Who Does the Healthcare Reform Bill Really Help?

Since the beginning of the healthcare debate, many things have been said about how healthcare reform will help all of us. Lower premiums, a ban on pre-existing conditions and affordable care for those who don't have insurance are just a few. Many of the provisions don't kick in until 2014, but the extra taxes have already started. Our elected officials have decided in their infinite wisdom that 10 years of income collection vs. 6 years of benefits somehow makes this bill budget neutral, but they didn't even get that right. We all know that the new healthcare law will cost far more than they have told us, but who is really benefiting from our additional expense?

People with pre-existing conditions can no longer be denied for health insurance, but they will be placed in high risk pools with subsidized and high premiums. This is a good thing for those that couldn't get health insurance previously because of a health condition, but everyone else will have to make up the difference in cost. Regardless of how you feel about income redistribution, this provision is good for about 15% of the population at the expense of the other 85%. They say the costs will be partially offset by government subsidies, but the government's money comes from the same people in taxes; so one way or another everyone will be paying more. Still, most people agree that something needed to be done to help these people and this seemed like the only real choice.

Children up to the age of 26 can now remain on their parents health insurance as long as they are in college or still living at home. By the age of 26, Alexander the Great had already conquered all of Persia and assumed control of one of the largest empires in history. I don't believe a person in their twenties can be considered a child, and there are many other options for young adults in college. Parents still have to pay more to have their children on their policies, so this is more about additional income for the insurance companies from a portion of the population that hardly ever needs to use it. This will help keep everyone else's premiums down, but again, we are back to the income redistribution issue that most people don't want.

About 16% of the American population falls below the poverty line and these people don't typically have health insurance. There is a mandate that starts in 2014 that will force people to purchase health insurance if they don't have it, and Americans below the poverty line will be exempt. Congress believes that the additional customers will bring premiums down to a level that will make it affordable for those below the poverty line, but most believe that this mandate is unconstitutional and will be thrown out; so where does that leave us? A healthcare exchange will be formed in 2014 that will put people into pools and make it cheaper to purchase a policy; but again for most people below the poverty line, premiums will still be too expensive to get. The idea is to make it possible for 16% to get insurance and mandatory for the other 84%, but what does that say about the America we live in today?

The new healthcare law does help some people without a doubt, but it hurts almost everyone except the politicians. This is yet another great example of the government trying to "help" us by telling us how to live our lives. In 2014, the rest of our "help" will kick in and really corrode the level of our healthcare system. It won't be budget neutral for the first 10 years, and it will skyrocket in cost the 10 years after that. All this when companies like Ameriplan and others already had good alternatives to solve the problem. All or part of the healthcare law may be repealed at some point, but we still need to address the needs of those that fall through the cracks.

I have been working with Ameriplan insurance health and dental discount programs for several years now. During that time, healthcare has declined and become more expensive; but there are solutions.

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Healthcare Reform, Key Initiatives - Timing and Implications

Healthcare Reform Overview

The Patient Protection and Affordable Care Act will have a profound effect on healthcare providers, including reductions in reimbursement to hospitals and physicians; focus on value based purchasing - higher quality and lower costs; financial incentives and penalties tied to clinical quality outcomes and a transition away from fee-for-service payment to bundled payments and Accountable Care Organizations (ACOs).

Healthcare Providers: Recommended Responses

Healthcare organizations developing plans to respond to reform initiatives must create a path for the organization that:

• Aligns the board, executive staff, medical staff, and clinical staff


• Implements measurement, monitoring and benchmarking systems for costs and quality


• Streamlines processes to enhance clinical outcomes and reduce costs


• Integrates information technology, including electronic health record technology, with clinical and administrative processes to support care management across all settings


• Focuses on improving clinical performance through evidence based medicine

It will be critical for organizations to get a clear understanding of their strengths and weaknesses relative to each reform initiative.

Thriving under reform initiatives will require organizations to evaluate the entirety of their business, optimizing operations in all areas to enhance net revenues and reduce labor, supply, drugs and other costs. The goal should be to achieve or beat 'best' quartile performance.

Hospitals must continue to improve quality while increasing cost effectiveness.

Hospitals should undertake an in-depth evaluation of what service lines are crucial for their success - and which lines might be scaled back or divested based on funding limitations.

Healthcare reform will forever alter the landscape of medical care in the U.S.

Hospitals will have to align medical staff to address quality of care and comprehensive performance improvement under healthcare reform measures.

An organization's ability to collaborate with physicians to redesign clinical processes, minimize unnecessary services, lower readmission rates, and reduce hospital acquired conditions will be critical to their success under reform.

Hospitals now not only need margins to meet their missions, they need margins to meet the demands of reform.

Short-term and long-term savings from critical performance improvements will help position organizations to succeed under reform and beyond.

While many of the ramifications of healthcare reform and its effect on hospitals remain to be seen, one thing is certain: there will be less money in the system to go around.

ABOUT WELLSPRING+STOCKAMP, HURON HEALTHCARE

Wellspring+Stockamp, Huron Healthcare is the premier provider of performance improvement solutions for hospitals and health systems. By partnering with clients, we deliver solutions that improve quality, increase revenue, reduce expenses, and increase physician, patient and employee satisfaction across the healthcare enterprise.

To see how Wellspring+Stockamp, Huron Healthcare solutions can empower your mission visit http://huronconsultinggroup.com To learn more about the Healthcare Reform implications for healthcare providers visit http://www.huronconsultinggroup.com/category.aspx?categoryId=2366

Author:
West Johnson,
Vice President, Healthcare Revenue Consulting

Co Author:
Gordon Mountford,
Vice President, Healthcare Operational Consulting

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Health Care Reform and Physicians Shortage From a Hospitalist Perspective

A recent BusinessWeek article "Physician, Clone Thyself" suggests an alarming physician shortage in the future due to an increasing access to medical care. The author speculates that once 30 some million additional patients become insured, that will put a tremendous stress on a primary care system. There is already a shortage of the primary care physicians and even more patients 'eligible' to see a doctor will, surely, make it worse.

Lets look at it from a hospital based physician perspective.

Many patients with chronic conditions like Diabetes or Hypertension simply do not have any adequate outpatient follow-up. Thus, these patients use Emergency Rooms and Hospitals as their care providers which add tremendously to the cost of care. Many patients 'have to wait' until their condition is bad enough so that they could go to the Emergency Room and be admitted.

Managing chronic conditions on an outpatient basis might reduce readmission rate and, actually, cut the cost of the healthcare. By preventing complications of many chronic diseases like Diabetes, patients could avoid costly treatments and procedures in the future. For example, being compliant with your insulin will decrease the risk of kidney failure, coronary artery disease, stroke etc. Once those complications develop, treating them is very costly. On a national level it adds up to the billions of dollars.

The problem, though, goes beyond insurance issues. Some patients, even with a good insurance, are simply not being compliant with their treatment. They can afford. They just don't care enough about it to make any changes. And if things get worse? Well, then they just be readmitted to the Hospital since somebody else is paying for it anyway.

As far as shortage of the primary care providers, the problem will likely to get worse. The issue, though, is not the increasing number of the 'eligible' patients. If anything this is a welcome change. This is the whole point of the healthcare reform - to make everybody insured. The real problem is how unattractive the specialty became for the medical students and residents. When I was finishing medical residency, the general attitude was - you have to try to get into fellowship or become a hospitalist. And if you can't, well... than you go to primary care. Oh, and if you are a foreign medical graduate on a J-Visa, you might get stuck doing primary care to get a visa waiver.

We can open a lot more Medical School spots, but until Primary Care becomes more attractive for the new graduates, nothing is going to change.

This article was originally published in http://www.realicu.com blog by Ralph Gordon.

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