels. The Centers for Medicare and Medicaid Services (CMS) have applied this sports theory to its rankings system of Medicare Advantage (MA) and Prescription Drug Plans (PDP) plans. And there’s billions of dollars up-for-grabs for healthcare plans.

CMS Ups the Ante on Star Ratings
Since 2007 the CMS has posted rankings of MA and PDP plans to give consumers an informational tool when comparing and selecting plans. It was designed to help identify poor-performing plans and provide consumers …

Continue reading Billions at Stake in CMS’s Pay-for-Performance Rankings »

In February 2009, the American Recovery and Reinvestment Act (“Stimulus Act”) provided significant financial incentives for healthcare providers to adopt and implement electronic health records. Because healthcare providers were encouraged to electronically store and transmit patient protected health information, patient advocates became concerned about the privacy and security protections for patient information. In order to improve the privacy and security requirements, the Stimulus Act included an entire section that enhanced the security requirements and increased the penalties if the providers failed to comply. This section of the Stimulus Act is the Health Information Technology for Education and Clinical Health Act (“HITECH”) and it modified the Health Insurance Portability and Accountability Act (“HIPAA”). HIPAA created the minimum privacy and security requirements. HITECH takes security and privacy to a new level. Over the last three years, hundreds of pages of …

Continue reading It Is Here….The HIPAA Omnibus Rule Is Released »

Last month we tiptoed away from the fiscal cliff. This month we are bumping up against the debt ceiling, and if we avoid that concussion, later this spring we’ll clash on the budget threatening to shut the Federal government down. Congress members from Harry Reid to John Boehner are declaring that we can’t continue to kick this can of long-term budget deficits down the road.

With respect to health care I would suggest that “kicking the can down the road” is exactly what we should be doing. Our current deficits are largely the result of a large tax cut, two wars, and the Great Recession. Hopefully the wars are winding down, we are slowly growing our way out of the recession and for better or worse some of the tax cuts have been repealed. In any case, in the short term deficits are having no effect on the economy: interest rates near zero, price inflation in minimal, and the cost to the government of borrowing is as low as it has ever been.

In the long term however, large …

Continue reading Lets Kick The Can Down The Road »

As the Georgia legislative session gets into full swing this month, many events are being held around the Capitol to help legislators get acquainted (or reacquainted) with each other, their constituents, and the issues and organizations impacting the state as a whole. The recent Healthcare Unscrambled event put on by Georgians for a Healthy Future highlighted three big areas of legislative interest: Medicaid expansion, telemedicine, and child-only insurance policies.

Continue reading Child-Only Policies, Telemedicine & Medicaid Expansion in Georgia Legislative Spotlight »

This week Health and Human Services announced the first HIPAA breach settlement involving less than 500 patients. Hospice of North Idaho will pay a fine of $50,000.00 for breaches of electronic PHI. The breach resulted when an unencrypted laptop was stolen containing PHI of 441 patients.

In its press release regarding the breach and settlement, HHS emphasized that Hospice of North Idaho had not conducted a risk analysis to safeguard their electronic PHI and further did not have policies and procedures in place regarding electronic devices.

This is the first indication from HHS of how serious they are taking HIPAA breaches, especially involving electronic devices. In response to this case, HHS has even started a mobile device initiative, which can be found at www.HealthIT.gov/mobiledevices

In an era where every Healthcare Executives is carrying multiple mobile devices at any given time, it will behoove every organization to take a strong look at their policies and …

Continue reading HIPAA and Electronic Devices »

 The GBI reported that prescription drug deaths jumped 10% in 2010 and the Centers for Disease Control is calling prescription drug overdose deaths an epidemic (recently report in GA Public Broadcasting News).  If this substance abuse has not affected you, your family or people you associate with, just wait. It could  be that you are not aware of the problem which lurks so close to your home.

The prescription drug problem is additive to the illegal drug market which has been both condemned and glamorized. Drugs (and alcohol) are a daily crutch for many of us whether we meet the criteria for abuse and dependence or not. Too many of us turn our heads to these problems which are so prevalent at home and on the job. Crime and abuse are frequently connected to people who are abusing some type of illegal or legal substance. Also many of those who are diagnosed with mental illness tend to abuse substances for self medication or, in many instances; the substance is the root cause of …

Continue reading Substance Abuse is Usually Close to Home »

Today, Secretary Geithner informed Congress that the United States would hit the debt ceiling limit on Monday, December 31st. The following day, absent successful Congressional intervention, Physicians will incur a twenty-six and half percent (26.5%) reduction in Medicare Reimbursement. And yet one day later on January 2nd, if Congress fails to address the “fiscal cliff”, healthcare providers will incur a two percent (2%) reduction in Medicare payments. The two percent (2%) decrease is projected to save over $11 Billion from the Medicare program in 2013 alone. So while many Americans are focused upon the potential increase in taxes, healthcare providers must evaluate how to address these dramatic pay cuts.

Each year, physicians demand for Congress to correct the Medicare Sustainable Growth Rate (“SGR”) to prevent this significant decrease in Medicare reimbursement. Each year, the physicians have successfully obtained a delay in the implementation of the payment …

Continue reading The Fiscal Cliff and Healthcare »

Healthcare consumers have been hearing a lot about 2014 lately, especially with regard to what their health insurance options will be. Most know that in just over 12 months, a big change is coming to the health insurance landscape, but I’m willing to bet that the majority of that “most” doesn’t yet have a firm grasp of what a health insurance exchange is, what it will look like in Georgia, and how it will benefit their pocket books.

As an average healthcare consumer, here is my brief attempt to demystify this term, and to break down its implications for Georgia citizens.

What is a Health Insurance Exchange?
According to Kaiser Health News, a health insurance exchange (also referred to via the HIX acronym) is a state-specific marketplace/website “where individuals and small businesses can shop for coverage, which will take effect on Jan. 1, 2014, and also find out whether they are eligible for federal subsidies or for Medicaid.”

States can choose to either set up and run their …

Continue reading Demystifying Georgia’s Plans for Health Insurance Exchange »

In 2012 most of the big questions surrounding the Affordable Care Act (ACA) were answered in 2012. The biggest questions were settled with the Supreme Court ruling in June and the election results in November. Those two events determined that the ACA will be the law of the land and will shape the future of the health care financing and delivery system. The actual shape of the health care delivery system will be determined in 2013.

In the coming months decisions by HHS, the State of Georgia, insurers, and providers will determine access to care, the cost of health care, and the health of the population.

The largest decision with respect to access to care will be the states choice on Medicaid expansion. If the state participates in Medicaid expansion the percentage of Georgians without health insurance will fall from 22 percent to less than 9 percent. Without Medicaid expansion the ACA reduces the uninsured to about 18%. Medicaid expansion is expected to cover between …

Continue reading Not Yet Ready It’s Time To Get Set »