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Posts tagged with "Obamacare"

What’s Going to Happen to Health Care Reform, and Why Should We Care?

Last week the Treasury Department announced that employers with more than 50 employees would be granted a one-year reprieve (December, 2015), to meet the requirement of the Affordable Care Act (ACA known as Obamacare) that mandates they must provide health coverage for their workers or pay penalties.

While this may be viewed as a setback for Obamacare, in fact, according to a survey released in 2012 by the Kaiser Foundation, 61 percent, of employers with three to 99 employees currently provide employee healthcare coverage; 94 percent of companies with 100 to 199 workers, and 98 percent of those with 200 or more, also currently cover their workers.

The Kaiser Foundation annual survey of employers is a detailed look at trends in employer-sponsored health coverage, including premiums, employee contributions, cost-sharing provisions, and other relevant information. The 2012 survey included 3,326 randomly selected public and private firms with three or more employees. There were 2,121 companies that responded to the full survey and 1,205 who responded to an additional question about offering coverage.

The recently announced postponement raises questions about what will happen to the establishment of state-based health insurance marketplaces (exchanges) where uninsured Americans can shop for a health insurance policy. These exchanges are intended to help lower and middle-income people who qualify with insurance subsidies. The deadline for the states’ implementation of these exchanges was not delayed. Since the subsidies are integrated with what an employer offers workers and what it does not, delaying the requirement for businesses to provide insurance to all employees creates confusion as to who qualifies for the insurance exchanges and who does not,

The significance of this is two-fold. Postponing the requirement for employers sends a message to them that it may be more cost-effective and acceptable to drop coverage and pay the penalty. If that happens, a lot of smaller company employees will be pushed into the health insurance exchanges, requiring these exchanges to handle far more individuals than was intended in the law and throwing the whole system into chaos.

Another blow to Obamacare surfaced this week when several hospitals in a Medicare Pioneer program, (called Accountable Care Organizations), which is aimed at changing the way medical providers are paid, announced that they may pull out. The program is designed to reduce health care expenses by requiring clinicians to forgo fee for service payments and agree to a monthly stipend for the care of patients who have chronic diseases. When certain criteria are met (determined by Medicare) the ACO hospitals receive bonus payments. The intent is to reward good care while executing a cost-containment approach to care. With this system, clinicians are responsible for controlling costs for the populations of Medicare patients assigned to them. However, their ability to manage these patients’ care is limited. For these reasons ACO institutions are re-evaluating their commitment to this program that is intended to change the way healthcare providers are reimbursed and reduce the large healthcare expenditures we experience as a nation.

There is one positive outcome of the Obamacare regulations. According to Thomas Friedman (The New York Times, May 25, 2013)   “Incentives in the recovery act for doctors and hospitals to shift to electronic records, is creating a new marketplace and platform for innovation that has the potential to create better outcomes at lower costs by changing how health data are stored, shared and mined.”

Undoubtedly , implementations of electronic health records by clinicians has increased significantly following the passage of legislation that mandates that physicians must have electronic data and communicate with patients to meet the criteria of Meaningful Use Stage 2 which also goes into effect  by the end of 2014.. Although 71% of physicians had a basic EHR by the end of 2012 compared to just 25% at the end of 2010), we are a long way from achieving the results that must be in place including:

Providing a summary of the care record for 50% of transitions of care during referral or transfer of patient care settings.

Providing patient-specific education resources identified by Certified EHR technology to more than 10% of patients.

Engaging in secure messaging to communicate with patients on relevant health information.

Making available all imaging results through certified EHR technology.

Providing clinical summaries to more than 50% of patients within one business day.

It is essential that patients care about, and pay attention to these issues because they impact our ability to communicate with our providers, engage more directly in our health care and enable us to find viable health insurance options. All of this will impact the quality of our care, make the health care system more efficient and hopefully reduce costs.

While we all agree that there is a serious need for health care reform, it would appear that executing these new programs in our complex health care system is more difficult than the architects of the ACA anticipated.


Why the Supreme Court Decision Will Drive More People to Become e- Patients

Now that the dust has settled and the political posturing has calmed down a bit, it is clear that the debate  about the  Patient Protection and Affordable Care Act (Obamacare)  has pushed healthcare to the forefront for many people who have been ambivalent in the past. The complexities of this legislation and the extensive discussions in the media, are forcing people to think about their own health issues and realize that they must become more personally  involved if they are to manage their health care costs and their interactions with the system.


Although many of these same people, in the past, passively followed the advice of their medical providers without asking a lot of questions or challenging the system, they now must take a proactive stance. The discussions in the press raised awareness so that, given the choice, people should  want to know all about their health and medical  options, particularly about the cost of care, competence of their medical providers, and benefits and downside of their treatment  choices.


Sifting through the gobbledygook of the Obamacare discussions,there are several key points that all patients should understand, including the following:


The legislation prohibits insurance companies from denying coverage to patients with chronic and pre-existing  conditions. It requires insurers to provide consumers with easy-to-understand summaries about their coverage and requires health plans in the individual market to offer essential benefits needed to prevent and treat a serious condition.


The ruling preserves vital provisions that enables patients to access needed care, so they can  see their doctor earlier rather than waiting until they are truly sick. It also supports the patient’s ability to access  preventive services such as mammograms and colonoscopies without co-payments and  eliminates arbitrary dollar limits on coverage that can suddenly terminate care when a person gets sick. It provides expanded coverage for preventive and wellness care.


The legislation forbids insurance companies to charge individuals with health issues a higher premium than healthy individuals and ends lifetime caps on insurance.


Obamacare allows  2.5 million young adults to remain covered under their parent’s health insurance policies.


The  age of Patient Empowerment is finally here!  Every health care consumer must take an active role, understand the issues and make intelligent choices  if they want to be well taken care of when they fall ill.


Changes to Health Delivery System Key to Reducing Care Costs

With all the talk this week about Obamacare and whether or not the Supreme Court will declare the law constitutional, partially unconstitutional, or take no stand, the law will not have a measurable impact on the cost of health care delivery to patients until significant changes take place in the way the delivery system works.

There are several reasons why the cost of care has risen so radically, and there are measures that can be taken to reduce some of these costs, simply by changing patient and provider behaviors in areas such as medication adherence, fast access to care and preventive care.

Medical Adherence

One-third to one-half of patients in the U.S. do not take their medications as instructed. This leads directly to poorer health, more frequent hospitalizations, a higher risk of death and as much as $290 billion annually in increased medical costs. Non-compliance includes not taking medication on time, not sticking to the proper doses, or simply ignoring the medication by not filling the prescription, or filling it and not taking it. Reasons patients give for their non-compliance include: unpleasant side effects, confusion, forgetfulness, language barriers and feeling “too good” to need medicine. 

It is a known fact that patients with chronic conditions such as diabetes and high blood pressure are among the group less likely to follow their medication regimen. Perhaps if more providers were reimbursed based on outcome rather than on their fees for service, they would invest in the time, resources, counselling services, and necessary technology to educate patients and foster better adherence.

A study by researchers at NYU School of Medicine confirms that positive affirmation, when coupled with patient education, seems to help patients more effectively follow their prescribed medication regimen. How does that reduce costs? We know that with adherence comes better management of health issues. With better management of health issues comes fewer visits to the ER. With fewer visits to the ER comes lower cost of care because the patient who gets better by following the treatment prescribed does not need further intervention.

Access and Information

One of the most significant obstacles to improved patient care, at a reasonable cost, is access. The relative lack of real-time access to care and the absence of comprehensive patient information at the point of care are essential to improving outcome. Better access to care will lower the cost of care because patients do not have to wait to see their doctors and avoid having their health issues precipitate from an issue to a crisis. An example of that is an elderly woman who called her doctor’s office to request an immediate appointment for a rash that was painful and itchy and would not go away with topical medications. The doctor was on vacation and when the patient was finally seen several days later she was diagnosed with Shingles. Instead of a few days on an oral dose of an anti-viral medication, she ended up hospitalized for several days on IV medications, with a very severe case of shingles that had spread to several locations in her body.

The new patient-centered medical home model of care resolves some of these issues, by extending access to patients using the services of nurses, nurse practitioners, physician assistants and other well- trained professionals to deliver many basic health care services. With digital health records as a part of the medical home model, all of the patient’s information is available to all of these providers when the patient needs to be seen. This allows the physicians in the practice to focus on diagnosis and deal with the tough issues, while other competent, well trained healthcare professionals handle routine exams, coordinate follow up appointments, deliver counseling, and make sure that screen tests, vaccinations and other milestones for the patient are achieved.


Preventive Care

Prevention is clearly one of the touchstones of health care. To prevent deadly or disabling disease from occurring, or to stop it at an early stage, seems like an obvious way to cut health care costs and improve population health. Early intervention health and wellness programs are available but patients have to be willing receptors of these efforts, and providers have to spend time and energy to make these programs work. It is not an easy task. Some suggestions for carving out programs where preventive care is the focus include:

1. Doctors or their nurse practitioners or physician assistants have to provide patients with education and tools for proper weight control, fitness programs, stress reduction and relaxation techniques because we know that diet and fitness play a huge role in keeping people healthy

2. Immunizations and vaccinations need to be kept current. With the assistance of digital health records, there are no longer reasons why these should not be up to date.

3. Warnings about exposure to certain disease triggers need to be passed along to patients so they are aware of the risks when they travel or expose themselves to certain environments.

4. Doctors and patients have to engage in discussions about family history so they are aware of the genetic make up the of individual that could cause disease. Based on that information the patient needs to be sure to get certain screenings when appropriate.
Current initiatives in patient-centered care medical homes and accountable care organizations are a giant step toward collaborations between patients and physicians to jointly work toward better adherence, more immediate access and availability of information and better preventive care. These efforts will produce reductions in the cost of care but it will be a slow process.