An ACA primer: Much more than insurance

http://www.healthcaredive.com/news/an-aca-primer-much-more-than-insurance/429497/

Remember the Affordable Care Act? Enacted in 2010, it expanded healthcare insurance to millions of uninsured Americans and increased access to care. But the ACA is much more than expanded coverage; it set in motion a variety of reforms in the healthcare delivery systems aimed at lowering costs and improving quality of care.

That fact was lost on presidential candidate Donald Trump, who told Fox News recently, “I don’t use much Obamacare, I must be honest with you, because it is so bad for the people and they can’t afford it.” Trump’s comments imply Obamacare is an insurance plan people can buy, which is not the case. As we wrap up year six since the ACA was enacted, here‘s what the law is really about and how it impacts providers.

Playing hardball: doctors start negotiating with doctors

Playing hardball: doctors start negotiating with doctors

Since the introduction of Obamacare, a growing number of physicians are part of what are called Accountable Care Organizations, where physicians, nurses and other providers are responsible for the health of their patients and the costs of that care.

The shifting landscape is rearranging incentives, and leading doctors into corners of their work they’ve rarely visited.

On a late Friday afternoon last month, the Family Health Associates practice in Charleston, West Virginia is empty.

Empty except for Dr. Julie DeTemple and her staff.

“I should be home and I’m here typing away doing my notes, charting,” DeTemple said.

The primary care doctor has had to adjust from examining patients – why she got into the business – to examining data.

Her quality time with spreadsheets has ramped up this year, now that’s she’s co-founded the Aledade West Virginia ACO, made up of 11 physician practices in the state.

The physicians constantly meet, looking for ways to improve care and cut out wasteful spending.

Doctors cut costs by getting to know their patients

Doctors cut costs by getting to know their patients

76-year old Millard Scott who suffers from COPD and community health worker Nurse Samantha Runyon.

The healthcare landscape is changing, even as Obamacare bumps along.

In the past six years, we’ve seen the rise of Accountable Care Organizations, now numbering more than 800, where doctors or hospitals work together to streamline care. For physicians that means they now get some compensation through contracts that reward improving health and controlling costs, as opposed to simply making money for every service provided regardless of the outcome or expense.

There are now an estimated 28 million Americans enrolled in these ACOs, and that means, at least for some, their care looks radically different than even just a few years ago. That’s particularly true for some of the sicker people in the country.

People like 76-year-old Millard Scott.

Scott, who lives in the small town of Williamson, West Virginia, population 3,000, suffers from Chronic Obstructive Pulmonary Disease. When his COPD kicks up, struggling to breathe is Scott’s big problem.

Expanding role of hospitalist PAs achieves similar outcomes at lower cost, study finds

http://www.healthcarefinancenews.com/news/expanding-role-hospitalist-pas-achieves-similar-outcomes-lower-cost-study-finds?mkt_tok=eyJpIjoiWlRkaE16VTBPRGhrTmpWbSIsInQiOiIxRk44S3JKdEd3Mzl5czNscEJZNjI1N210RWE0b0RxNWd3RHhoZUg2TXJCM3U2QnZJWm1VcFhMS2daQ1pmRzEyTG5DU2E0cWFCdGtWQlJKS0N0NE51Y2FubWdZbWptcTRhVHRZaTZJNDM1VT0ifQ%3D%3D

Though more medical centers are relying on hospitalists — hospital-based internal medicine specialists who coordinate the complex care of inpatients — a new study suggests that hospitals can safely lower the cost of hospitalist programs without sacrificing quality of care

The 18-month study published in the Journal of Clinical Outcomes Management compared two hospitalist groups — one with a high physician assistant-to-physician ratio (“expanded PA”) and one with a low PA-to-physician ratio (“conventional”) — and found no significant differences in the important clinical outcomes achieved by both groups.

The study saw little difference in patient mortality, hospital readmissions within 30 days, lengths of stay or specialty consultant use among patients treated by the expanded PA group and those treated by the conventional group.

From January 2012 to June 2013, the researchers implemented an expanded PA staffing model to see larger numbers of adult patients alongside physicians. The expanded PA group consisted of three physicians and three PAs, with PAs caring for 14 patients each day. At the same time, a conventional hospitalist group composed of nine physicians and two PAs had PAs caring for nine patients each day. Physicians in both groups cared for approximately 13 patients a day.

Vermont all-payer ACO model approved, will count for MACRA

http://www.healthcarefinancenews.com/news/vermont-all-payer-aco-model-approved-will-count-macra

Under model, rates paid to a given provider are set so that all third parties pay the same price for services to particular provider.

Clinton vs. Trump: 5 critical election issues

http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/hillary-vs-trump-5-critical-election-issues?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=25102016

While Hillary Clinton vows to forge ahead with Obamacare if she is elected president, Donald Trump would scrap it altogether. The end results would be two very different forms of healthcare, and industry leaders have much to consider.

Brill“Many different factors are weighing on managed care executives such as the costs of pharmaceuticals, diagnostics and devices; the impact of consolidation amongst hospitals, physicians, health plans; and the losses in the exchange marketplace,” says Managed Healthcare Executive editorial advisor Joel V. Brill, MD, chief medical officer, Predictive Health, LLC, which partners with stakeholders to improve coverage of value-driven care. “With each of these factors, plans can, at least at a high level, make some educated guesses about the relative risk of each factor and impact to the bottom line.”

The election results, however, are much less certain, which from a risk perspective, weighs heavily on the minds of healthcare executives, Brill says. “How can you plan for business knowing that whatever you are doing currently could be upended in the beginning of November?”

To help provide some clarity, Managed Healthcare Executive identified five of the top industry issues, reviewed the candidates’ platforms for each, and asked industry experts to weigh in.

Healthcare Triage News: Health Care Reform, and the Issues We Face

Healthcare Triage News: Health Care Reform, and the Issues We Face

Image result for Healthcare Triage News: Health Care Reform, and the Issues We FaceImage result for Healthcare Triage News: Health Care Reform, and the Issues We FaceImage result for Healthcare Triage News: Health Care Reform, and the Issues We Face

As we approach the election this fall, it seems like the news media report on little else. Unfortunately, too little news coverage addresses health care reform. That’s wackadoo, because there is still so much to be done to improve the cost, quality, and access for patients within the US health care system.

So let’s talk about the major health policy issues we in the US face. This is Healthcare Triage News.

21 statistics on high-deductible health plans

http://www.beckershospitalreview.com/finance/21-statistics-on-high-deductible-health-plans.html

Image result for 21 statistics on high-deductible health plans

Hospital and health system executives are well aware of the affects high-deductible health plans have had on hospital finances, from patient collections to bad debt. To help quantify the impact of increasing patient financial obligations on the business of healthcare, here are 21 statistics to know about high-deductible health plans.

The 10th Annual ReviveHealth Trust IndexTM reveals an alarming gap

http://thinkrevivehealth.com/topic/trust/

Health system pie chart

13% VALUE • 87% VOLUME

During the course of calendar year 2016, what percentage of your total commercial revenues will be based on volume versus value?

 

The case of the disappearing hospital beds

http://www.healthcaredive.com/news/the-case-of-the-disappearing-hospital-beds/427211/

Click to access 2016chartbook.pdf

Healthcare is leaving the traditional four walls of hospitals. As patients, payers, and providers seek to reduce costs and improve quality, they are relying less on inpatient stays and more on outpatient services. A growing reliance on outpatient services could drive healthcare costs down as costly inpatient services are increasingly reserved for patients who truly need them.