Gut check: Change is coming, and healthcare executives don’t necessarily think it’s a bad thing

http://www.healthcarefinancenews.com/news/gut-check-change-coming-and-healthcare-executives-dont-necessarily-think-its-bad-thing

Self-Discovery

The future of healthcare policy is a bit murky these days. President-elect Donald Trump has pledged to repeal the Affordable Care Act, and the Republican-run U.S. Congress is already fast at work to make that happen.

What’s not known, however, is what will change for the thousands of U.S. healthcare businesses that have not only adapted to the ACA but also made millions in investments in areas such as electronic health records, value-based reimbursement and reporting to align with the policies of the outgoing administration.

Healthcare Finance spoke with several executives at healthcare businesses to get their perspectives on not only the changes they expect but also their thoughts on what the healthcare sector actually needs to do to provide the best care while still safeguarding the health of its business model.

 

Private vs. public prices

http://www.academyhealth.org/blog/2017-01/private-vs-public-prices

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You probably knew that the prices private health insurers pay hospitals are higher than those of Medicare and Medicaid. But you may not have known that the gap between private and public payers used to be a lot smaller and has grown tremendously in recent years.

Using Medical Expenditure Panel Survey (MEPS) data, by payer (private health insurance, Medicare, and Medicaid) and over time (1996-2012), the chart shows average hospital payment rates (in constant dollars), adjusted for age, sex, race/ethnicity, geography, income, health conditions, charges, length-of-stay, and whether or not a surgical procedure was performed. To produce figures for the chart, the authors used this model to predict hospital payment per stay for each MEPS observation, as if they were covered by private insurance, Medicare, or Medicaid, in turn.

As is clear from the chart, adjusted, average private pay rates have always been above public rates, but were closest in 1996-2000. Back then, private rates were no more than 10% above Medicare rates. Perhaps this was the effect of managed care, which kept growth in private rates down. Those rates began to grow during the managed care backlash, until 2005. From 2005-2009, adjusted, average private hospital rates—while considerably above Medicare and Medicaid rates—held steady. Then, in 2009, they took off again. In 2012, adjusted, average private rates were about 75% higher than Medicare rates.*

Medicaid payments were about 90% of Medicare’s in most study years.

Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

Healthcare Triage News: Medicaid for Children Leads to Better Outcomes Later in Life

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The recent election has caused many to question whether significant changes are about to happen to Medicaid. Repeal of the Affordable Care Act would, of course, lead to the elimination of the Medicaid expansion, which could result in significant numbers of adults losing their coverage overnight.

But even without repeal, many Republican replacement proposals also result in significant changes to Medicaid, whether it be through funding, eligibility, or benefits. So, again, let’s talk about what Medicaid does, and whether it’s long term benefits are worth it. This is Healthcare Triage News.

Top managed care trends to watch in 2017

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/top-managed-care-trends-watch-2017?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=13012017

 

Top 10 challenges facing physicians in 2017

http://medicaleconomics.modernmedicine.com/medical-economics/news/top-10-challenges-2017

2016 was a challenging year on many fronts for healthcare providers.

Physicians have just started to digest the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its changes to physician reimbursement. A long presidential election finally reached its conclusion, but the consequences of a Republican Congress and President-elect Donald J. Trump for U.S. doctors and patients remain unclear. And running a private practice did not get any easier. Balancing the need to deal with patients who won’t listen or won’t pay while also seeking positive patient satisfaction scores remains a daily struggle for many. 

These were just some of the challenges physician readers told Medical Economics they experienced this year and anticipate continuing for the foreseeable future. 

For the fourth consecutive year, Medical Economics reveals its list of obstacles physicians will face in the coming year and, more importantly, how to overcome them. For this latest presentation, we asked readers to tell us what challenges they face each day and where they needed solutions.

Here are their responses, starting with the biggest challenge of the coming year.

States That Leaned In on the Affordable Care Act Have Much to Lose

http://www.commonwealthfund.org/publications/blog/2017/jan/states-that-leaned-in

The Affordable Care Act (ACA) created health insurance marketplaces to make it easier for consumers to shop for and compare plan options in one place. As of December 24, 2016, over 11.5 million people had signed up for coverage through the marketplaces, and the U.S. Department of Health and Human Services projects that 13.8 million consumers will have selected a plan for 2017 by the close of this open enrollment period.

However, our new president and Congress are committed to the repeal of the ACA. Repeal could cause as many as 30 million to lose coverage, 9.3 million of whom receive federal premium assistance through the marketplaces. Nearly one-third of these enrollees reside in the 17 states that embraced the chance to set up and manage their own ACA marketplace.1  All but one of these states also expanded their Medicaid program and most incorporated the ACA’s consumer protections into their own state insurance laws, effectively adopting them as their own. These states not only embraced the ACA’s vision of improving access to affordable, quality health coverage, but also took full advantage of the flexibility for states provided under the law to design an insurance market to meet local needs.2

Within days of the ACA’s enactment, legislators, agency staff, and health care stakeholders from these states began working to develop the policy and operational infrastructure needed to build and maintain a sustainable health insurance marketplace. Doing so not only gave these states greater autonomy and flexibility to manage their insurance markets, but also allowed them to tailor public education and outreach efforts to their local population.

 

 

Medicaid’s Future: What Might ACA Repeal Mean?

http://www.commonwealthfund.org/publications/issue-briefs/2017/jan/medicaids-future-aca-repeal?omnicid=EALERT1152581&mid=henrykotula@yahoo.com

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Abstract

Issue: Republicans in Congress are expected to repeal portions of the Affordable Care Act (ACA) using a fast-track process known as budget reconciliation.

Goals: This issue brief examines how repeal legislation could affect Medicaid, the nations’s health care safety net, which insured 70 million people in 2016.

Findings and Conclusions:Partial-repeal legislation that passed Congress but was vetoed by President Obama in 2016 offers some insight but new legislation could go further. It could repeal the ACA’s Medicaid eligibility expansions for adults and children but also roll back other provisions, such as simplified enrollment and improvements in long-term services and supports for beneficiaries with disabilities. Additionally, the Trump Administration could expand use of demonstration authority to introduce deeper structural changes into Medicaid, such as eligibility restrictions tied to work, required premium contributions and lock-out for nonpayment, annual enrollment periods, and coverage limits and exclusions. Together, these changes would have far-reaching implications for Medicaid’s continued role as the nation’s safety-net insurer.

7 things you need to know about the future of Obamacare

http://www.latimes.com/politics/la-na-pol-obamacare-explainer-20170105-story.html?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=40201659&_hsenc=p2ANqtz-9Uem4u-88vm0uSaKSUtpimygRZcnoFsTKnFjgSMV_-DO2M1uADZ2botlQqf2or2w1gLrjuw6jxaztyZOpFjfhhh2nvKQ&_hsmi=40201659

You’ve seen the headlines and you’ve heard the slogans: Obamacare is on the chopping block and President-elect Donald Trump is going to replace it with “something terrific.”

But what are the new president and Congress really going to do? How much of the current law will really go away? And what could “Trumpcare” look like?

In case it’s been a while since you read about the Affordable Care Act and the GOP replacement plans, here’s a refresher on the biggest Obamacare issues.

Beyond ‘Repeal and Replace,’ Further Health Reforms Loom

http://www.healthleadersmedia.com/leadership/beyond-repeal-and-replace-further-health-reforms-loom?spMailingID=10175220&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1080402683&spReportId=MTA4MDQwMjY4MwS2#

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The old saying, “May you live in interesting times,” may sound like a blessing.

U.S. healthcare leaders know it is a curse.

All they’ve been working toward and preparing for since the Patient Protection and Affordable Care Act was enacted almost seven years ago has been turned upside down in the wake of the Republican election sweep.

Yet, for all their campaign promises to repeal the ACA, most congressional Republicans and President-elect Donald Trump must know that healthcare costs are too much for many Americans, and abolishing Obamacare with no replacement could be politically dangerous.

A report from consulting firm KPMG and an opinion piece published on LinkedIn by a Navigant executive predict that the Republican Congress and the executive branch will change the healthcare reform efforts initiated through the ACA, but the concept of value-based care will stay.

Governors signal support for Medicaid expansion

http://www.fiercehealthcare.com/payer/state-governors-signal-support-for-medicaid-expansion?utm_medium=nl&utm_source=internal&mkt_tok=eyJpIjoiTldOaE1qUm1ZMlV6T0dJNCIsInQiOiJVQWx2aDRmUXpsaGlUeEJcL0xFb1ZzcVFpbWp6ak1sU0VmUVY3Sk5BUHduNEVjeXNUUGw5emdwZVR6ajcrR0x1VnB0WFJaMWdWXC9tbG1SeDlEcVUxa3NPTmR5dEFEZ1dMYVFHdU1VOHJJRE1FSjR2ZGd0aEZxYzRLWUo1ckFTWVZ3In0%3D

Some governors—including two Republicans—are voicing support for Medicaid expansion even as lawmakers on Capitol Hill move toward repealing the Affordable Care Act.

In Michigan, Republican Gov. Rick Snyder wants Congress and President-elect Donald Trump to preserve the state’s unique version of Medicaid expansion even in the event of an ACA repeal, The Detroit News reported. The Healthy Michigan plan, which has seen enrollment surge past initial projections, requires recipients to contribute to health savings accounts and allows them to reduce their co-pays through healthy behaviors.

“I think it’s important that as they look at the Affordable Care Act … I hope they carefully look at the success we’ve had in Michigan, because we didn’t just do Medicaid expansion,” Snyder told the publication.