What are the positive aspects of the Affordable Care Act?

The debate will continue for quite a period-of-time whether the Affordable Care Act achieved its objectives and was cost effective. While political parties and individuals posture the pro’s and con’s of the Affordable Care Act, there are some positive aspects.

Whether you loved or liked the previous healthcare insurance business model, the Affordable Care Act addressed three notable deficiencies. The following are those deficiencies and how the Affordable Care Act addressed them:

First – people with pre-existing medical conditions could not purchase insurance or it was cost prohibitive.

People with pre-existing medical conditions were not able to purchase insurance or the price was cost prohibitive. A number of individuals have pre-existing clinical conditions through no fault of their own. It could be a matter of genetics or other factors beyond their control. It is unreasonable to penalize individuals under these circumstances and put them at a financial disadvantage.

Second …

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2013: A Year of Debate and Delay

Historian Barbara Tuchman created Tuchman’s law: “The fact of being reported multiplies the apparent extent of any deplorable development by five- to tenfold (or any figure the reader would care to supply)”. That law applies directly to the events of 2013.

We started the year with tiptoeing away from a fiscal cliff. That political crisis would reappear later in the year, but the fear in January was that we would continue to kick this can of long-term budget deficits down the road. The problem is the major driver of Federal budget deficits is health care expenditures. Social Security, defense, and all other spending are projected to remain largely constant as a percentage of GDP. That means you could slightly lower future deficits by cutting other spending, but if health care costs aren’t addressed all long-term structural deficits will remain. Congress faces very few options in the current budget debate that would credited as reducing future Federal health expenditures …

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Still Work to do in EHR Adoption

Nearly 79% of primary care physicians are using some form of electronic health record (EHR) in their practices. This number continues to jump significantly from year to year. It surely is a testament to the innovative work that various sectors of the HIT industry have put into adoption efforts. It also speaks to the hard work that has been done by providers and their professional organizations to use Health Information Technology (HIT) tools to improve clinical outcomes for their patients. On the other side of the fence, there remains the 20% of providers who do not have EHRs. Medical Economics reports that, in 2012, among this group 48% said they did not plan to purchase an EHR. This is a 16% increase from 2011. These physicians are often referred to as “EHR holdouts”. Surveys show that most of these providers are the more elder physicians and physicians in small practices.

I am sure the term “hold out” is not meant to be derogatory but it could be interpreted by some that …

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Spreading Holiday Cheer and Health IT Job Growth

A conversation with Navicure CEO Jim Denny on why Atlanta is a great place for health IT, and could be even better if the right kind of growth continues.

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What To Be Thankful For in Healthcare Reform

As we approach Thanksgiving, we focus on giving thanks. Notwithstanding the rough, confusing and troubling roll-out of Healthcare Reform, there are some benefits that we can be thankful.

First, Healthcare Reform is focused upon improving quality care for patients. Specifically, Healthcare Reform implemented new payment models that pay providers based upon healthcare outcomes for patients instead of a fee for each patient. One example is the shared savings program. Under this program, providers integrate together to deliver care based upon patient centered protocols. The providers then report on the quality metrics for their patients and if the costs are reduced and the patient outcomes improve, the providers will receive a share of the savings achieved by reducing the costs to the government. The integration of providers together with an agreed upon approach to treat the patient should improve communication between the healthcare providers.

Healthcare Reform is also …

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What is the most important focus for healthcare providers – reduce costs or improve quality outcomes?

The conundrum healthcare providers are facing is how do they financially succeed in an era of growing patient demand and shrinking reimbursement. Additionally, the financial model is changing where healthcare providers are being pushed towards assuming a higher level of financial risk based upon patient outcomes, and financial penalties for not improving their quality performance (e.g. Value Based Purchasing).

Therefore, where should healthcare providers focus their energy, reducing costs or improving quality outcomes? To most organizations, these two concepts are in direct conflict. If you reduce costs, there is the risk of quality being compromised. If you improve the quality of outcomes, there is an associated premium cost. For healthcare providers, there is a fallacy in this logic. Healthcare providers have the opportunity to reduce costs and derive the benefit of improved quality outcomes.

Some organizations have taken the approach of looking for peer reviewed best …

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ACA Questions and Answers

Nobody has signed up so the Affordable Care Act is a big failure, right?

The website is nice feature (or will be when and if it ever becomes fully functional): one stop for determining eligibility for tax subsidies, shopping for plans, and enrolling. However,  the most important part of the Affordable Care Act is not the website, it’s the change in the operation of the individual health insurance market.

The principals underlying the ACA were developed before there was an Internet. The original depictions of the marketplace for health insurance used as examples a farmer’s market, or a shopping mall, or the Sears catalog: a method that allowed consumers to compare plans and prices when shopping for health insurance. But consumers would be unable to shop for health insurance in that way until the individual health insurance market was reformed.

The proposal then and the law now prevents insurers from denying coverage or increasing premiums based on an individual’s health …

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The Case of Abuse and Health Information

Recent cases of child abuse in our community have struck a nerve with many. Most would agree that the idea of parents starving and murdering their own kids is incomprehensible. In this nation, there are over 4 deaths per day from child abuse with the most prominent form of child abuse being neglect. Eighty Percent of those who die from abuse are under the age of 4 years old and most of these deaths are not recorded as abuse on the death certificate. Unfortunately, in most cases the perpetrator is a parent.

There are many education and training programs out in the field that are helping abusers and the abused. Much help is needed not only with the abuse of children but for other forms of abuse such as spousal abuse and elderly abuse. Oh yes, there are abuses of every kind. It is amazing how depraved the human mind can get. In many cases, poverty along with mental and physical disabilities are associated risk factors. Somehow people get so angry and deranged that they have to …

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The Health System of Tomorrow – More Guts, Not More Information

I had the pleasure of attending the US News Hospital of Tomorrow conference last week in Washington, DC. Right in the midst of the heated debate around the failures and successes of the Accountable Care Act and the less than stellar rollout of Healthcare.gov, leaders from many of the top health care provider systems across the US congregated to share their insights about how the health care delivery system will look in the future. While there was passionate dialogue about how to best solve our current problems, the common consensus was clear amongst most of the top executives – the shift from volume to value based care will ultimately reduce costs, improve quality, and expand access.

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What is a Patient-Centered Medical Home (PCMH)?

Guest Blogger:  Wayne Hoffman, MD – Healthcare Consultant

Many of us grew up getting our health care through our family doctor or pediatrician – the doctor who knew everything about you and your family, and helped keep you healthy. He or she was the one you went to see no matter what was wrong with you, and for your annual check-up. Somewhere along the way we have lost that ideal. Health care now is fragmented, illness (not wellness) focused, expensive, and doesn’t always deliver the best outcomes. There is now an exciting new model of care that is beginning to sweep the country – the Patient-Centered Medical Home or PCMH. The term was first coined by Pediatricians in the 1960s, but has only recently been expanded to all of Primary Care. In 2007 the four main primary care organizations (American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and the American Osteopathic Association) got together and developed the joint principles …

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