Category Archives: Accountable Care

Think Obamacare Doesn’t Affect You? Think Again

Even If You Don’t Get A Subsidy,  Obamacare Affects You

Open enrollment season is coming to an end. People all of the country are tucking away their insurance cards as dreams of government subsidies dance through their heads. And as the Obama administration touts the success of the program, many Americans who get more traditional coverage through their employer are turning an apathetic ear.

Those Americans who have insurance through an employer are under the impression the Affordable Care Act (also known as Obamacare) doesn’t affect them because they are not getting a subsidy. As a result they have tuned out the debate over health care coverage.

If you are one of those people that think that the Obamacare law doesn’t affect you, this post will give you a few reason to think again.

Stifling Patient Choice

Lost in all the noise about mandated health insurance coverage is the fact the Affordable Care Act completely changed the way Hospital systems and physicians are reimbursed.

At the Hospital level, the reimbursement system changed to a focus on individual outcomes rather than the number of patients and the time in which they are treated. Now insurances are looking for whether or not hospitals are evaluating patients for all possible health issues that could cause a readmission. That includes anticipating medical needs the patient might have after discharge form the hospital.

In general, if a patient is readmitted within 30 days the hospital system receives a penalty imposed on future reimbursement. The system includes the hospital and all of the doctors that work within it.

This change in focus has resulted in massive changes in healthcare systems. Because Hospitals are forced to anticipate future healthcare needs of patients, they have been expanding into other services like home care, hospice and even nursing homes.

By doing this hospitals hope to avoid readmission by controlling where patients are referred after discharge. This can stifle patient choice if patients lack knowledge about the services to which they are being referred.

Read Related Story: Hi-jacked Healthcare and How I Regained Control

Restricted Hospital Admissions

In order to be Re-admitted to the Hospital you have to be admitted in the first place. That is why now more than ever Hospitals are careful about who they actually admit to the hospital. Many people don’t know that when a patient goes to the emergency room they are not actually admitted to the Hospital. Emergency falls into a type of outpatient care where admission to the hospital is not necessary.

Because of the focus on outcomes, Hospitals are now increasingly careful which patients they actually admit for inpatient care. If there isn’t a clear positive outcome, hospitals may resist admitting a patient in order to avoid a re-admission later on.

The difference between admission and outpatient treatment is a key distinction for insurance companies. Some tests and treatments aren’t covered if given on an outpatient basis. Hospital admission is also trigger for insurance coverage of other services like Sub-Acute Rehab. If a visit to the ER turns into an overnight stay, don’t assume you have been admitted, ask the attending physician.

We Are All Stakeholders

Even if you don’t receive a direct subsidy for your healthcare coverage, Affordable Care Act regulations have most definitely effected your company’s health care insurance policies. Whether it be an increase in premium or change in enrollment procedures this law effects everyone.

It is silly to think that universal healthcare coverage will be repealed, no matter who wins the white house in 2016. That is why it is important to be aware of the changes in our healthcare system and they effect the average American. If the country is going to get universal healthcare coverage right, we need the input from every American.

Home Health Care Agencies Must Innovate To Meet Demand

Home Health Care Report: Innovate Or Die

Home Health is considered by many analysts to be a major are of growth in healthcare in the coming years.  With the retiring Baby Boomer demanding more convenient, personalized and home based care options, Home Health Care is in an excellent position to capitalize on massive influx of new patients.

But with all the potential in the home care market there have been even more challenges.  Fraudulent activity and substandard care have caused consumer trust in home health care to erode.  In response to the fraud, regulatory agencies have added restrictions, cut reimbursement and doubled down on law enforcement.  The punitive nature of this enforcement has stifled innovation and caused home health agencies to be overly cautious with new service delivery models.

Home Health Companies are looking for the next great money making innovation. photo courtesy Freedigitalphotos.net
Home Health Care companies are looking for the next great money making innovation. photo courtesy Freedigitalphotos.net

The regulations surrounding insurance reform and the proliferation of Accountable Care Organizations have many independent small to medium-sized home care companies grasping at ways to grow census in a system becoming increasingly exclusive.  The companies who fail to innovate and develop multiple revenue streams have been forced to close their doors while other are working to develop new service delivery models to meet the rising demand for home care services.

Some of that demand can be found in specialized services focusing on diagnoses that cause the most hospital readmissions.  There is a push to reduce hospital readmissions under the new Accountable Care system that penalizes hospitals for return trips to the ER after a hospital stay. To accomplish this goal hospitals are partnering with Home Health Care companies to find new ways to treat patients who are at high risk for readmission.

These programs often include disease education, raising awareness of community resources and frequent visits from Home Care professionals to help with the transition.  What is more, these programs are often reimbursed outside of the traditional Medicare system Home Care companies have become comfortable with.

Home Health Care programs that prove the ability to reduce health care cost are often funded by third-party insurance “carve-outs” or grants which fund healthcare innovation.  Palliative Care, Care Transition and disease management programs are all examples of programs that are being funded by these sources.

The innovation game isn’t just for the large Home Care companies.  A small to medium sized company can jump in if they have a solid structure that favors permanent over contract employees. A company who works almost entirely with contractor may find it difficult to control cost and quality in a newly developed program that could sudden operational changes.  However companies who focus on permanent employees may find the cost of change easier to manage.

Home Care companies who are able to innovate in the new Accountable Care system would thrive in the years to come.  More innovation can only serve to improve the greatest healthcare system in the world.

Questions about this post?  Email AnthonyFischer@elderadvocacygroup.info

Baby Boomers Poised To Change Healthcare

The Baby Boomers have drastically changed nearly every industry over the last sixty years.  So it should be no surprise that they are having significant effect the healthcare industry as well.

In fact Baby Boomer’s present the single largest challenge the American healthcare industry has ever faced. The Boomers will be using the system at historic rates as the industry tries to meet demand with an aging  and depleting workforce.

This is the most powerful force operating in our health system right now, this generational change,” says Jeff Goldsmith, president of Health Futures Inc., Charlottesville, Va. So far, the growth in the number of senior citizen boomers has been incremental, and its impact on health care has been overshadowed by federal reform and budget battles. “People aren’t paying much attention,” via hhnmag.com

The Post World War II generation is also demanding changes in the healthcare system causing a shift to home-based services such as home care, visiting physician services and hospice.  That is a demand lawmakers believe America’s health care system can rise too.

In July, Senator Ron Wyden (D-ORE) told Medpage Today that he believes a Baby-Boomer inspired revolution is coming to healthcare.

“I believe Medicare and Medicaid are going to lead a revolution in caring for people at home,” Wyden said, especially for chronic illnesses such as cancer, diabetes, stroke, and Alzheimer’s, which account for 93% of Medicare’s costs.

Home Care can save the Medicare system money.  With technological advances in the Bio-med field and electronic medical records, the licensed healthcare professional can access medical information and order treatments just as efficiently than a hospital facility.  For patients who don’t need 24 hour monitoring by a Register Nurse or physician, home care can be a very cost effective service delivery system.

Hospital systems have already figured this out.  They are investing more time and resources into home care services as a way to boost patient outcomes and cut hospital readmission. Minimizing readmission is a key part to the new reimbursement system Medicare has put in place as a result of the affordable care act. By having some control over the patients healthcare delivery after discharge, hospitals hope to curb readmission and provide better outcomes.

With the healthcare industry already embracing the shift to home care and lawmakers willing to fund it.  Look for more innovation in the field of home health care over the next fifteen years.  Innovation that could save the Medicare system from financial collapse.

 

Obama Care Battle Continues After Federal Ruling

Just when you thought all the fuss about Obama Care was over.  Wednesday’s ruling  by Federal Court Judge Rosemary Collyer put the Obama Care fight back on the table and thrusting it into the political spotlight after years of battle.

At the core of the judges decision is funding for the monstrous trillion-dollar healthcare program which was allocated by executive order instead of the regular appropriations process.

“The House of Representatives as an institution would suffer a concrete, particularized injury if the Executive were able to draw funds from the Treasury without a valid appropriation,” Judge Collyer said in her 43-page decision.

Because congress was passed over in the appropriations they did not have the opportunity to excercise their constitutional duties.  Now according to the Judge they can sue for the right to fund (or defund) the program, a lawsuit that will likely land Obama Care on the steps of the supreme court once again.

“The president’s unilateral change to Obamacare was unprecedented and outside the powers granted to his office under our Constitution,” Mr. Boehner said in a statement after the ruling. “I am grateful to the court for ruling that this historic overreach can be challenged by the coequal branch of government with the sole power to create or change the law.”

What does the Republican lawsuit mean for consumers.  Not much considering Republicans are not likely to strip millions of American’s of health coverage during an elections cycle.  However if congressional republicans are success in the suit against the executive branch you may see some changes to the health insurance market place.

If you are hoping that the Collyer’s decision will be the beginning of the end of Obama Care keep hoping.  Reams of paper have already been used to write the regulations guiding the implementation of the wide-reaching health care law.  Consumers may see some tweaks but don’t expect the program to completely roll back.  But don’t expect that to stop the candidates from talking about it as Obama Care will become a hot campaign issue once again thanks to the ruling.

Listen to the Fischer Report during Conversations In Care on Wednesday’s at 8 pm.