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Is the PP-ACA Un-Constitutional?

A Texas court has declared the entire ACA unconstitutional

Austin Frakt PhD

By Austin Frakt PhD

And I’ve got an op-ed in the Washington Post about why the court is wrong. Here’s a taste:

Who cares if a zero-dollar mandate is constitutional or not? Why does it matter in the slightest? And what on earth does it have to do with the rest of ACA?

You might have thought that the right remedy would be to invalidate the penalty-free mandate. Doing so would align with Congress’s evident view that an ACA without an individual mandate was preferable to an ACA with it. That’s what I argued in an amicus brief with a bipartisan group of law professors.

Instead, the court held that the entire ACA was “inseverable” from the purportedly unconstitutional mandate. To reach that conclusion, the judge leaned heavily on Congress’s findings from 2010, where it said that the individual mandate was “essential” to the law.

But the mandate that the 2010 Congress said was essential had a penalty attached to it. The finding is irrelevant to a mandate that lacks any such penalty.

In any event, it doesn’t matter what Congress meant to do in 2010. It matters what Congress meant to do in 2017, when a different Congress made a different call about whether the mandate was essential. We know what Congress wanted to do in 2017: repeal the mandate and leave the rest of the act intact. Its judgment could not have been plainer. (I know. I was there! So were you. It wasn’t that long ago.)

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You can read the whole thing here. My co-amici, Jonathan Adler and Abbe Gluck, have a New York Times op-ed sounding similar themes.

I’ll probably write them up more extensively in the coming days, but I’ve also got tentative thoughts about the immediate consequences of the decision (short answer: nothing right now) and the potential difficulties with getting a quick appeal of the decision.

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Conclusion

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Election Impacts ACA, Medicaid Expansion and Marijuana

Healthcare Triage News: Election Results Impact the ACA, Medicaid Expansion, and Marijuana

via Aaron Carroll

The recent election results of last week have a lot of impact on health care in the United States.

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Pot House

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The new Democratic House of Representatives and the ACA, expansion of Medicaid in red states, and medical and recreational marijuana are all affected by recent returns.

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MORE: What The Midterm Election Results Mean for Health Care?

http://www.msn.com/en-us/news/us/what-tuesdays-midterm-election-results-mean-for-health-care/ar-BBPsC1G?li=BBnb4R7

Assessment

Your thoughts are appreciated.

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Why 75 Years of American Finance Should Matter to Physician Investors

A Graphic Presentation [1861-1935] with Commentary from the Publisher

By Dr. David Edward Marcinko FACFAS MBA CPHQ CMP™

http://www.CertifiedMedicalPlanner.org

As our private iMBA Inc clients, ME-P subscribers, textbook and dictionary purchasers, seminar attendees and most ME-P readers know, Ken Arrow is my favorite economist. Why?

About Kenneth J. Arrow, PhD

Well, in 1972, Nobel Laureate Kenneth J. Arrow, PhD shocked Academe’ by identifying health economics as a separate and distinct field. Yet, the seemingly disparate insurance, asset allocation, econometric, statistical and portfolio management principles that he studied have been transparent to most financial professionals and wealth management advisors for years; at least until now.

Nevertheless, to informed cognoscenti, they served as predecessors to the modern healthcare advisory era. In 2004, Arrow was selected as one of eight recipients of the National Medal of Science for his innovative views. And, we envisioned the ME-P at that time to present these increasingly integrated topics to our audience.

Healthcare Economics Today

Today – as 2019 nears – savvy medical professionals, management consultants and financial advisors are realizing that the healthcare industrial complex is in flux; and this dynamic may be reflected in the overall economy.

Like many laymen seeking employment, for example, physicians are frantically searching for new ways to improve office revenues and grow personal assets, because of the economic dislocation that is Managed Care, Medi Care and Obama Care [ACA], the depressed business cycle, etc.

Moreover, the largest transfer of wealth in US history is – or was – taking place as our lay elders and mature doctors sell their practices or inherit parents’ estates. Increasingly, the artificial academic boundary between the traditional domestic economy, financial planning and contemporaneous medical practice management is blurring.

I’m Not a Cassandra

Yet, I am no gloom and doom Cassandra like I have been accused, of late. I am not cut from the same cloth as a Jason Zweig, Jeremy Grantham or Nouriel Roubini PhD, for example.

However, I do subscribe to the philosophy of Hope for the Best – Plan for the Worst.

And so dear colleagues, I ask you, “Are the latest swings in the economic, healthcare and financial headlines making you wonder when it will ever stop?”

The short answer is: “It will never stop” because what’s been happening isn’t any “new normal”; it’s just the old normal playing out before a new audience.

What audience?

The next-generation of investors, FAs, management consultants and the medical professionals of Health 2.0.

How do I know all this?

History tells me so! Just read this work, and opine otherwise, or reach a different conclusion.

Evidence from the American Financial Scene, circa 1861-1935

The work was created by L. Merle Hostetler in 1936, while he was at Cleveland College of Western Reserve University (now known as Case Western Reserve University). I learned of him while in B-School, back in the day.

At some point after it was printed, he added the years 1936-1938. Mr. Hostetler became a Financial Economist at the Federal Reserve Bank of Cleveland in 1943. In 1953 he was made Director of Research. He resigned from the Bank in 1962 to work for Union Commerce Bank in Cleveland. He died in 1990.

The volume appears to be self published and consists of a chart, approximately 85′ long, fan-folded into 40 pages with additional years attached to the last page. It also includes a “topical index” to the chart and some questions of technical interest which can be answered by the chart.

Link: http://fraser.stlouisfed.org/75years

Assessment

And so, as with Sir John Templeton’s [whose son is an MD] four most dangerous words in investing (It’s different this time), Hostetler effectively illustrates that it wasn’t so different in his era, and maybe—just maybe—it isn’t so different today for all these conjoined fields.

Conclusion      

Your thoughts and comments on this ME-P are appreciated. While not exactly a “sacred cow,” there is a current theory that investors will experience higher volatility and lower global returns for the foreseeable future.

In fact, it has gained widespread acceptance, from the above noted Cassandra’s and others, as problems in Europe persist and threats of a double-dip recession loom. But, how true is this notion; really?

Is Hostetler correct, or not; and why?

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“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

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Doctor Shortage Under Obamacare?

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 Fears Put to Rest

By AUSTIN FRAKT PhD

The demand for primary care doctors has gone up as more people have gotten health care coverage …. But so has appointment availability.

Doctor Shortage Under Obamacare? Fears Are Put to Rest

 Conclusion

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States with the Greatest Declines in Uninsured Children in Rural Areas

In 2008-2009 and 2014-2015

http://www.MCIOL.com

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Conclusion

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PP-ACA Silver Plan Premium Costs

Changes for 2017

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Impact of Repeal/Replace Uncertainty on Stakeholder Budgets and Business Plans

An Electronic Voting Poll

By http://www.MCOL.com

We encourage you to participate in the this brief e-Poll on the impact of the uncertainties surrounding repeal and replacement of the Affordable Care Act (ACA) on your organization’s budgets and business plans.

Participants will receive a free report of the findings from the survey results. In order to participate, your responses are due by Friday April 21st, 2017.  

The e-poll asks the following questions:

  • Are you a purchaser, provider or vendor/other?
  • Has the uncertainty during the last five months regarding repeal and replacement of the ACA affected your organization’s business plan, budget and hiring plans?
  • Overall, how do you feel the uncertainty during regarding repeal and replacement of the ACA will impact your organization for the 2017 calendar year?
  • Ultimately, how do you feel the current environment will lead to challenges vs. opportunities?

Assessment

To take the e-poll now, go VOTE: http://register.healthwebsummit.com/mcolepoll0417

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POLL: Should the Government Pay for Health Care?

A VOTING POLL

Most young people say gov’t should pay for health care
[By Staff reporters]

Most young Americans want any health care overhaul under President Donald Trump to look a lot like the Affordable Care Act signed into law by his predecessor, President Barack Obama.

But there’s one big exception: A majority of young Americans dislike the “Obamacare” requirement that all Americans buy insurance or pay a fine.

In fact, a GenForward poll says a majority of people ages 18 to 30 think the federal government should be responsible for making sure Americans have health insurance. It suggests most young Americans won’t be content with a law offering “access” to coverage, as Trump and Republicans in Congress proposed in doomed legislation they dropped on March 24. The Trump administration is talking this week of somehow reviving the legislation.

NOTE: Conducted Feb. 16 through March 6, before the collapse of the GOP bill, the poll shows that 63 percent of young Americans approve of the Obama-era health care law. It did not measure reactions to the Republican proposal.

http://www.msn.com/en-us/news/politics/poll-most-young-people-say-govt-should-pay-for-health-care/ar-BBzmVny?li=BBnbcA1

Do you agree?

VOTE NOW!

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PP-ACA Change or Repeal for 2017?

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Potential Component Changes

By http://www.MCOL.com

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infographic

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MORE: Podcast: Third Quarter Health Plan Financial Reports

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Racial Disparities in UnInsured Rates

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On Health Insurance [PP- ACA]

By http://www.MCOL.com

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graphoid111616

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Are Soaring Health-Care Costs Hurting the U.S. Economy?

Are Soaring Health-Care Costs Hurting the U.S. Economy?

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dan

By Dan Timotic CFA

About 8% of U.S. household spending went toward health care in 2015, up from 5.8% in 2007. Even though the growth of nationwide health-care spending has slowed, the cost burden is falling more heavily on consumers.1

More than 118 million people qualify for coverage through government programs such as Medicare, which serves individuals age 65 and older and the disabled, or Medicaid, which provides care for the poor. Still, more than 55% of the U.S. population rely on health insurance provided by an employer.2

The health-care landscape has changed over the last decade, but some economists believe uncontained costs still pose a threat to broader economic growth. Here’s a closer look at recent trends, and why it’s more important than ever to be an informed health-care consumer.

Public Spending

Growth in U.S. health-care spending has outpaced total economic growth over the past five decades. In 2014, health-care expenditures accounted for about 17.5% of GDP, up from 5.6% in 1965.3 Though major advances in medical technology have contributed to spending growth, they have also led to better health and well-being overall.4

Public-sector spending has grown more quickly than private spending, largely due to an aging population, rising Medicare enrollment, and the expansion of Medicaid. The share of total spending by Medicare and Medicaid increased from 6.8% in 1966 to 36.8% in 2014.5

ACA Under Way

The Affordable Care Act created state-based exchanges where self-employed individuals, part-time workers, and others without access to group coverage can buy private health insurance. Consumers can compare plans online, and families with incomes up to 400% of the federal poverty level may be eligible for tax credits that reduce premiums. As income rises, subsidies decrease. In 2016, about 85% of the 12.7 million individuals who purchased coverage from the Health Insurance Marketplace received a subsidy.6

Since 2014, all citizens and legal residents have been required to have “minimum essential” health coverage or pay a penalty. The health insurance mandate was intended to add healthy individuals to the insurance pool and counterbalance a provision that prohibits insurers from excluding people with pre-existing conditions. As a result, the uninsured rate has decreased from 13.3% in 2013 to 9.1% in 2015.7

division-of-population-health-logo_crop

Workplace Plans

Employers have been paying around 80% of individual health insurance premiums, but plan changes, including higher deductibles and coinsurance rates, have shifted costs to workers who use health-care services.8

For example, the average deductible for individual coverage in an employer-provided health plan was $1,318 in 2015, up from $917 in 2010. A deductible is the amount the patient must pay before the insurance payments kick in. Health insurance deductibles grew 67% between 2010 and 2015, almost three times as fast as premiums and about seven times as fast as wages and inflation.9

If health insurance premiums continue to rise, it is conceivable that employers could pass more of the costs on to workers by raising premiums and coinsurance or limiting wage increases.

Accounting for Costs

It’s estimated that total U.S. health- care spending increased 5.5% to reach $3.2 trillion in 2015, and growth is projected to average 5.8% annually through 2025. Cost increases have moderated after averaging nearly 8% annually over the previous two decades, but they are still increasing much more than overall inflation.10 Prescription drug prices have been rising at a faster pace. According to one drug-benefits manager, the average price of brand-name drugs rose 16.2% in 2015, surging 98.2% since 2011.11

The research and development of breakthrough medical technologies is undoubtedly a valuable endeavor. Even so, experts say newer and more expensive treatments are not always more effective than existing lower-cost options. It has also been suggested that the fee-for-service payment model — in which insurers reimburse providers based on the number and type of treatments — may drive inefficiency and unnecessary spending by rewarding the quantity rather than the quality of care.12

Economic Impact

Even with insurance coverage, an illness or injury can cause financial pain for a middle-class family with limited disposable income. The prospect of medical bills may cause some families to skip or postpone necessary care, and those who do seek treatment have less money available to spend on other basic needs. A Brookings Institution analysis found that middle-income household spending on health care increased nearly 25% between 2007 and 2014, while spending on restaurant meals and clothing dropped significantly (–13.4% and –18.8%, respectively).13

Health spending across the economy is expected to accelerate and reach 20% of GDP by 2025, which could put additional strain on consumers, employers, and the federal budget.14

Obama Care

Open Enrollment

This is the time of year when employers introduce changes to their benefit offerings, so choosing — and then using — your health plan carefully could help you save money. Before you sign up for a specific plan, consider the extent to which your prescription drugs are covered, estimate your potential out-of-pocket costs based on last year’s usage, and check to see whether your doctors are in the insurer’s network.

Citations:

1, 8, 11, 13) The Wall Street Journal, August 25, 2016 2, 7) U.S. Census Bureau, 2016 3, 5, 10, 14) Centers for Medicare and Medicaid Services, 2016 4, 12) The Brookings Institution, 2015 6) U.S. Department of Health and Human Services, 2016 9) Kaiser Family Foundation, 2015. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Sherlock Health Administration Expense Benchmarks Invitation

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Sherlock Benchmarks – Participation and Licensing

By Douglas B. Sherlock CFA

sherlock@sherlockco.com

thoughtSherlockHello All ME-P Readers and Subscribers:

This email invites your participation and/or licensing of the Sherlock Benchmarks.

A central effect of the Affordable Care Act is to sharply increase the incentive for health plans to minimize their administrative expenses. The Sherlock Benchmarks can be a catalyst to respond to these incentives since they identify and prioritize cost variances.

Use of the Sherlock Benchmarks reflects this:

• At least 40 health plans serving at least 40 million people with health insurance are so far committed as participants in this year’s Sherlock Benchmarking study.

• Of the 36 U.S. – based Blue Cross Blue Shield primary licensees, one-half are participating in this year’s Sherlock Benchmarking Study, either as an enterprise or through a subsidiary.

• Of the 13 members of the Alliance of Community Health Plans that are not focused on public programs or are staff-model plans, 11 are participating in this year’s Sherlock Benchmarking Study for Independent / Provider – Sponsored Health Plans.

• Most of the largest members of the Health Plan Alliance that are not focused on public programs are participating in this year’s Sherlock Benchmarking Study for Independent / Provider – Sponsored Health Plans.

• Health plans serving at least one-half of all insured Americans are licensed users of Sherlock Benchmarks since January 1, 2015.

Licensing and participation is available to all health plans

We have recently launched the Independent / Provider – Sponsored and Blue Cross Blue Shield surveys. There is still time, but the financial metrics survey form must be returned to us by the end of April.

So please contact me immediately if you wish to join these robust panels.

Our universes of Medicaid and Medicare plans will launch in a few months to avoid conflict with your Medicare bid process. If a plurality of your members are in either Medicare or Medicaid, please contact us about participation. Note that all costs are segmented by product as well as by function to assure an apples-to-apples comparison between the plans.

Licensing is available without participation. Licensing costs more but it entails less effort.  The 2016 Sherlock Benchmarks for Blue Cross Blue Shield Plans and Independent / Provider – Sponsored plans will be available beginning in July. The 2016 Sherlock Benchmarks for Medicare plans and Medicaid plans will be available beginning in September. 

Assessment

We look forward to working with you.

Conclusion

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The PP-ACA’s Impact on Medical Liability Insurance?

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BY ROBERT JAMES CIMASI; MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP

HEALTH CAPITAL CONSULTANTS, LLC

www.HealthCapital.com

Aside from differences in insurer behavior, malpractice lawsuit rates, and political responses at the state level, the ACA may also have an impact on the medical liability insurance market. Following several months of partisan controversy and political debate during President Obama’s first term, Congress passed the ACA in March 2010.[1] While not achieving a universal coverage insurance program or a single payor system, the 2010 healthcare reform legislation marked the beginning of a new era in healthcare reform, resulting in a paradigm change in the way healthcare services are delivered and paid for in the U.S.

Some of the ACA’s initiatives have already had significant impact upon many aspects of the healthcare delivery system, including: (1) increased regulatory scrutiny aimed at combating fraud and abuse and antitrust violations; (2) health plan regulation; (3) addressing physician shortages; (4) access to and quality of care initiatives; and, (5) increased attention to public health and wellness activities, among others.[2]

In contrast, the ACA’s impact on the medical liability insurance market, and the medical malpractice system, is relatively unknown. The Medical Liability Monitor’s 2010 annual rate survey noted that 41% of medical liability insurers did not believe that the ACA would impact medical liability insurance markets;[3] however, by 2011, as stated above, this attitude had changed to reflect increasing concerns about provider consolidation and self-insurance for professional liability by providers.[4] These concerns continue to reflect the thinking of medical liability insurers, in part, because there have been few, if any, answers to alleviate their concerns and measure the ACA’s impact on the incidence and cost of medical malpractice.

Some of the medical liability insurer concerns regarding the ACA’s impact stems from the reality that the only one of two sections of the ACA directly relating to medical liability insurance and the current medical malpractice system have been implemented. Section 6801 of the ACA simply provides a policy statement regarding medical malpractice, stating that the U.S. Senate believes that “health care reform presents an opportunity to address issues related to medical malpractice and medical liability insurance,” and encourages Congress, as a whole, to develop demonstration programs with the goal of discovering alternatives to the current civil litigation system for medical malpractice.[5] Additionally, Section 10607 of the ACA authorizes HHS to award grants to states “for the development, implementation, and evaluation of alternatives to current tort litigation” for medical malpractice claims.[6] This section allows HHS to make $50 million available for these demonstration projects subject to Congressional approval.[7] To date, neither Congress nor the President has requested funding for these projects.[8]

Even without these direct impacts, the medical malpractice system may still face changes as a result of the ACA. First, as providers consolidate with larger health systems, medical liability insurers fear the medical liability insurance market “will shrink as their former customers become their competitors.”[9] From 2011 to 2014, medical liability insurers consistently noted to the Medical Liability Monitor that hospital or ACO acquisitions of physician practices act as “the biggest threat to their market share” because of the entity’s ability to better absorb the risk related to malpractice liability.[10] In theory, this ability to absorb medical professional liability risk will allow higher rates of self-insurance, which can affect the rates of straight indemnity insurers.  Second, the number of malpractice claims is expected to increase as more individuals gain health insurance coverage as a result of ACA enactments.

Obama Care

A 2007 Journal of the American Medical Association study concluded that insured persons who suffer a chronic condition receive higher quality and increased care compared to non-insured persons; reinforcing earlier studies suggesting insured persons receive more care than uninsured persons.[11] Building on this premise, a RAND report on the ACA and liability insurance relationships estimated that with the expected influx of newly-insured individuals, particularly in states expanding Medicaid, more physician-patient encounters will increase the volume of overall medical errors, leading to an increase in medical malpractice lawsuits.[12] Consequently, the RAND report estimates that the number of liability payments in medical malpractice actions will increase by 3.4% between pre-ACA insurance plan enrollment and enrollment post-ACA implementation.[13]

Additionally, the RAND report argues that, due to an increase in insurance plan enrollment, medical malpractice payments per claim will actually decrease in states adopting limitations to the collateral source rule. Under the collateral source rule, the damage awards for injured parties do not take into account payments previously received from other sources; consequently, the damage award includes the value of funds collected by another source (e.g., insurance) while allowing the injured party to keep the benefits of that previous value received.[14] In the medical malpractice context, plaintiffs in states adopting the collateral source rule can collect from the physician (or his medical liability insurer) as well as keep the benefits of healthcare reimbursed by their own health insurer. However, some states limit the application of the collateral source rule in medical malpractice cases where the plaintiff’s health insurance already paid for care resulting from the negligent actions of the physician, thereby preventing the plaintiff from receiving this double windfall. As insurance rates rise, RAND estimates that payouts per claim will decrease by 0.6% nationally.[15] Considering the three effects together, RAND projects that total liability claim costs will increase by 2.8% nationally by 2016 as a result of the ACA.[16]

Conversely, other healthcare industry commentators argue that the ACA’s expansion of coverage to previously uninsured individuals, as well as quality of care initiatives, will actually decrease malpractice costs by reducing the number of adverse events suffered by patients.[17] In a 2010 editorial in the Journal of Law, Medicine, and Ethics, Mark A. Rothstein, the Director of Institute for Bioethics, Health Policy, & Law at the University of Louisville – Louis D. Brandeis School of Law, argued that quality and infrastructure initiatives such as increased EHR usage, expansion of outcomes research and use of evidence-based medical standards, and better care coordination, will limit the number of adverse events that provide the basis for a medical malpractice claim.[18] Further, Rothstein posited that, by simply being insured, “significant numbers of injured patients are likely to forego medical malpractice claims.”[19]

Although President Obama signed the ACA in 2010, the effects of this landmark law on the medical malpractice market remain hazy. The current trend toward healthcare consolidation, accountable care, and self-insurance mirrors similar consolidation practices in the mid-1990s, which increased competition in the medical liability insurance market and eroded proper underwriting practices. Nevertheless, other critical ACA effects remain unknown. The impact of the expansion of health insurance coverage will likely remain unclear for the near future because new enrollees began receiving coverage through health insurance exchanges in 2014, limiting the amount of exposure to healthcare interactions that could give rise to an adverse event and result in a medical malpractice suit. Additionally, the average length of litigation surrounding preventable adverse events lasts 43.1 months from the date of the incident to the date of resolution,[20] which limits medical liability insurers from realizing the full costs of a claim and the aggregate of claims in its risk pool.

RISK

Assessment

Now, assuming that increased enrollment does not affect the average length of medical malpractice litigation,[21] the average newly insured person who suffered a preventable adverse event in July 2014 will not resolve his or her claim until March 2018. With this lag time of almost four years between adverse events and claims, it is likely that the full impact of the ACA on the medical malpractice market and medical liability insurance premiums will not be fully known until the next decade.

Conclusion

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References 

[1]      “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 119 (March 23, 2010); “Health Care and Education Reconciliation Act” Public Law 111-152, 124 Stat. 1029 (March 25, 2010).

[2]       “Restructuring, Consolidation in Health Care Make Reform Top Health Law Issue for 2010,” By Susan Carhart et al., BNA Health Law Reporter, Vol. 19, No. 5 (January 8, 2010).

[3]       “Now Hard & Crunchy on the Outside: Could Strong Financials be Hiding a Market That’s Growing Soft Within?” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 35, No. 10, October 2010, p. 4.

[4]       “From Crunchy Candy to Simmering Frogs: Waiting and Hoping for a Hardening Market as the Market Trends Slowly, Steadily Softer,” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 36, No. 10 (October 2011), p. 5.

[5]       “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 804 (March 23, 2010).

[6]       “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 1009 (March 23, 2010).

[7]       “Patient Protection and Affordable Care Act,” Public Law 111-148, 124 Stat. 1014 (March 23, 2010).

[8]       “Medical Liability Reform – Demonstration Grants,” American College of Physicians, 2013, http://www.acponline.org/advocacy/where_we_stand/assets/iii12-medical-liability-reform-demo.pdf (Accessed 12/23/14).

[9]       “From Crunchy Candy to Simmering Frogs: Waiting and Hoping for a Hardening Market as the Market Trends Slowly, Steadily Softer,” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 36, No. 10 (October 2011), p. 5.

[10]     “The Slinky Effect: With Medical Professional Liability Insurance Rates Continuing to – Slowly and Steadily – Decline During the Most Recent Soft Market, It Appears It will Take Several More Years Before the Market Hardens and Rates Accelerate Upward,” By Chad C. Karls, FCAS, MAAA, Medical Liability Monitor, Vol. 39, No. 10 (October 2014), p. 6; “Casualty Actuarial Society Session Debates Potential Medical Professional Liability Implications of PPACA,” Medical Liability Monitor, Vol. 39, No. 7 (July 2014), p. 4.

[11]     “Insurance Coverage, Medical Care Use, and Short-Term Health Changes Following an Unintentional Injury or the Onset of a Chronic Condition,” By Jack Hadley, Ph.D., Journal of the American Medical Association, Vol. 297, No. 10 (March 14, 2007), p. 1080.

[12]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 30.

[13]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 30.

[14]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 18.

[15]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 18.

[16]     “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 37.

[17]  “How Will the Patient Protection and Affordable Care Act Affect Liability Insurance Costs?” By David I. Auerbach et al., RAND Corporation, 2014, p. 40-41

[18]     “Currents in Contemporary Bioethics: Health Care Reform and Medical Malpractice Claims,” By Mark A. Rothstein, Journal of Law, Medicine, and Ethics, Winter 2010, p. 871.

[19]     “Currents in Contemporary Bioethics: Health Care Reform and Medical Malpractice Claims,” By Mark A. Rothstein, Journal of Law, Medicine, and Ethics, Winter 2010, p. 872.

[20]     “On Average, Physicians Spend Nearly 11 Percent of their 40-Year Careers with an Open, Unresolved Malpractice Claim,” By Seth A. Seabury et al., Health Affairs, Vol. 32, No. 1 (January 2013), p. 114.

[21]     This assumption is faulty, as it is unknown at this point whether or not claims will increase, whether insurers will or will not enter the market, and whether malpractice caseloads will increase due to the ACA.

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors

[Best Practices from Leading Consultants and Certified Medical Planners™]

   Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

 Harvard Medical School

Boston Children’s Hospital – Psychiatrist

Yale University

***

Health Insurance Costs [circa 2016]

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The most devious tax increases in modern history? 

Rick Kahler MS CFP

By Rick Kahler MS CFP®

http://www.KahlerFinancuial.com  

A few months ago I scoffed when my wife told me about a report from CNN that the average individual, unsubsidized health insurance premium was going up over 60%.

After receiving my 2016 premium notice from Wellmark Blue Cross and Blue Shield, I’m no longer scoffing. My monthly premium for family coverage went from $1,400 to $2,140, an increase of $740, or 53%. According to healthcare.gov, the average Wellmark increase in South Dakota is 43%.

I immediately started looking for ways to decrease my premiums. This has become an annual ritual ever since Obamacare was pushed through Congress in 2010. Back then, my family health insurance policy (now considered a Platinum plan) had a low deductible with a maximum out-of-pocket of $3,500 and cost $660 a month.

Despite the President’s promise that “If you like your plan you can keep your plan,” I can’t even purchase that same plan today. If I could, I estimate it would cost over $3,500 a month. In order to keep health insurance affordable, each year I’ve reduced my coverage, increased my deductibles, and paid a higher premium than the year before.

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kidney

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I set out to analyze my options for 2016. After spending six hours crunching numbers and pouring over online calculators, I admitted defeat. There is no simple way to analyze plans to determine whether, based on your personal health care expenditures, you are better served to go with a copay or a deductible plan, a Bronze or a Silver plan, or if a Health Savings Account is preferable to a plan with coinsurance. All the online calculators I found were limited in scope and woefully generic. My health insurance agent didn’t know of any better ones, either.

Adding to my angst, while Wellmark makes policyholders’ year-to-date healthcare expenses available on its website, it doesn’t provide any breakdown of costs. You must figure out for yourself how many drug or doctor co-pays you had, the average cost of a copay visit, the average total costs of those visits, and any other information you need for any type of analysis.

This task was daunting for me, a financial planner and numbers guy. How are average consumers supposed to navigate it? The need for this information is so obvious, one wonders what the insurance companies are hiding by not providing it.

Ultimately, I selected a Bronze plan with no copays and an out-of-pocket cap of $11,900 on in-network providers and $18,500 on out-of-network providers. Based on my family’s average health care costs for the last three years, my out-of-pocket spending for premiums, covered drugs, and approved in-network medical providers will be $2,612 per month, or $31,344, in 2016. It was $11,420 in 2010. That’s an increase of 273%, or 18.3% a year.

By comparison, during the same time period medical costs only increased 16.0%, or 2.7% a year. The increase in premiums is clearly not about increasing health costs.

The $1,660 extra per month I had available to spend on consumer goods and services in 2010 is now going to insurance companies to subsidize the health care of others. This is a clear-cut example of a massive transfer of wealth.

Based on my family’s needs, if I earned $97,000 a year I would qualify for a subsidy of $912 a month. But since I earn over $98,000, I pay the full premium.

***

incontinence

***

Assessment

Clearly, the only people who find the Affordable Care Act affordable are those who receive a subsidy or who have preexisting conditions. For them, Obamacare was a godsend. For the rest of us, it turned out to be one of the most devious tax increases in modern history. 

Conclusion

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On Criminal Penalties for Acts Involving Federal Healthcare Programs

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“Knowingly and Willfully”

Carol S. Miller

[By Carol S. Miller RN MBA]

Individuals and entities are prohibited from “knowingly and willfully” making false statements or presentations in applying for benefits or payments under all federal and state healthcare programs. Individuals also are prohibited from fraudulently concealing or failing to disclose knowledge of an event relating to an initial or continued right to payments.

There is also prohibition against knowingly and willingly soliciting or receiving any remuneration (including any kickbacks, bribes, or rebates) directly or indirectly, in cash or in kind, in exchange for referrals. Violations may result in felony convictions with penalties including imprisonment and fines.

Individuals or entities can be excluded from Medicare and Medicaid and more than 200 other federal healthcare programs for a minimum of five years if there is one prior fraud or abuse conviction. Thee exclusions last for ten years and if there are two prior convictions, the exclusion can become permanent. The minimum period of discretionary exclusion is three years, unless DHHS determines that a different period is appropriate.

It is just as important to communicate to the employees when laws or regulations do not impact your organization, such as the Family Medical Leave Act (FMLA), the employment provisions of the Americans with Disabilities Act (ADA) or continuation of health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). These benefits apply only to organization with a specific number of employees, so smaller organizations are not necessarily required to offer these benefits.

***

business-valuation

***

However, the Patient Protection and Affordable Care Act (PPACA) provides a slightly different situation for the provider’s practice. PP-ACA mandated coverage, penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively.

Further the Act stated: 1) all individuals not covered by an employer sponsored health plan, Medicare or Medicaid or other public insurance programs such as Tricare to secure an approved private-insurance policy or pay a penalty, unless the individual has a financial hardship or is a member of a recognized religious sect exempted by the Internal Revenue Service and 2) businesses, including larger medical practices which employ 50 or more people but do not offer health insurance to their full-time employees will pay a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means.

This is known as the employer mandate. What this means for the provider’s practice is that if the provider is offering healthcare benefits to their staff, the coverage needs to be comparable with the requirements stated in the PP-ACA and if the practice is not offering healthcare benefits, then the practice must direct the individual to one of the Health Insurance Exchanges that are offering individual coverage plans.

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[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

 Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™  Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Three common misunderstandings and reality checks about the ACA’s Cadillac tax

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Beginning in 2018

[By Grant Thornton]

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3-misconceptions-about-the-affordable-care-acts-cadillac-tax-1-638

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A primer to tonight’s GOP debate

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Health Entitlements & the Deficit

By Nancy Chockley PhD

NIHCM.org

Congress is poised to pass a budget plan that will raise funding levels for the next two years. While these changes are paid for, the plan does not include structural changes to the health entitlement programs that are a leading driver of our budget deficits and mounting debt.

The GOP presidential candidates are likely to discuss a variety of proposals for structural reforms to these programs during tonight’s debate.

As a primer to this important conversation, this chart story presents essential facts about spending for Medicare, Medicaid and the Affordable Care Act and the impact of these programs on the deficit.

http://www.nihcm.org/health-entitlement-spending-a-growing-threat#one

business-valuation1

See the rest of the story

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Finally – Why the Healthcare.gov Site Failed?

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No … Really!

By Robert E.H. Khoo MD FRCS(C) FACS

http://www.colondoc.com

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health care gov

Why the Healthcare.gov Site Failed

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Product Details

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ME-P News Stories Wrap-Up for August 2015

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Latest News

Editor’s Pick: 

Daily Round-Up of Headlines for August 2015

BREAKING-EVENTS AND AGGREGATED STORIES 

[Editor’s Pick: A Daily Round-Up of Headlines for August 2015]

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Editor’s Pick: 

Daily Round-Up of Headlines for July 2015

BREAKING-EVENTS AND AGGREGATED STORIES 

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Daily Round-Up of Headlines for May 2015

BREAKING-EVENTS AND AGGREGATED STORIES 

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)  

Editor’s Pick: 

Daily Round-Up of Headlines for April 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)  

***

Editor’s Pick: 

Daily Round-Up of Headlines for March 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

***

Editor’s Pick: 

Daily Round-Up of Headlines for February 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)* 8

***

Editor’s Pick: 

Daily Round-Up of Headlines for January 2015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)* 8

Editor’s Pick: 

Daily Round-Up of Headlines for December 2014

 ***

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

***

Editor’s Pick: 

Daily Round-Up of Headlines for November 2014

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Blue Cross Blue Shield, Independent / Provider – Sponsored Plans

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Transcripts and Slides

DougBy Douglas B. Sherlock, CFA sherlock@sherlockco.com

The Affordable Care Act is intended to create strong incentives to reduce the administrative costs of health insurers. The medical loss ratio rules and the new ACA-related taxes are manifestations of this policy, and the recent announced business combinations between leading national health insurers are adaptations to these incentives.

It follows that the most recent rate of increase in health plan administrative expenses, excluding the new taxes, is dramatically lower than in recent years. Sherlock Company materials summarizing the results of our surveys are found below.

Independent / Provider – Sponsored Plans

Blue Cross Blue Shield Plans

Assessment

The contents above are a very small portion of the 1,000 page Sherlock Benchmarks for each of these universes. The Sherlock Benchmarks are essential tools to manage administrative costs for your health plan.

budget

Conclusion

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On Health Plan Member Portals

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By http://www.MCOL.com

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Will you receive a tax credit to help you purchase health insurance?

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An Infographic

By Healthinsurance.org

This infographic helps Americans determine whether they will be eligible for a health insurance premium subsidy under the Affordable Care Act aka Obamacare.

The infographic accompanies a story by blogger Maggie Mahar, who explains not only how eligibility for health insurance tax credits is determined, but also how much recipients should expect to receive.

The article also includes a chart with federal poverty level (FPL) numbers and links to a Kaiser Family Foundation premium subsidy calculator

Link: Healthinsurance.org

The graphic was created by Mahar, HIO editor Steve Anderson, and designer Barb Etzkorn. It was posted on the Blog of the Health Insurance Resource Center, one of the longest running sources of consumer health insurance information on the Web.

***

obamacare-and-premium-subsidies-590x371

[Click to Enlarge]

Assessment

All healthcare and medical professionals should be aware of the information in this info-graphic; all FAs, too!

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Un-Insured Adults in the USA

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Fall 2014

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On Medicare ACOs

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Percent of Regionally Covered Populations

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2015 Health Plan Premium Increases

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Projections

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Some Financial Health Insurance Hardships and Concerns of Adults

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***

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***

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The “ObamaCare Opportunity” for Financial Advisors

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Why Physicians Need Financial Advisors Now!

[By Vicki Rackner MD]

http://www.CertifiedMedicalPlanner.org

VR MDI recently attended a surgical meeting. Most conversations with my physician colleagues turned to the same singular topic: physicians’ new financial reality.

And the message is, “It hurts!”

Physicians’ Financial Plans

Financially savvy physicians execute thoughtful retirement plans. Yet, today about half of surveyed physicians are behind where they would like to be in retirement preparedness. Further, today only about half of physicians work with professional financial planners.

As a physician myself, I understand why smart physicians fail to take smart financial action. We physicians dedicate ourselves to the alleviation of pain and suffering of others. Retirement is a distant personal concern that does not cause immediate financial pain today. We put it off.

Lesson from My Dentist

Years ago my dentist recommended that I undergo a procedure to replace a filling. He explained that the filling material put in my mouth about 40 years ago tends to pull from the tooth over time and allow new cavities to form.

As much as I like my dentist, I actively avoid spending time in his dental chair. I put off the recommended filling replacement year after year. That is, of course, until I experienced vague throbbing from that tooth. I rearranged my schedule so I could tend to this small problem before it became a much bigger problem. Who wants a root canal!

For physicians retirement planning is like that proactive filling replacement. We understand that without action there will be problems down the road. However, the threat of a problem in the distant future does not propel many like myself to action today.

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The ObamaCare [PP-ACA] Opportunity for Financial Advisors

ObamaCare is the source of acute financial pain for physicians. It’s the financial toothache. Practicing physicians are looking at:

  • Higher taxes. Doctors represent 9 of the 10 highest earners in the US.
  • Rising costs of goods and services as businesses address their own higher tax bills.
  • The costs of building the infrastructure that will lead to greater healthcare efficiencies, like converting to electronic medical records, hiring new staff to address new administrative demands and aligning with new compliance requirements.
  • Lower professional fees. The 24% Medicare fee reduction that was averted this year will become reality soon. As Medicare goes, so, too, go the rest of the insurance fee schedules.
  • Decreasing patient referrals as primary care doctors sell their practices.
  • Physicians know they need to act now to avoid the financial root canal. Each physician is in the process of creating a personal ObamaCare plan.

Physicians’ Wants and Needs

As a financial advisor, you know that physicians NEED a retirement plan. Kids need to eat their broccoli, too. It’s good for them.

Physicians WANT a plan to help them achieve the personal, professional and financial goals that drew them to a career in medicine. Engaging physicians by address their ObamaCare plan is about as hard as getting kids to eat ice cream.

What This Means for You

Today physicians actively seek experts to help them create their ObamaCare plans.

Financial advisor are winning new physician clients. As Seattle Seahawks quarterback Russell Wilson asks, “Why not you?”

If you want to work with more physician clients, this is your moment! Seize it. You have a chance to join the high-performing financial advisors mining the treasures in the medical market.

Assessment

Should wish to learn more here’s a video that addresses 4 questions:

  • Why do physicians need you now?
  • What do you need to know about physicians now?
  • How do you engage physicians now?
  • How do you conduct yourself so physicians want to conduct business with you now?

About the Author

Vicki Rackner MD is an author, speaker and consultant who offers a bridge between the world of medicine and the world of business. She helps businesses acquire physician clients.

VIDEO: https://www.youtube.com/watch?v=CeCyidc4JP8&feature=player_embedded

Enter the Certified Medical Planners

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Update on US Health Insurance Coverage

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Census Bureau 2013 Data

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PP-ACA Premium Percent Changes from 2014-2015-2017

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For the Silver Plan 

[By Kaiser Family Foundation]

Premiums for the silver insurance premium plan that is used to benchmark tax credits under the Affordable Care Act (ACA) will fall by an average .8% in 2015, according to a new study.

Meanwhile, premiums for the lowest-cost bronze option available through the ACA’s healthcare exchanges will increase by an average of 3.3%.

Silver plans were chosen by 65% of exchange enrollees in 2014, and bronze plans were chosen by about 20% of enrollees, according a report from the U.S. Department of Health and Human Services.

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kaiser_chartfinal

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Reference: http://medicaleconomics.modernmedicine.com/medical-economics/news/aca-exchanges-silver-premiums-decrease-average-8-2015

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State Uninsured Patient Rate Reductions

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Five State with Highest Percentage Change for 2013-14

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State Requirements for Individual Market Benefit Design and Cost-Sharing

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ACA State Requirements

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Employer Health Benefits Post PP-ACA

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 HealthcareWebSummit Events

Upcoming Webinars:

On Demand: IBM Webcast: Using Analytics to Improve Outcomes at the Point of Care
On Demand: A Fresh Approach to CDH: 5 Ways to Get In It to Win It
Predictive Modeling Web Summit June 4, 2014
Large Employers and Exchanges: Minimum Standards and Private HIX Considerations June 5, 2014
Cigna’s Collaborative Care Strategy: Engaging Healthcare Professionals June 18, 2014
Provider Contracts and Quality Measurement June 19, 2014
Understanding Medicare DSH Changes-Hospital/Medicare Advantage Plan Implications June 24, 2014
Accountable Care at a Tipping Point: Oliver Wyman ACO Research Findings June 27, 2014
2015 Medical Cost Trends & Implications: PwC Research Behind the Numbers July 15, 2014
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Two Healthcare Sectors the Stock Market Got Wrong on Election Day 2012

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How various sectors in the Health Care Industry fared under the PP-ACA legislation?

[A SPECIAL R&D REPORT FOR THE ME-P]

By David K. Luke MIM, MS-PFP, CMP™ [Certified Medical Planner™]

Website: http://www.networthadvice.com

David K. LukeThere has been a lot of speculation since the words “Affordable Care Act” were first whispered years ago on how the various sectors in the Health Care Industry would fare under such legislation. I proposed that a good indicator would be to look at the performance of the individual health care sector stocks on the first trading day after the election.

(See With Obama Election Win, “Mr. Market” Weighs in on the ACA Equity Winners and Losers by David K. Luke on November 16, 2012).

Link: With Obama Election Win “Mr. Market” Weighs in on the ACA Equity Winners and Losers

The day after Pres. Obama’s reelection on Wednesday, November 7, 2012 the stock market was down over 2% as measured by the S&P 500 and the Dow Jones Industrial Average (DJIA). The common reason given was increased doubt that the impending “fiscal cliff” issue, which was splitting the House and the Senate, would be resolved. There was however, another big concern on investor’s mind: the future of the Affordable Care Act. While the election was close when measured by the popular vote with President Obama earning 51.06% versus Mitt Romney with 47.20%, the electoral vote showed a hands-down Obama victory with 332 versus 206 votes. Investors voted with their pocketbooks with that first trading session following the election showing certain healthcare sectors up in price, other healthcare sectors with moderate returns, and certain healthcare sectors down in price.

Disparate Health Care Sector Returns

It is interesting to look back now over a year and a half later and see how accurate those investor votes were on that first day of realization that health care reform was continuing forward at a much faster pace now that President Obama would be serving a second term. Keeping in mind that the day was a very negative day as a whole in the stock market, a number of healthcare sectors were up in price. This group includes Hospital Stocks and Medicaid HMOs. Note the phenomenal one-day returns (in a down 2% market!) on the sample stocks in these two groups:

Hospital Stocks

  • Health Management Associates (HMA) +7.3%
  • HCA Holdings Inc. (HCA) +9.4%
  • Community Health Systems Inc. (CYH) +6.0%
  • Tenet Healthcare Corp. (THC) +9.6%

Medicaid HMOs

  • Molina Healthcare Inc. (MOH) +4.6%
  • Centene Corp. (CNC) +10.1%
  • WellCare Health Plans Inc. (WCG) +4.4%

Such positive returns on a big down day in the market indicates investors assessing these healthcare sectors being good investments under an Obama presidency and a positive outlook for the implementation of the Affordable Care Act. The other up sector on that day was the Drug Wholesalers, up almost 1% on that negative day. (See “Selected Health Care Performance” Chart – below).

The market had a tepid response to the Pharmacy Benefit sector, as well as the Generic Pharmacy, Testing Labs, and Big Pharma. In my sample group, these sectors were down -.4%, -7%, -1.7%, and -1.4% respectively. It is important to note however that these sectors while slightly positive or barely negative still performed better than the general market that day.

Two Sectors

But, the two healthcare sectors that the stock market severely punished with the voting of substantially more sellers than buyers by investors on that first post-election day were the Medical Device Companies (down 2.5% in the sample group) and the Medicare Part D Companies (down 4.7% in the sample group). The thought at the time was that Medical Device Companies, facing an impending medical device excise tax of 2.3% on the sale of most medical devices in the United States, would be devastated, and that Medicare Part D Companies would face severe profit constraints with tighter-fisted government regulations imposed by the ACA.

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Stock_Market

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The Retro-Specto-Scope

In hindsight, investors were correct on two out of the three predictions based on stock market prices on the various healthcare sectors. Hospital Stocks, Medicaid HMOs, and Drug Wholesalers, the leading sectors indicated to be winners with the impending implementation of the ACA, are up 69.8%, 63.6% and 76.5% respectively in the sample groups since November 7, 2012. This remarkable and closely parallel return for these three sectors seemed to prove that the stock market on November 7, 2012 correctly picked the three winning health care sectors! The S&P 500 index for the same time is up 32.02%, a nice return for 1 ½ years but about half the return of these apparently huge benefactors of the ACA. The healthcare sectors that investors felt less positive about (but more positive than the general stock market) on that first postelection day were Pharmacy Benefit Companies, Generic Pharmacy Companies, Testing Labs, and Big Pharma. These four health care sectors are up 43.8%, 40.5%, 6.4%, and 20.5% respectively. Again, in terms of ranking the sectors, these four sectors performed in line based on the comparative returns of the other healthcare sectors.

Wisdom of Crowds

Amazingly, it appears that the emotional Mr. Market predicated quite accurately on Wednesday, November 7, 2012, in one day of trading, not just which health sectors would be good investments for the near future, but the actually ranking of the future performance of the sectors! It seems as though the stock market, as one large voting machine, precisely dissected the over 20,000 pages + of resulting legislation created from the original 906 pages (pdf here) of the PPACA law and distilled it down to profits and losses with the resulting winners and losers in the health care industry in one trading session.

Two [2] Big Misses

Investors however were way off on their concerns about Medical Device Companies and Medicare Part D Companies. The two sample groups were up 71.3% and 66.4% in the time of November 7, 2012 to May 19, 2014 respectively, more than double the S&P 500 for the same period, and in line with the best performing sectors! This is spite of the fact that stock sample of these two groups were the two worst performers on post-election day trading. What happened?

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Bear + A Falling Stock Chart

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The “Medical Device Excise Tax” Fable and the “Private Insurers Will Control Costs” Fairy Tale

Wall Street has sharpened their pencils in the last year and a half and realized they have gravely underestimated the profit potential of the Medical Device makers and the Managed Care Health Insurers, in spite of the ACA. Based on stock price performance of the sample group of major players in the past 18 months, fewer sectors look as profitable as the Medical Device Industry and the Medicare Part D Industry. What happened?

The Medical Device industry states that the tax will cost the US “tens of thousands of jobs” and that those jobs will be shipped overseas. A number of issues that are involved here however refute these claims (http://www.factcheck.org/2013/10/boehner-and-the-medical-device-tax/. It appears that any targeted reductions were not related to the implementation of the tax, which became effective January 1, 2013, in spite of heavy protest by the industry. Medical technology continues to have a bright future regardless of the tax.

The notion that the “Affordable” Care Act will help reign in the rampant cost increases of Medicare’s “Part D” program seem to be elusive. Private insurers have done a poor job of keeping drug prices down, especially when compared to the discounts the government gets for Medicaid. Medicare Part D companies wield significant influence on Capitol Hill, and impending steeper discounts look unlikely.

Everybody Wins, Except …

Before the ACA implementation, about 85% of Americans had health insurance. Currently with an additional 7 million Americans with health insurance thanks to Obamacare, an additional 2.2% of Americans now have coverage, or about 87% of all Americans. How can such a slight increase in new health care consumers be responsible for such large anticipated profits in the health care sector? It cannot. Wall Street is telling us that the new health law is not about new customers, but about increased profit margins for the health care industry. I can draw three conclusions:

  1. The Affordable Care Act may not be so affordable for health consumers
  2. Most companies in the Health Care Industry stand to gain financially with ACA. There is one sure loser with ACA: The physician, who can only look forward to increased workloads and mpending Medicare SGR pay cuts.

THE CHART [Research and Development]

Selected Health Care Sector Stock Performance Random Sampling of Publically Traded Companies From President Obama Re-election Date to Present

Chart

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How the ACA Affects Your RXs

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On Four Large Groups of Import

By http://www.HelpRx.info

To give you a jumpstart about how the Affordable Care Act will impact you and your prescription drug coverage we’ve researched the major impacts on four large groups of people who could see the greatest impact.

Review the info-graphic below to learn about the benefits and requirements of the ACA and share it with your friends and family that still have questions about how the ACA will affect them.

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infographic

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Assessment

See more at: http://www.helprx.info/blog/infographics/infographic-how-the-affordable-care-act-impacts-you#sthash.6bk5zU0D.dpuf

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Regional Distribution of Un-Insured Adults in the Coverage Gap

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The New “Patient Centered Health Plan” Video

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An Alternative to Obamacare?

[By Staff Reporters]

Did you know that Tennessee’s US senatorial candidate, Dr. George Flinn, just announced his Patient Centered Health Plan as a sustainable alternative to Obamacare?

“This country needs a strong, positive alternative,” said Flinn. “We need to unite behind a solid proposal now because the longer Obamacare is in place, the harder it will be to repeal.”

The PCHP [Patient Centered Health Plan]

The Patient Centered Health Plan advocates a quality, affordable system promoting principles such as portability, competition across state lines, and the expansion of health savings accounts (HSA).

Flinn stated that his plan aims to end the assault Obamacare has created on our liberty and free enterprise in this country.

From massive job loss, decreased quality of care, doctor shortages, layoffs in health services, and millions still uninsured, Obamacare is doing the opposite of what it was made to do.

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GF

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The Plan Link

The plan is available in detail at www.patientcenteredhealthplan.com

Selected Lists On Health Savings Accounts:

Assessment

Both parties criticize one another for different aspects of Obamacare. The only consensus is its inability to effectively function. For the betterment of the United States, party lines need to be overlooked in order to find a solution.

Patient Centered Health may be the answer.

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Appreciating the Highest Rates of Uninsured or Underinsured‏ Americans

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For the Five States with the Highest Percent of People Under Age 65

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Uninsured

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Health Plan Rankings and Satisfaction‏

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 Top 20 Private Health Insurance Plans [HIPs]

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The State SHOP Market-Places 2014

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Total Number of Plans for Small Employers 2014

SHOP

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Can Politically-Correct Names Save Obamacare?

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Saving Electronic Health Record Interoperability?

1-darrellpruittBy D. Kellus Pruitt DDS

If HHS successfully persuades Americans to use happy names for its bad ideas, will the cheap trick save electronic health record interoperability which is critical to the success of Obamacare?

Healthcare Lexicon 

According to the government’s modernized healthcare lexicon, doctors have been demoted to “providers,” insurance companies, including Medicare/Medicaid, have been promoted to “payers,” and patients’ position in the hierarchy has diminished from “principals” to “stakeholders” – a rank on par with 3rd parties such as insurers, HHS and other unaccountable parasites.

Wall of Shame

Ominously, HHS recently changed the contentious name “Wall of Shame” to a more innocuous“ breach reporting tool,” to describe the public list of data breaches involving the medical records of more than 500 patients. It turns out that the growing list of major data breaches is unexpectedly shaming  far too many providers and payers – including Medicare/Medicaid. Imagine that!

In fact, since Americans’ growing disgust with privacy breaches threatens the very success of Obamacare, there is evidence that HHS has turned to betraying its lawful obligation to the nation by hiding breaches from those who are most vulnerable – Americans.

HIPAA Failure

The half-baked plan to shame providers who experience data breaches – perhaps through no fault of their own – is not working out like HHS had hoped. Due to HIPAA’s abysmal failure to halt data breaches, the Wall of Shame has become a national embarrassment and an obstacle to EHR adoption. I expect the public listing of major breaches to be quietly scrapped soon in favor of keeping patients in the dark concerning their risks of identity theft.

Dentistry 

In dentistry, on the other hand, common sense as well as market resistance evidently caused HHS and other stakeholders to give up trying to prohibit use of the 8 syllable “electronic dental records” in favor of the 14 syllable “electronic health records for dental practices.”

Nevertheless, holdouts (including Dissent Doe) still occasionally feel it is important to correct this dentists when I use “EDR” instead of “EHR.” You got to love ‘em.

Obama Care 

Assessment 

Transparent silliness suggests that HHS is failing in its duties. Due to lack of accountability, we can expect EHRs and EDRs to become even more expensive and more dangerous, possibly bringing an end to Obamacare.

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Eligibility for Health Insurance Coverage as of 2014

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Among the Currently Un-insured for Selected United States

By www.MCOL.com

Eligibility

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American’s Personal Experience with the PP-ACA

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The Law of the Land

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ACA

More:

Assessment

So, tell us your personal experi9ence with the ACA

Conclusion

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Percentage of Families with Medical Care Financial Burdens

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The CDC Definition

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CDC

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Enrollment, Coverage and the PP-ACA

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For Medicaid

By www.MCOL.com

ImageProxy

Assessment

1. Aetna CEO: Only 11% Of ObamaCare Signups Have Been Uninsured 
2. The Individual Mandate for Health Insurance in the U.S.
3. Survey of Americans’ Preparations for Health Care in Retirement
4. Medi-Cal at a Crossroads: What Enrollees Say About the Program 
5. The Affordable Care Act: The Exchanges Go Live

Conclusion

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My Experience with ObamaCare

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Not a Unique Story – to Date

Rick Kahler CFPBy Rick Kahler CFP® http://www.KahlerFinancial.com

Like millions of Americans, I jumped on Healthcare.gov on October 1 to view the long-anticipated plans on the insurance exchanges mandated by the Affordable Healthcare Act, known as Obamacare. I needed a new healthcare plan and purposely held off buying one in September to compare the coverage and prices of an Exchange plan.

My disappointment paralleled that of thousands of other Americans wanting to do the same. After six tries that day, I gave up. I tried the site multiple times for each of the next six days. No luck.

The Short Form

Finally, on the seventh day, the site actually let me start an application. I chose to go with the “short” form since I was certain I would not qualify for a subsidy.

The short form application took 30 minutes to fill out. There were very few questions about health, just whether anyone in the household smoked. A number of questions had me wondering if I was applying for a passport. These included my Social Security number, race, citizenship, relationships to everyone in the family, and whether I was ever incarcerated.

When I reached the end of the form, I hit “submit,” anticipating that plan options and costs would appear. Instead, I was sent back to the starting page of the form. After 60 minutes of trying to get out of this endless loop, I gave up.

Three More Weeks of Trying

For the next three weeks, I went to the site at least once a day. I was never able to get past the endless loop to view plans or prices. I took a two-week break.

On November 14, I tried again. Success! Well, sort of. No endless loop. Instead, the site said it lost my original application and I needed to complete a new one. After another 60 minutes filling out the application, I ended up stuck in a loop again, unable to view plans or prices, much less choose one.

Giving Up

Frustrated, I decided to give it a rest until the site re-launched on December 1. I figured I would still have plenty of time to meet the December 15 deadline for enrollment.

On December 1, I eagerly popped onto the site. Not only was the site not functional, it had lost my application for the third time.

I gave up.

Enter the Insurance Broker

I phoned my insurance broker. She was able to give me all the information I had tried to get out of healthcare.gov for the past 60 days. She also said my insurance company was canceling my current plan. Obamacare deemed the coverage substandard because it did not cover pregnancy, mental health costs, and pediatric dental and vision costs. Although I don’t want or need any of that coverage, Obamacare gives me no choice.

Prices

My old policy cost $1,192 a month. The new one costs $1,506, which includes $59 a month in mandated surcharges on non-exchange policies to help fund Obamacare. My maximum family out-of-pocket expenses must also increase $208 a month. The total potential increase is a staggering $524 a month.

###

Obama Care

###

A Skeptic

As someone who listened with great skepticism as politician after politician promised that Obamacare would lower health care costs, lower our deficit, and guarantee we could keep any existing plan, I feel sadly vindicated. In March 2010, when Congress passed Obamacare, I paid $660 a month for health care that had better coverage than I have now. For that same coverage today, my premium would be $2,450 a month.

Assessment

Unfortunately, my story is not unique. It is ubiquitous to the average American who has health insurance. Our elected officials and government agencies failed us miserably. So far, there appears to be no relief in sight.

More

Conclusion

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Pity the Poor Hospitals?

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A Historical Look-Back to the Future?

wayne-firebaugh

By Wayne Firebaugh CPA, CFP® CMP™

www.CertifiedMedicalPlanner.org

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future. … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been effected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect. [1]

In Agreement

Many health administration and endowment managers would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. Although they might be startled to learn that Dr. MacEachern made these observations in 1932, there is the old truism that there is nothing new under the sun.

Today

More current healthcare statistics after the November 7th 2012 presidential election and Patient Protection-Affordable Care Act confirmation, suggest that the financial crises are much the same for today’s hospitals as they were for hospitals during the Great Depression.  The American Hospital Association (AHA) recently reported a number of gloomy statistics for hospitals: [2]

  • Hospitals provided $39 billion in uncompensated care to patients in 2010 representing 5.8% of their expenses.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million, that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.

More Metrics

A further review added more daunting numbers: [3]

  • In 2010, 22.4% of hospitals reported a negative total margin.
  • From 1997 through 2009, hospitals saw a small net surplus from government payments from sources such as Medicare and Medicaid deteriorate into a deficit approaching $35 billion.
  • Emergency departments in 47% of all hospitals report operating at, or over, capacity partially reflecting an approximate 10% decline in the number of emergency departments since 1991.
  • The average age of hospital plants has increased 22.5% from 8.0 years to 9.8 years in just fifteen years.
  • From 2003 through September 2007, hospital bond downgrades have outpaced hospital bond upgrades by 19%.

In a time when so much seems different yet so much seems the same, hospitals are increasingly viewing their endowments as a source of help. But what is an endowment?

Latin Roots

The same Latin words that give rise to the word “dowry” also give rise to the word endowment.[4] Interestingly, the concepts of a dowry and an endowment are in many ways similar. Both are typically viewed as gifts for continuing support or maintenance.

With respect to the healthcare entity, an endowment is generally used to smooth variations in operating results and to fund extra programs or plant purchases. Any entity that enjoys the support of an endowment also encounters the conflicting objectives between current income and future growth.

Hospital

Assessment

Dean William Inge, a 19th century cleric and author, aptly noted that: “Worry is interest paid on trouble before it is due.”

When managing an endowment, it is important that the institution focus its attention on those items that it can control rather than worrying about those it cannot control. Successful endowment managers seem to agree that there are at least two major areas subject to the endowment’s control: asset allocation (also known as investment policy) and payout policy.

More:

Conclusion

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[1]   MacEachern, M.T., MD. “Some Economic Problems Affecting Hospitals Today and Suggestions for Their Solution.” The Bulletin of the American Hospital Association. July 1932.

[2]   Steinberg, C. Overview of the U.S. Healthcare System.  American Hospital Association (2003). Carline Steinburg is Vice President, Health Trends Analysis, for AHA.

[3]   “Trends Affecting Hospitals and Health Systems.”  TrendWatch Chartbook 2010.  American Hospital Association (2010).

[4]   Merriam-Webster Online.

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What is Form 834?

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President Obama’s Most Important Number

[By Staff Reporters]

This is an “834 EDI transmission.”

Health Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see on the Federal Website. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And, it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

Washington Post Article:

This is an “834 EDI transmission.” Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

HIEs

What is the ANSI 834 Enrollment Implementation Format?

The 834 Transaction is the HIPAA-compliant Benefit Enrollment and Maintenance Transaction. Its purpose is to electronically transmit enrollment and dis-enrollment information.

In 2004, DHCS implemented a 4010 834 solution, however, this was implemented along with a supplemental transaction that held eligibility history.

The HIPAA 5010 version of all transactions is scheduled to be implemented on January 1st, 2012. DHCS will implement a compliant 5010 834 on this date. The current FAME file will continue to be made available for a short period of time after this date to allow plans time to transition. Once this transition period has been completed the FAME file will no longer be made available to managed care plans.

Impacted Covered Entities

Internal DHCS program areas and DHCS Health Plan trading partners.

Links:

5010 834 Documents

General FAME Documents

MEDICARE PART D INFORMATION

Project Information

DHCS Medicare Part D information web page

MMA Part D Carrier Cross Reference Table (pdf)

File Layouts

MMEF 2100 Medicare Part D layout (pdf)

MMEF REC Medicare Part D layout (pdf)

Assessment

best-diagram

Conclusion

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Take the Accountable Care Organization 2013 e-Poll

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TAKE THE POLL

www.MCOL.com and Accountable Care News are conducting the 2013 Accountable Care e-Poll. Please respond by 5 PM Pacific, Friday December 13th, 2013. Results will be emailed to participating respondents upon request.

e-Poll

You can take the e-poll by going to: http://aco2013.questionpro.com/
The e-poll asks the following questions:

  1.  Please indicate your perspective:
  2. Is your organization involved with ACOs- including development, operation, or contracting arrangements?
  3. When would you estimate ACOs would have a material impact in your marketplace:
  4. If ACO Medicare pilots are not ultimately successful, will that cause commercial and Medicaid ACO arrangements to generally fail as well?
  5. What will be the impact of the newly enrolled individuals coming into the system as a result of Medicaid expansion and the health insurance exchanges?
  6. How confident are you that ACOs will actually generate the necessary savings?
  7. Will bundled payments prove to be a more effective delivery and payment reform model than ACOs?

Advocacy

Assessment

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Conclusion

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On Healthcare.Gov System Availability

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A Review of Website “Uptime”

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HG

Conclusion

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