Tag Archives: Health Policy

3 ways hospitals must prepare for a likely recession

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http://www.fiercehealthcare.com/healthcare/3-ways-hospitals-must-prepare-for-a-likely-recession?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTmpjd1pURm1NR0ZqTlRWbSIsInQiOiI5MkdaMWJlaGV4dlppeWNkY1NqNTNtTFJ1MFlrcWtQQWxcL2hvYWVUK3lmNEJRT1lCVTJLQTFwdGFcL0dLWWlGMnBzbGNQbXhDdnFDVUdsdkthR3Y4UzJIVm5sT25iNHJmYWd2aGlFXC9ycVNDST0ifQ%3D%3D

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Bad economic times are coming, says Jeff Goldsmith, Ph.D.

The U.S. is in the 89th month of an economic recovery–among the longest since World War II–which means a recession is overdue and healthcare organizations should prepare now, writes Goldsmith, a national adviser to Navigant Healthcare, in Hospitals & Health Networks.

Healthcare systems can get ready for that inevitable economic downturn by taking the following steps:

Look for ways to do more with less. Healthcare organizations can expect to live with slow or shrinking revenues. Scrutinize physician compensation and productivity. Reduce layers of management and examine contracts for supplies and services.

Tighten up revenue cycle functions.  Improve your patient collections process. Make payment obligations clear to patients and ensure that billing staff keep better track of denied claims from insurance companies.

Fight for health policies that work for healthcare organizations. Lobby members of Congress, state legislators and governors to protect Medicaid funding. “Hospitals must insist that policymakers keep their commitments when times are tough,” Goldsmith says.

Donald Trump is about to face a rude awakening over Obamacare

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https://www.washingtonpost.com/news/wonk/wp/2016/11/12/donald-trump-is-beginning-to-face-a-rude-awakening-over-obamacare/?utm_source=RealClearHealth+Morning+Scan&utm_campaign=c672ab1b84-EMAIL_CAMPAIGN_2016_11_12&utm_medium=email&utm_term=0_b4baf6b587-c672ab1b84-84752421

After reiterating his promise to repeal and replace the Affordable Care Act, President-elect Donald Trump has indicated that he may keep two of the law’s most popular provisions. One is straightforward enough — children up to age 26 being allowed to stay on their parents’ plan. The other — preventing insurance companies from denying coverage because of preexisting conditions — offers a perfect illustration of why Trump and most of the other Republicans critics of Obamacare don’t understand the health insurance market.

Let’s say that in the beautiful new world of “repeal and replace,” insurers are required to sell you insurance despite the fact that your kid has a brain tumor. Insurance companies know what to do with that. Their actuaries can calculate that kids with brain tumors typically require (I’m making this number up) about $200,000 a year in medical care. So they’ll offer to sell you a policy at an annual premium of $240,000.

At this point your response will probably be that such an outcome is not fair. When the law says insurance companies can’t discriminate on the basis for preexisting conditions, surely what it means is that they have to charge roughly the same price for health insurance, irrespective of your preexisting condition. In the language of insurance, that’s called “guaranteed issue at community rates.”

Unfortunately, in the states that have tried guaranteed issues at community rates, the insurance markets have collapsed. That’s because if you guarantee everyone the right to buy health insurance at community rates, then some consumers will game the system. The young and healthy ones won’t buy any health insurance at all — they’ll go without until they are diagnosed with diabetes or a brain tumor or get hit by a truck crossing the street. And when that happens, they will immediately call up Aetna or Anthem and exercise their right to buy health insurance at the low community rate, irrespective of their medical condition. It won’t be long before insurance companies begin losing a ton of money and are forced either to raise premiums through the roof or stop writing policies altogether.

Here’s why Trump is already waffling on Obamacare

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https://www.washingtonpost.com/posteverything/wp/2016/11/12/heres-why-trump-is-already-waffling-on-obamacare/

President-elect Donald Trump is already signaling that he might backpedal on his promise to repeal the Affordable Care Act, telling the Wall Street Journal Friday that he’d consider hanging onto popular Obamacare provisions such as “the prohibition against insurers denying coverage because of patients’ existing conditions, and a provision that allows parents to provide years of additional coverage for children on their insurance policies.”

His apparent reluctance to scrap the entire ACA is understandable. In the long run, waffling on repeal will probably be less painful than causing a health-care catastrophe. Trump capitalized on Republicans’ long dislike of the Affordable Care Act by focusing on news, in the last weeks of the campaign, that premiums would increase sharply for many Americans purchasing insurance through its exchanges. But he didn’t promise a pared-down health-care regime. He promised to repeal and replace Obamacare with a plan that would cover everyone, offer more choice and cost less.

It was a populist approach to health care that wasn’t new. Sixteen years ago, in “The America We Deserve,” he wrote: “I’m a conservative on most issues, but a liberal on this one,” an appeal that didn’t hurt candidate Trump. But President Trump is likely to find the issue challenging. Repeal requires only the will of Congress. Replacement is subject to the laws of economics and mathematics, which aren’t on his side.

In the campaign, Trump proposed replacing the Affordable Care Act with a tax deduction for individuals who pay for health insurance out of pocket. Like all tax deductions, such a deduction is worth more to people with higher tax rates. But most of those who would be left without coverage by an ACA repeal are lower-income individuals with tax rates that are already low. Thus, the benefit they’d receive from a deduction doesn’t come close to the financial hit they would experience from an ACA repeal. Independent estimates suggest repeal would cause about 20 million people to lose coverage, only one-quarter of whom would purchase insurance with the deduction. The rest wouldn’t be able to afford it.

Here’s Why 24 Million People Still Don’t Have Health Insurance

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http://www.thefiscaltimes.com/2016/08/19/Here-s-Why-24-Million-People-Still-Don-t-Have-Health-Insurance

Despite its seemingly endless political and financial travails, Obamacare has taken a big bite out of the number of uninsured Americans since it was enacted in 2010. An estimated 20 million more people are now covered by private health insurance obtained through subsidized government exchanges or expanded Medicaid for the poor.

But as the curtain begins to ring down on President Obama’s administration, roughly 20 million to 24 million people still lack health insurance, a huge piece of unfinished business that will be left to the next president and a new Congress to address. And that raises two interesting questions: precisely who are the uninsured today and why haven’t they been able to obtain coverage?

A national survey by the Commonwealth Fund conducted last February through April finds “notable shifts” in the demographic composition of the uninsured since the Affordable Care Act first took effect in 2014.

A quick snapshot of the detailed findings tells the stories of millions of people either purposefully rejecting health care insurance, not qualifying for a federal program, or being unaware of their options to acquire coverage.

Obamacare Faces New Challenge as the Uninsured Rate Plateaus

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http://www.thefiscaltimes.com/2016/11/03/Obamacare-Faces-New-Challenge-Uninsured-Rate-Plateaus

Amid the administration’s latest drive to sign up millions of Americans for Obamacare coverage, a new government study warns that the uninsured rate may have plateaued after years of dramatic decline.

There were roughly 28 million uninsured Americans during the first six months of this year, a significant change from the 48 million consumers who lacked coverage at the time of the enactment of the Affordable Care Act in 2010. Government-subsidized health insurance policies for low and middle-income people, along with an expansion of the Medicaid program in more than half of the states, have helped more than 20 million uninsured people obtain coverage.

The Impact of Obamacare, in Four Maps

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Three years into the Affordable Care Act, there remain places where many people still lack health insurance. But their share keeps shrinking.

The share of people without health insurance keeps falling.

Since 2013, when the major provisions of Obamacare went into effect, the uninsured rate has fallen in every state. And some states that you might not expect have led the way.

The news about the Affordable Care Act has been grim lately: The price of health plans in new marketplaces is up, and choice is declining in many places. But amid the difficulties, new data highlight the law’s effectiveness in getting coverage for millions of Americans.

Over all, the gains are substantial: a seven-percentage-point drop in the uninsured rate for adults. But there remain troublesome regional patterns. Many people in the South and the Southwest still don’t have a reliable way to pay for health care, according to the new, detailed numbers from a pair of groups closely tracking enrollment efforts. Those patterns aren’t an accident. As our maps show, many of the places with high uninsured rates had poor coverage before the Affordable Care Act passed. They tend to be states with widespread poverty and limited social safety nets. Look at Mississippi and Texas, for example.

But many of the places that have reduced their uninsured rates the most had similar characteristics in 2013. Look at Kentucky and Arkansas. Over the years, you can see them diverge sharply from their neighbors.

 

EXECUTIVE COMPENSATION: Aligning Clinical and Financial Strategy for Value-Based Care

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Click to access executive-compensation.pdf

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As our industry continues to wrestle with the impacts of the Patient Protection and Affordable Care Act and value-based purchasing, it appears that a number of organizations are questioning whether their executive compensation models are appropriate to the times. Besides the more obvious issues surrounding a shift from volume- to value-based financial models, hospital trustees and directors also must respond to consumer and labor advocacy groups, which question the value of the executive team. Indeed, there have been several efforts of late to legally limit the total compensation allowable to CEOs.

This environment can create a bit of a dilemma for governing boards, as they try to balance the need for executive horsepower with a compensation package that is defensible to their constituents. And while base pay and benefits loom large in this equation, there are certainly reasons to evaluate how bonuses are structured if, in fact, bonuses should be paid at all.

In an effort to get at the core of these compensation issues, HealthLeaders Media recently surveyed more than 300 industry leaders of varying stripes to gain insight into their approach to executive compensation and to determine whether these leaders thought that compensation models were aligned with organizational goals. The results were telling.

When organizations were asked what best describes their executive compensation strategy for both the financial and patient care objectives of healthcare now, 17% of the respondents for each objective reported that no change was needed. More than 50% of the respondents indicated that group or team incentives have been or are expected to be modified for executive compensation packages to address the perceived shift from volume to value, and 38% of respondents reported that executive compensation incentives were either slightly or seriously misaligned with organizational strategies.

While a significant number of respondents (61%) reported that their executive compensation programs are currently perfectly or pretty well aligned, the survey results could be an indication that fundamental changes are taking place. These changes not only affect how leaders are paid, but also impact what is expected of them, as the survey attempts to explore this issue as well.

At the end of the day, each organization will have to determine how to use executive compensation to achieve its mission. Obviously, that could lead to a number of acceptable and effective options provided they are carefully considered in light of the complexity of our environment and the culture we wish to create.

Will Consumerism Rein in Healthcare Costs? Why the Answer Is No

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Click to access Healthcare-Consumerism_Rising-Costs_LEK-Executive-Insights_1806.pdf

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In the first of our multipart Executive Insights series on consumerism in healthcare, L.E.K. Consulting examines why a more engaged consumer — despite the increasing optimism — will not be nearly enough to bend the healthcare cost curve or even stop the rising rates substantially.

Big Changes and Big Risks Are Ahead for Health Policy

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http://www.realclearhealth.com/articles/2016/11/09/big_changes_and_big_risks_are_ahead_for_health_policy__110237.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=37390717&_hsenc=p2ANqtz-_CzB7SB8_jTflW9iZbujhPgbEgYoEGH0CmjnZCWfYQ6OhRFxv03I_g24L5CSEuvETzsbKwqacigRbc9C9fAU0zdkkgyw&_hsmi=37390717

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The election outcome itself could create more problems for the ACA. The insurance plans sold on the law’s exchanges have already experienced substantial losses due to adverse selection, leading many insurance companies to pull back on their participation. The prospect of a Trump administration steering ACA implementation may be enough to convince some of the insurers still offering products on the exchanges in 2017 to rethink their plans. If more insurance companies head for the exits, the exchanges could become even less stable than they already are.

The “replace” part of “repeal and replace” has always been the tricky part for ACA opponents, and that will also be true for the incoming Trump administration. During the campaign, Trump offered only the vaguest outline of a plan that wouldn’t come close to serving as a starting point for a workable proposal. The ACA, for all of its problems, brought many low-income households into insurance coverage, through an expansion of the Medicaid program and through heavy subsidization of the insurance plans offered on the exchanges. Unless Trump wants to preside over a massive increase in the number of Americans without health insurance during his presidency, he will have to offer a plan that ensures households with low incomes can secure health insurance in some new way.

Repeal Would Be Even Worse Than Obamacare

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https://www.bloomberg.com/view/articles/2016-11-09/trump-s-repeal-of-obamacare-would-make-health-care-even-worse?_hsenc=p2ANqtz–YThbb5bpWZsv2RkIpmzMfJQVehsyht_urAaJaQ5SnNPcxHVC6wCEdCEdPdr4egAghSWH7nSB4oSMsFzceJ7fcw1WYUg&_hsmi=37390717&utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_content=37390717&utm_medium=email&utm_source=hs_email

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I wouldn’t say the mood among Republicans is exactly giddy. Even Fox News seemed a little bit stunned by the news that Donald Trump had been elected president of the United States. But these past 12 hours, one priority has joined #NeverTrumpers and those who want to Make America Great Again: time to repeal Obamacare.

I’ll believe it when I see it.

Can Republicans pass a bill repealing Obamacare lock, stock and barrel? Technically, yes. They have control of the House and the Senate. Democrats in the Senate could filibuster, but I doubt the filibuster survives Trump’s term in any event, so I don’t see this as a permanent obstacle.

There’s still a wee bit of a problem, however, which is that they have to get Republicans to vote for a repeal.

I have no doubt that Republicans would like to vote for something they can call “repealing Obamacare.” The problem is that repealing Obamacare will involve getting rid of two provisions that are really, really popular: “guaranteed issue” (insurers can’t refuse to sell insurance to someone because of their health status) and “community rating” (insurers can’t agree to sell a policy to some undesirable customer for a million dollars a year; the company has to sell to everyone in a given age group at the same price).

These two provisions are consistently popular with voters across the spectrum. Unfortunately, they tend to send health insurance markets into what’s known as a “death spiral”: People know they can always buy insurance if they get sick, so a lot of them don’t buy insurance until they get sick. Because the sick people are really expensive to cover, insurers have to raise the price of the insurance, which means that the healthiest people left in the pool drop their insurance, which means the price of the insurance goes up. … After a few rounds of this, everyone has a guaranteed right to buy insurance — but the sticker price is astronomical.

Obamacare is built to counter this problem — with subsidies to bring down the price for many Americans, with a mandate for individuals to buy insurance or face tax penalties, with rules on enrollment timing to complicate “gaming the system.” These are the unpopular parts of Obamacare.

Repeal will involve getting rid of the unpopular bits. But it will also involve getting rid of the popular bits. Republicans will be under enormous pressure to repeal just the unpopular parts, which would, of course, make the individual market even more dysfunctional than it is now. I wish good luck to President Trump or to any member of Congress who explains to voters that if they want the popular parts, they need the unpopular parts too. Believe me, I’ve tried.

So I suspect that “Repeal Obamacare” will meet the same fate as Social Security reform. Legislators were gung ho. Even the base was sort of theoretically in favor of it. President George W. Bush made it his signature initiative for his second term. But the more that Bush talked about what Social Security reform would actually involve, the more he spooked voters.  Even though his party had control of both the House and the Senate, Bush eventually had to admit he couldn’t get it done. His own party would not back him in the face of voter resistance.