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Will Obamacare result in better care across the healthcare continuum?

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Affordable Care Act

 

Is Obamacare backing patients into a corner?

There has been a lot of controversy surrounding Obamacare ever since it was launched. It has drawn criticism from all sides. Physicians are cribbing about the tremendous amount of paperwork they have to put up with. And, the pressure to comply with, several federal regulations.

Obamacare which was hoped to improve healthcare outcomes and give the uninsured a new lease of life has been accused of not delivering its promises.

No card no service!

This is the arithmetic of the current healthcare scenario. Many patients have no idea whether they are insured or not. Several of them have walked out of hospitals, despite ailments, fearing a huge bill.

There is no way for patients to prove that they’re insured and this has led to mayhem, untreated patients and frustrated doctors. The sticker shock patients face, gives rise to one pertinent question, whether Obamacare is another failed promise?

Technology will drive healthcare costs down…

Healthcare IT has emerged as the biggest hope for the healthcare industry to cut down on costs and move towards a better model of working. Bending the cost curve isn’t easy but certain medical specialties like radiology have seen a drastic decrease in procedural expenses. From being one of the most expensive specialties, radiology has now managed to become less expensive and contain costs.

Even the skeptics have agreed that the Affordable Care Act can be a harbinger of change. Despite it’s, shortcomings, and a very worried American public.

Here is why the ACA isn’t so bad after all!

  1. The act has empowered patients and has aided them in choosing providers and services that better suit their requirements.
  2. The ACA has standardized medical billing and documentation to a large extent.
  3. It has provided medical practitioners the impetus to explore newer revenue and workflow models.
  4. Risk sharing pay systems can help physicians move away from the traditional fee for service model.
  5. The ACA has made the entire healthcare industry more tech-driven. This means better patient communication and care.

Infographics: Obamacare – A Precursor for Financially Sound Healthcare Practice

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Affordable Care Act(ACA)

How Obamacare Benefits Medical Practitioners?

As a medical practitioner, you will be glad to know that “Obamacare” has proved its mettle in reviving fortunes of the medical business fraternity. Obamacare¸ also known as the Affordable Care Act (ACA) was enacted as federal law by President Barack Obama on March 23, 2010. ACA, along with the Health Care and Education Reconciliation Act, has effectively overhauled the US healthcare system.

ACA, the new health care reform law in America, enhances the affordability, quality, and availability of insurance policies from public and private payers to about 44 million uninsured citizens. This will increase collection of insurance reimbursement collection of hospitals and clinics for providing healthcare services to patients. In addition, it also curtails the rise in healthcare spending.

Any Statistical Evidence That ACA Will Prove its Worth?

Sure – no doubt about that!

Healthcare establishments across the US stand to gain since public opinion favours ACA. Proof of the pudding lies in the fact that statistical survey reports justify the fact that ACA has started gaining momentum across the US. Due to competition in the insurance marketplace, premiums have started dipping below the projected levels. This will lead to estimated savings of roughly $190 in the federal budget during the next 10 years. This fact is a vital early indicator that the ACA is performing much better than anticipated to decrease federal budget deficits and national spending on healthcare.

Due to these savings, the healthcare deficit will be lowered to the tune of 174%. In terms of savings in healthcare suggested by the Simpson-Bowles commission (namely the National Commission on Fiscal Responsibility and Reform) -, this works out to be around 40%. In addition, reduction in premiums will further decrease the number of uninsured citizens by 700,000. Since insurance will be less expensive, more number of citizens will opt for insurance policies, resulting in additional reimbursement receipts for hospitals.

Statistical Surveys Reinforce Credibility of ACA

Recently, Washington-based Gallup conducted a daily tracking survey, with a random sample of 1,528 adults. These adults were bracketed in age groups of 18-29, 30-49, 50-64, and older than 64. Maximum support for the plan came from the 18-29 age group. The number of persons in the younger generation category who approved the Obamacare plan exceeded the numbers in the same category who disapproved the plan. This implies that more numbers of younger adults are likely to be uninsured in comparison to people in the upper age groups. In addition, there is a steady rise in the population of younger adults. Their willingness for opting for insurance policy is a crucial factor for success of Obamacare.

Do Medical Practitioners Gain by Entry of New Insurance Agencies in the Market? 

Of course! According to the McKinsey Center for U.S. Health System Reform, new insurance payers form about 26% of the number of insurance agencies in the US. Entry of these additional players has led to more intense competition in the insurance market. These agencies priced their premiums lower than existing ones in the market. Lower premiums will lead more people to go in for insurance policies. This will boost up insurance receipts of medical entities.

In addition, the Kaiser Family Foundation conducted a preliminary study of insurance plans offered in 18 areas. 15 out of these 18 areas experienced premiums that were less than premiums estimated by the national Congressional Budget Office (CBO).

Reduced premiums imply that more and more number of citizens will walk into the insurance coverage basket. It has been estimated that the number of citizens who are not insured will be reduced by 2.8% due to 16% drop in premiums. This, in turn, results in additional revenue collection for hospitals and clinics.  In addition, insurance coverage will be increased for 700,000 citizens by 2013 since CBO had projected a reduction in number of uninsured citizens by that time.

Any Plans Related to ACA Coverage?

You will be pleasantly surprised to know that insurance policies are already available which incorporate the need for minimum coverage. With effect from Jan 1 2014, the ACA mandates that most of the US citizens opt for minimum essential insurance coverage or pay a penalty. Following plans are available for US citizens:

  1. Medicare or Medicaid federal sponsored programs.
  2. Private insurers’ plan in the individual insurance market.
  3. Employer sponsored plans.
  4. Health plans available in States’ individual markets.
  5. Certain health plans that were operative before ACA.

Win-Win Scenario for Doctors and Patients!

Doctors and patients both stand to gain as Obamacare counters effectively insurers’ tendency to deny payment for pre-existing health conditions and impose limits on annual payment by insurance payers. Now pre-existing conditions will also be covered for insurance payment. Citizens will also avail plans that cover out-of-pocket expenses, for the first time in the country. Medicaid coverage is being expanded by many states, so that additional citizens are covered by 2014. The ACT will also cheer-up small business owners who form bulk of uninsured people. This means additional reimbursement receipts for medical units.

For further enquiries on Obamacare, rewards and incentives for wellness programs, tax credits, free EHR/EMR subscriptions, and so on, you are welcome to contact us any time convenient to you.

Increased Reimbursement For Primary Care Physicians, A Closer Look !

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A welcome respite for primary care physicians !

Everybody knows that primary care physicians are struggling to stay in business. A mandate by the Affordable Care act has announced that Medicaid rates for certain primary care procedures will be paid on par with Medicare rates.

 To receive additional reimbursement physicians will have to fill out, a, state specific Medicaid self-attestation form.

Medicare

Who are covered ?

Family practices, pediatricians and general internal medicine physicians are eligible for increased reimbursement. So are several other sub-specialties and physicians who perform high levels of primary care services. The major criteria are that, physicians should be board certified and have a billing history that indicates that about 60% of their billing is for primary care codes.

The rate increase will be in effect till the end of 2014. Physicians, who’ve registered through MITS and are approved by the Office of Medical Assistance, can see more digits in their pay check from April 2013.

The code to more dollars !

Primary care physicians will be reimbursed in accordance to HCPCS codes related to primary care. Evaluation and management codes from 99201 through 99499 are eligible, as are certain vaccine administration codes.

The rough and tumble of practicing primary care…

Primary care physicians are working under heavy financial pressure. The sequestration cuts of 2013 have taken a heavy toll on medical practices. The sustainable growth rate formula has quickly turned in to a nightmare for physicians.

 Reimbursement cuts, operational pressures and complicated regulations scared the daylights out of physicians.

Quite arguably it was primary care practices that were the hardest hit. Primary care centers were soon shutting their doors as it became increasingly difficult to practice. Primary care practitioners were finding it almost unfeasible to take care of their elderly Medicare patients.

At a time when it was needed the most !

The increase in reimbursement has come at a time when physicians need it the most. The increased Medicaid reimbursement means physicians are offered a reprieve after all the financial pressures they’ve gone to.

Want a few tips to increase the revenue of primary care practices ?

Will Accountable Care Organizations Pave the Way for Change?

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 ACO’S- And the Debate continues…

Are accountable care organizations the future of the healthcare industry ? Or will they force independent practices to shut their doors ?

According to a recent report 49 percent of primary care physicians and 53 percent of endocrinologists are expected to switch to the ACO model in the coming year.

Financial Security and Better Care.

Physicians who’ve partnered with ACOs are provided incentives for prescribing more generic medication. They are also encouraged to lower hospitalization costs. This accent on the quality of care and containing costs can offer clinical benefits and savings, for healthcare providers.

 The much needed Compass…

One of the major reasons attributed to the popularity of ACOs is that they provide a sense of direction. And help physicians to focus on quality metrics, to receive reimbursement and incentives.

It is Not all Gravy…

There are strong oppositions to practices adopting the ACOs model of working. Some section of the healthcare sector, feel it can pressurize independent practices, to join larger organizations. The clinical benefits it offers are also viewed with a sense of skepticism.

The sustainability of independent hospitals is one major concern. And the fact that it focuses more on hospitals rather than physicians is another key factor that works against acos.

Will it join the IDNs of the 90’s ?

Integrated delivery networks were followed by several healthcare providers in the 90’s. Hospitals followed and pursued two strategies, of vertical and horizontal integration. There were different models such as strategic alliances and acquisitions. There was one common factor that bound all the models together, they just didn’t work.

Whether acos join the ill fated idns of the 90’s, or become the, future of the healthcare industry, remains to be seen.