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Modern Physician: Practice Makes Perfect: Preparing for shared-risk reimbursement models
In June, the MGMA-ACMPE released the results of a questionnaire that ranked members’ most-pressing practice management challenges. In this edition of “Practice Makes Perfect,” we’ll tackle No. 2 on that list: Preparing for reimbursement models that place a greater share of financial risk on the practice.
One of the many hot topics at our upcoming annual conference in San Antonio will be the changing healthcare environment and how practices can—and should—prepare for new payment methodologies. The federal government and commercial insurance companies are in the midst of changing the way they pay hospitals and doctors. Some of these changes are the result of the Patient Protection and Affordable Care Act as well as market forces. These changes will affect practices in all settings, and it’s important to prepare for reimbursement models that place a greater share of financial risk on the practice.
Physicians may soon be at financial risk as payers test and adopt new payment methods. The CMS and private insurers are proposing models to replace separate payments to hospitals, doctors and other providers with a single bundled payment, and we are seeing multiple definitions of bundling. A common type of bundled payment involves a single payment for all services furnished before, during and after a hospitalization, including outpatient diagnostic tests, inpatient facility costs, drugs, supplies and the professional services of every physician involved in the patient’s care.
In addition, the CMS and many insurers are testing variations on the capitation payment concept that was widely used in the health maintenance organization craze of the 1990s. Commonly referred to as “global payment,” this reimbursement method pays a set amount per patient (usually adjusted by demographics) and the provider accepts responsibility for a predetermined set of services regardless of the costs.
Both bundled and global payment reflects a sea change from the traditional fee-for-service payment system. Payers hope that bundled and global payments will create incentives for primary-care physicians, specialists and hospitals to better coordinate services and share accountability for the cost and quality of services. They hope the new payment systems will improve the care their beneficiaries receive while lowering the total cost of care by eliminating redundant services.
These new payment methods require doctors to think in new ways and will challenge the information systems of even the most sophisticated fee-for-service practice. Bundled and global payments change a practice’s profit calculation from emphasizing service volume to operating efficiency.
In this new payment environment, practices that gather the right information and provide high-quality, lower-cost care will be the most profitable.
See on home.modernphysician.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Guest opinion: Medicare Part D: A success story for Florida’s seniors
Lawmakers in Washington are working hard to reduce entitlement spending and lower the deficit. These are worthy goals. However, during this process, it’s vitally important that policymakers not compromise successful federal programs.
Medicare Part D is such a program. Part D needs to be preserved and protected, as it has dramatically improved seniors’ access to prescription drugs and has cost taxpayers far less than expected.
Part D employs a unique market-based structure that offers enrollees genuine choice in their coverage and harnesses competition to keep prices down. The government doesn’t directly provide coverage through Part D — private insurers do. Seniors are free to choose among a broad range of plans based on their needs. The government monitors the market and provides financial support to enrollees.
See on www.news-press.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
From HMOs to ACOs: Meet the newest model in health care management – TwinCities.com
When critics look at health care in America, many describe a system that’s fragmented, inefficient and burdened with waste.
Doctors and hospitals generally are paid a fee for every service they provide, the critique goes, so they lack financial incentives to effectively coordinate care and make sure patients get only the services they need.
Patients often have a front-row seat on the dysfunction, critics say, as they are shuffled off to specialists without needed paperwork, undergo unnecessary tests or make repeat hospital visits when medical centers don’t get it right the first time.
Enter “accountable care organizations,” a new structure in health management that the federal government, health insurers and some physicians hope will tame the woes. Doctors, hospitals and clinics would be given responsibility to provide care for a group of patients — within a budget. If health care providers better coordinate care to provide good quality for less money, they can share in the savings.
Republicans and Democrats “agree that transitioning from fee for service to global payments in health care will be necessary in order to deal with the budget deficit,” Bottles wrote in an email. “The consolidation of the health care industry will continue no matter which party prevails in the November election.”
This push for accountable care organizations (or “ACOs”) is driving a consolidation trend among health care companies that’s increasingly being felt in Minnesota. The clearest example is a plan announced in August to combine the HealthPartners and Park Nicollet health systems into one of Minnesota’s largest nonprofit health companies, with 20,000 employees, including 1,500 physicians.
See on www.twincities.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Manoj Jain: Doctors need to eliminate waste from healthcare — Memphis Commercial Appeal
Dr. Manoj Jain is an infectious disease physician and also writes for The Washington Post. His articles can be seen on MJainMD.com.
Thirty percent of health care spending — amounting to $750 billion a year — is wasted, according to a recent report by the Institute of Medicine.
I know. As a doctor, I am party to this waste, and I think doctors can play a major role in recovering it.
In a private conversation, a cardiologist tells me about his partners — “loose guns” he calls them. “At the hint of chest pain they will do a cardiac cath and this makes everyone happy,” he says. The patient feels good that something was done, the doctor gains certainty of his presumptive diagnosis and the hospital makes money. While it may seem like a win-win-win, in fact, we all lose as the health care expenditure tops $2 trillion, siphoning funds from education, housing and business innovation.
The IOM report notes that unnecessary services are responsible for nearly a third, or $210 billion, of wasted expenditure.
I, too, order excessive services like CT and MRI scans, without regard to cost. Often these services are in the gray zone of medicine where it is unclear if some procedures are really necessary.
When we doctors talk about waste, we often beat around the bush. We know the system is full of waste, but when confronted we blame the patients or malpractice attorneys.
There is another less-talked-about reason for unnecessary services. One person’s waste is another person’s income. Another cardiac catherization, another back surgery means more income for doctors, hospitals and the health care system and its archaic administrative services.
To reduce waste, doctors need to become integral partners in the cost-cutting process.
See on www.commercialappeal.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Medicare Advantage Enrollees Face $515 Cut to Medicare Advantage Plans
ObamaCare imposes major cuts on the popular Medicare Advantage program, and while the Obama administration has largely delayed them until after the election, enrollees will lose an average $515 in benefits in 2013, according to an IBD analysis.
Some 14.4 million people are expected to enroll in Medicare Advantage in 2013, up from 13.1 million this year, the Center for Medicare and Medicaid Services (CMS) said Wednesday. Advantage plans are run by private firms, providing more benefits at a somewhat higher cost — usually 13% to 17% — to the government than traditional Medicare.
That added cost has made Advantage plans a target. ObamaCare will cut MA by at least $7.4 billion in 2013.
See on news.investors.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
D.C. Week: Lawmakers Talk Health Before Heading Out — Focus is on Medicare Advantage Plan Cuts under the ACA
WASHINGTON — Members of Congress tackled several health-related issues this week before leaving the nation’s capital and hitting the campaign trail for a final election push.
Democrats and Republicans traded jabs this week on health reform’s impact on Medicare Advantage plans, with one side praising the law’s effects and the other predicting it will hurt the program.
The Obama administration reported that the Affordable Care Act (ACA) has strengthened Medicare Advantage. Since the ACA was passed in 2010, Medicare Advantage premiums have fallen by 10% and enrollment has risen by 28%, according to a statement from the Department of Health & Human Services (HHS).
HHS also projected enrollment to increase 11% in the next year with premiums remaining steady.
But Republicans in the House of Representatives held a hearing Friday on Medicare Advantage plans and took the opportunity to bash cuts in the plan under the ACA saying it will negatively impact enrollment and benefits for seniors.
See on www.medpagetoday.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
CMS Press Release: Medicare Advantage Program is projected to remain strong with an increase of 11% for 2013
Enrollment in the Medicare Advantage (MA) program is projected to increase by 11 percent in the next year and premiums will remain steady, Health and Human Services Secretary Kathleen Sebelius announced today. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent.
“Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries,” said Secretary Sebelius. “Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities.”
For the third year in a row, the Centers for Medicare & Medicaid Services (CMS) used authority provided by the Affordable Care Act to protect beneficiaries from significant increases in costs or cuts in benefits. Access to supplemental benefits remains steady and beneficiaries’ average out-of-pocket spending remains constant.
The average MA premium in 2013 is projected to increase by only $1.47 from last year, coming to $32.59. However, if beneficiaries choose lower cost plans at the same rate in 2013, as they did in 2012, the average premium is expected to increase by only 57 cents. Access to the Medicare Advantage program will remain strong, with 99.6 percent of beneficiaries having access to a plan. Additionally, the number of plan choices will increase by 7 percent in 2013.
Last month, CMS announced that the average estimated basic Medicare prescription drug plan premium was projected to be $30 in 2013, holding steady from last year. Today’s projections show that access to a Medicare prescription drug plan will remain strong in 2013. Everyone with Medicare will have access to a wide range of plan choices.
The Annual Open Enrollment Period for health and drug plans begins on October 15 and ends December 7.
See on www.cms.gov
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Virginia moving on implementing health reform
Virginia has made progress in updating its computer system for verifying eligibility for Medicaid and has passed insurance regulations in preparation for implementing federal health care reform, according to a report by a nonprofit organization tracking states’ efforts.
But Virginia is behind in some key areas — it hasn’t created health insurance exchanges or marketplaces where people could buy affordable health insurance plans, and it may not be producing enough doctors to care for hundreds of thousands of newly insured people expected to be covered when reform is fully implemented.
The report, paid for by the Robert Wood Johnson Foundation, a health care philanthropy, was done by researchers at the Urban Institute, a nonprofit policy research organization, “Virginia has made significant progress in health reform implementation, despite significant political opposition in and out of the state government,” conclude the report’s authors, Linda J. Blumberg, John Holahan and Vicki Chen, of the Urban Institute.
See on www2.timesdispatch.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
State health initiative in Indiana for poor may be on last legs
The future of a state health insurance program for the working poor is in jeopardy after the federal government granted only a one-year extension for the effort.
The denial puts extra pressure on state lawmakers and the next Indiana governor who must decide next year whether to expand Medicaid, which provides health care for the poor and disabled.
Michael Gargano, Family and Social Services Administration secretary, said Friday he received notification from the Centers for Medicare & Medicaid Services offering to approve a one-year extension for the Healthy Indiana Plan to Dec. 31, 2013.
The Centers for Medicare & Medicaid Services did not approve a multiyear extension for the program and declined to respond to the state’s questions about using it to serve Hoosiers who may be eligible under a Medicaid expansion if the state decides to do so in 2014.
See on www.journalgazette.net
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
Tax-exempt health insurance carrier planned for state
The Missouri Foundation for Health has donated $500,000 to help with the development of a new tax-exempt health insurance carrier for small employers and individuals in the state.St.
Louis-based not-for-profit consulting firm The Mission Center hopes to launch the Missouri Community Healthcare Co-Op by January 2014. The Mission Center also is submitting an application to the Centers for Medicare and Medicaid Services for low-interest loans for as much as $50 million to launch the co-op, according to a news release from The Mission Center.
Small businesses and individuals face the greatest hurdles in finding affordable coverage from for-profit companies. The co-op hopes to lower costs and improve coverage for entities that struggle to access coverage.
See on www.columbiatribune.com
For an aggregation of other articles on Hot Topics in Healthcare Law, go to my magazine on Scoop.it – Hot Topics in Healthcare Law and Regulation and my newspaper on Paper.li – Hot Topics in Healthcare Law.
For an aggregation of other articles on improving healthcare, go to my internet magazine Scoop.it! Changing Health for the Better.
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