Role of EMRs in Accountable Care Organizations

As the final rule on ACOs ( Accountable Care Organization) has come out, it is apparent that that the value that EMRs (electronic medical records) bring is unprecedented.  Under the Medicare Shared Savings Program, ACO participants (which may include medical practices, hospitals and payers) are graded and paid based on 4 domains of care quality: 1) patient experience;  2) care coordination and safety;  3) preventative health; 4) at-risk populations.  The program consists of a 3 year performance period in which the performance of the ACO mapped against thresholds set by CMS. To reap financial benefits from this program, providers must report on 23 of 33 quality measures spanning these 4 domains during the second year and 33 out of 33 in the third. Some of the measures, like # 20, which asks for the percentage of providers that have received Meaningful Use money are easy to satisfy if you have a Certified EMR.

ACO participants are incented to work together and efficiently because if they don’t meet the CMS thresholds they must pay money back. Data is key when trying to coordinate care and the exchange of clinical data must be done properly to meet the quality measures set by CMS.

Now it must be apparent to medical providers that if they want to join an ACO it is very important that they are comfortable using an EMR. The good news is that there are certain features of the software that allow providers to capture the necessary data for ACO quality measures easily. For example, in the Preventative Health domain there are measures such as Adult weight screening and follow-up and Tobacco Use Assessment. Both of these are Meaningful Use criteria and any certified EMR has screens and buttons to record this information. 

In another example, the domain of at-risk population contains a diabetes composite measure in which the number of diabetics who BP is less than 140/90 must be recorded. To do this, it may necessary to setup a report in which there are fields to search for a patient’s diabetic status and their blood pressure level concurrently. For instance, in Patagonia Health’s EMR, there is a section called “My Reports” where users can fully customize search criteria for certain disease conditions, procedures and demographic characteristics.

Finally, the exchange of health information between providers and entities requires ability for the system to send and receive data securely and in a format that the receiving end would be able to decipher. Exchange of clinical data is a Meaningful Use criterion and is done through CCR (care of continuity record) which generates a summary of the usually about the patient’s medication, laboratory, immunizations, provider names, vital signs, alerts. Providers simply need to press the CCR button and it generates a file. This file can then be sent in encrypted format through email currently (and through Health Information Exchanges later) to the other provider’s EMR.

EMRs have become a powerful tool that has empowered medical providers to collect the necessary data in order to provide medical care with a sense of accountability and level of quality in the form of an ACO. The Meaningful Use Program has further enabled different EMRs to have the standard features important for this data collection.

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Jitesh Chawla MD discusses the HIPPA Rule

Dr. Jitesh Chawla feels that in order to stay away from nasty trial lawyers and draining courtroom or legal cases or criminal charges, all providers should know the basics of the HIPPA (Health Insurance Portability and Accountability Act) rule.

Covered Entities

HIPPA contains the Privacy Rule whose goal is to protect healthcare information, especially in this age of health IT where information is exchanged frequently and easily. The first step in learing about HIPPA is  to understand who HIPPA applies towards –called “covered entities”..

• Health Plans
• Healthcare Providers (this includes both clinicians and organizations)
• Healthcare Clearinghouses (process non-standard health info to standardized versions –common in billing claims)

Business associates are entities or individuals, other than the covered entities, that provide services on their behalf and may have access to protected health information either by use or disclosure. The covered entity will need to use a Business Associate Agreement in this case in order to comply with the Privacy Rule. But the next question is what is protected health information.

PHI (Protected Health Information)

health information that is individually identifiable health information is one, including demographic data, that relates to:

• The provision of health care to the individual
• The individual’s past, present or future physical or mental health or condition,
• The past, present, or future payment for the provision of health care to the individual
• Anything that can be reasonably used to identify the individual

Common examples include full name, address, birth date, Social Security Number. Even photos can be included as such information.

Hypothetical Patient Jitesh Chawla’s Photo (unauthorized sharing of this could be a violation of HIPPA in some circumstances)

Penalties for non-compliance

These are classified into different degrees of offense.

1) Not more than $50,000, imprisoned greater than 1 year, or both;

(2) If done under false pretenses, fine shall not exceed $100,000, imprisoned not more than 5 years, or both

(3) If the intention is to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or to maliciously harm another, cannot be fine more $250,000, imprisoned not more than 10 years, or both.

Tips to stay out of trouble

1) Abstain from talking about patients in hallways, elevators or where others not involved in care are there

2) If using an electronic medical record, log off the software or the operating system when not using

3) Don’t share PHI in emails, on voicemails or jot down on notes/stickies which can be picked up by others

4) If an organization, make sure all new patients are given HIPPA paperwork, employees sign confidentiality agreements while being hired and 3^rd parties you enter with sign Business Associate Agreements.

You can never prevent all bad situations, particulary in Health Care, but with this knowledge and advice Dr. Jitesh Chawla hopes that meeting trial lawyers or courtrooms for violation of the Privacy Rule is nothing but a bad dream for you.

Please check out my new video on Patient Centered Medical Home at:
http://www.youtube.com/watch?v=FqLH7w9efqI

Dr Chawla reviews Insurance Billing: How to Get Paid For It

Getting a claim paid really starts at the front desk. Make sure you get good information. Get copies of insurance cards, driver’s license or ID. Have your staff verify the patient filled out your patient registration form completely. Verify healthcare insurance and coverage.

Entering Demographic Information
I strongly suggest that the front desk NOT enter the demographic information into the computer system.

Why? Distractions are always there. They are so busy answering phones, checking-in /checking-out patients, and helping patients and physicians, that causes mistakes to happen easily. Just have them enter enough demographic info to make an appointment. Accurate information from the onset makes the claim process go smoothly and quickly.

Additionally, have a good financial agreement for the patient to sign. Most agreements I have seen are only a couple of sentences and are quite inadequate. Include in your agreement collection fees, interest, attorney and court cost. This way if you have to go after the patient for payment they are responsible for the additional costs of collecting what they owe. You may also want to include that they agree to pay for after-hours telephone advice, no-show fees, form fees, prescription refills, and walk-in fees, returned check fees and a billing fee if a patient does not pay their copay at time of service. A good financial agreement gives you the tools you need to collect patient balances.

Charge Posting of Encounter Forms
Along with your front desk not entering demographics and insurance info, they should also not post charges for the same reason, distractions. Charge entry should be done in a quiet location. A claim with the smallest amount of inaccurate data will hold up your payment. Also your nurses or medical assistants provide logs of labwork, sonograms, EKGs or other procedures so that your poster can cross reference the logs to the fee tickets to insure nothing is missed. With EMRs and advance of Health IT, this tracking should become much easier.

Teach your staff good practices from day one. The front staff is essentially in receiving the clinical and financial information that needs to be passed onto billing staff. If a certain protocol is established with best practices is established it will save you a lot of hassle in the long run. The next series of articles will focus on how to train/advise your clinical staff so that your claims get accepted and billing to insurance becomes a bit easier.

Review of Systems: Its importance in Medical Billing

Combining history of present illness and review of systems is possible when doing medical billing. Many medical billers think this practice is breaking a rule or impossible. However, documenting an element once to account for HPI (history of present illness) and ROS is acceptable medico-legally when done correctly.

CMS states that physicians absolutely do not need to document an element two times just so the person performing medical billing knows it is meant to be used both for review of systems and history of present illness. It is perfectly acceptable to use an element for both.

The only time an element cannot be used in duplication is when you attempt to use it in the same area. For example, the complaint of chest pain cannot be used in ROS (review of systems) for musculoskeletal systems and the cardiovascular system. It can be used only for one location in the medical billing.

A medical biller also cannot use a timing phrase such as "began a couple of days ago" to account for both the HPI (history of present illness) duration and timing. Direct medical documentation must be used.

According to Dr. Jitesh Chawla, healthcare expert, the most important thing to accomplish in medical billing is to make the bill match the service that was actually given. With the increasing adoption of EMRs and Health IT this becomes much easier.When this occurs, payment is made quicker. Medical billing companies can assist medical practices with this task. Outsourcing your medical billing be beneficial for your practice, however, better yet is to use an EMR that has an integrated PM (practice management )/ Billing system that can send statements directly to the payer. This takes the worry off correctly coding and billing by manual means and physicians will see reimbursements much more quickly.

The unique EMR needs of Public Health

With the passage of the HITECH Act there is been an ever increasing push towards the use of electronic medical records (EMR). However, public health agencies have generally been slower to adopt for a variety of reasons. Also, their Health IT systems are often more outdated then the ones in the private, non-public sector. However, certain meaningful use rules, such as conducting syndromic surveillance and reporting to immunization registries, ask providers to communicate with public health agencies. Consequently, public health departments are under pressure to re-structure their technology platforms.

Public health has unique workflows which can have major implications for EMR vendors. To understand this it is important to explore how public health is different from medical care in doctors' offices or in hospitals.

1)      There is greater emphasis on population screening and treatment, resulting in separate clinics focusing on specific aspects of care provision – providing immunizations, conducting STD screenings, etc. Also, there may be many more staff involved, some of which play roles that are not present in outpatient practice.

2)      As part of their mission these organizations normally perform a community assessment at regular intervals. This helps to identify the rates of certain diseases in the community and can guide the deployment of conditions that are more prevalent. As a result the type of visits and demographic make-up of the patient panels can vary greatly over time.

3)      The type of data that needs to be tracked is such that epidemiological studies can be readily done on it (ie. incidence, prevalence, etc.).  

4)      There are certain forms that mandatory to use. One example is the use of Healthy Futures Pediatrics for pediatric physicals.

5)      There are unique situations where patients are seen in settings that are not typical for a doctor’s office. For example, a patient that has tuberculosis will be placed on home quarantine. The nurse will go there and obtain sputum samples and treat the patient with none of the interaction taking place in the clinic.

6)      Finally, there are specific reporting requirements by the State and Federal Government. This has implications on the type of and amount of data that needs to be collected. Also, there

As a result, the EMR vendor has to:

1)      Understand various different workflows, each specific to a particular clinic.

2)      Be able to work with a large number of users, some of which play unorthodox roles

3)      Incorporate data fields and a format to capture information that can be used for population reporting. The databases that are used should be able to store a large number of data points.

4)      Provide access to the EMR through a variety of mobile portals – phones, tablets, etc.

5)      Incorporation of or access to certain specific forms.

6)      Design reporting engines that can produce reports in a pre-defined format acceptable to the State and Federal Government requirements

7)      Ensure their product is highly interoperable and can regularly pass data back and forth from providers and to State Registries and between other organizations.

The EMRs that can successfully support public health needs have an architecture that allows need new programming code to be inserted readily without having to create a new. New features can be added through widgets that make it easier for the user to locate and utilize them.

The revolutionizing of Public Health IT infrastructure is a long-awaited milestone that is soon to pass and will improve the management of population health.   Dr. Chawla feels that this a trial period for these organizations.The Meaningful Use initiative has really started the ball rolling. The key is to use the right electronic medical record.

Stage 2 Final Rules: Implications for Providers

Dr Jitesh Chawla feels that for the longest time, the fate of health IT was on trial.

Finally, on August 23rd, CMS released Meaningful Use Final Rules for Stage 2 of the EHR Incentive Program. For those of you that are knowledgeable about Meaningful Use and saw the proposed Stage 2 Rules there are major changes that were made based on feedback from the medical community.

Nevertheless, since the final version is now out, it is important for medical providers and hospitals to understand what is expected of them and how the criteria differ from Stage 1. This article is a quick overview of the additions and changes in Stage 2 Rules and will present some tips to how clinicians can be ready. We will not cover hospital requirements here.

 Stage 2 Requirements

Stage 2 represents “Advanced Care Processes” according to the Meaningful Use stages plan as explained by ONC. A central theme is “connectivity” where different EMRs or EHRs can exchange data with each other. Also, the first stage allowed providers to get a certified EHR and  learn how to use it to collect some meaningful data. Now the goal is to have them use more advanced functions of the EHR and collect some of the same data for a larger pool of patients.

Some of these measures are new and others represent higher thresholds from Stage 1 (latter marked by *). Examples of few of these measures are highlighted below.

·         At least 5% of patients must access have access to their online health information

·         Providers must engage in secure messaging with at least 5 % of their patients

To be sensitive to practices in rural areas CMS is granting exclusion to providers without access to broadband internet. Both measures will require internet connectivity to communicate to patients regardless of whether the EHR is web-based or not.

·         Summary of care record for more than 50% of transitions of care and referrals*

·         Transmit summary of care for more than 10% of transitions and referrals to provider even if

       they  have vendor or organizational affiliation*. However, the 2 providers that conduct the

        exchange must be using EHRs from different vendors

·         Eligible providers must select and  report on 9 out of 64 total clinical quality measures (CQMs)

·         Tobacco screening for patients 13 or older is required for 80% or more of patients

In addition, all providers must select Clinical Quality Measures (CQMs) from at least 3 of the 6 key health care policy domains from the Department of Health and Human Services’ National Quality Strategy:

 •Population and Public Health

 •Efficient Use of Healthcare Resources

 •Clinical Processes/Effectiveness

 •Patient and Family Engagement

 •Patient Safety

 •Care Coordination

  

Compared to Stage 1, EPs (eligible providers) must satisfy 20 measures 17 core and 3 / 6 for menu. Reporting will be allowed such so that batches of EPs in the same group can attest together in 1 file. For a full report of Stage 2 measures and requirements visit the CMS website.

Getting Ready

1.The patient portal is likely the medium by which patients will access online information and use email (secure messaging) to communicate with their providers. Make sure to check with your vendor if the patient portal is set-up to support all these features. PP is included as part of all certified EMRs.

Dr. Jitesh Chawla posts a trial version of a patient portal screen

 

(reference: cliniclogo)

2.Ensure policies, procedures and workflow allows collection of data in at least 3 of the 6 domains part of the National Quality Strategy. There should be a logical approach to choosing the 3. Health departments may include Population/Public Health, behavioral health practices include care coordination and practices recognized for Patient Centered Medical Home may include Clinical Processes and Effectiveness. In all 3 examples, the CQM topic represents an area that practice or clinic may focused on as part of their daily operations and so the data is being collected anyways.

3.Adopt the practice of motivational interviewing as patient engagement is bigger theme in this stage of meaningful use. Motivational Interviewing has been becoming a more widely tool in health care, as it has been used in other industries or years.

4.Keep track of the Health Information Exchanges (HIEs) in your area and make sure your HER connects with them. The good part is that Stage 1, required you to test the CCD/CCR function a which is medium by which patient information is summarized and can be submitted in exchange through a standardized format.

Concluding thoughts

The step-wise government push towards the adoption and use of EHRs is not to advocate the use of technology, help vendors with EHR sales or to create some hurdles to jump though just to get free money. But, providers and practices that streamline their work processes, capture the right patient data consistently, strive for increased quality and safety will find that EHRs are actually enablers for those goals and achieving Meaningful Use, though time consuming, is just a little more than a formality.

This certainly feels like a painful trial period for many providers, but Dr. Jitesh Chawla would encourage practices to stay persistent.

Micro-electric therapy for smoking cessation??

Dr. Jitesh Chawla discuss smoking cessation clinical trials-failures and successes

 

The first anti-nicotine vaccine to enter Phase 3 clinical trial, NicVax, was in it’s the last stage of testing before hitting the market. The product works by inciting the immune system to produce antibodies that bind to nicotine in the bloodstream, much as antibodies would attack an invading microorganism. Once bound, the nicotine cannot cross the blood-brain barrier to enter the brain. It is the neurotransmitters in the brain that cause chemical reactions leading to addictive behavior. The vaccine was therefore expected to diminish the pleasure of smoking and make it easier to quit. Unfortunately, the failure of the vaccine serves as major set-back to harness the immune system’s power to fight additions such as tobacco abuse.

Nevertheless, Micro-electric  current therapy shows a lot of promise. In one trial, 1,000 cigarette smokers treated between July 2006 and January 2008, 972 (97.2%) lost their craving for cigarettes within 1 to 5 minutes into a 20 minute session of CES. In those who were in the process of quitting and often at the height of their withdrawal symptoms, cravings started to diminish within 2 minutes of initiating CES and usually disappeared within 10 minutes. Several were 2 or 3 weeks into quitting and still experienced craving.

Picture of Micro-electrical current device- as proposed by Dr. Chawla for smoking cessation clincal trials

 

There may be many reasons for the difference between success and failure including the solidity of the product, trial design, lack of capital, tough FDA reviewers but clinical trials. Even after successful trials and FDA approval some smoking cessation products, like the Nicotrol Inhaler, are not adopted well, as the side-effects and limited efficacy with mediocre outcomes serves as a stumbling block. It is time to try something new. Micro-electrical current therapy has a different mechanism of action than any other therapeutic agent for smoking cessation, currently in the market, and is worth a shot.

 If you interested in gaining access to new treatments to help your long-time smoking habit, when you go look for a doctor who conducst such studies. Dr. Chawla suggests the best way to find out if something works for sure is to conduct a small controlled trial .

The Use of Electronic Medical Records for Clinical Trial Recruitment

By Jitesh Chawla, MD.

About EMRs

With the advent of  the HITECH Act and Meaningful Use, EMRs (electronic medical records) have become very popular among practicing clinicians. The technology enables medical providers to chart patient data into structured fields. This allows information to be easily retrieved for analysis and reporting. Another major advantage of the EMR is the ability to provide clinical decision support  (CDS). Rules can be set to alert or inform about patient clinical information that would affect treatment at the point of care. Rule parameters are configured on a settings screen and the rule is run on patient data captured in those structured fields. One example of CDS in action is an OB/GYN clinic that set for an alert to come up for every woman that was overdue on her PAP smear based on age, prior history of PAP abnormalities and family history of cervical cancer. EMRs and CDS can play a vital role in clinical trials.

Clinical Trial Enrollment

Clinical trials are divided into the following phases: 1) using healthy subjects to test for drug safety 2) using a larger group healthly subjects tested for drug efficacy 3) treatment and control groups involved in a randomized control trial 4) post marketing surveillance.  The enrollment requirements significantly increase in each phase (see table below).

Table 1. Typical Enrollment Estimates of Clinical Trials¹

Phase	Subjects Needed
1	20-100
2	100-300
3	300-3000

  Since clinical trials can account for at least 50% drug development costs, which may run up to 1 billion dollars per product, delay or cancellation of a trial due to inadequate or late enrollment is very costly². Once source cites a company lose from $600,000 to 8 million per each day a trial is delay³. Furthermore, with increased government regulations of the pharmaceutical industries and fierce competition, many drug companies cannot afford any major delays or a cancellation.

Challenges and Possible EMR Solutions for Trial Recruitment

Some reasons why recruitment and retention of subjects for clinical trials presents a challenge include:

1)Finding patients that meet the criteria and finding them quickly. The study design specifies very clearly who does and does not quality for trial participation. Also, requirements change based on the phase of study. These inclusion and exclusion criteria are very strict and need several levels of approval (ie. IRB, sponsor, investigator) before any exceptions  are made.

2)   Patient interest. Many patients may not elect to be part of a trial when they otherwise had there been better explanation about the drug being tested or condition being treated. Furthermore, some patients are just too scared to be part of an “experiment” and are not convinced by all the precautionary measures that trial staff explains they have taken.

The beauty of the CDS feature in the EMR is that each inclusion/exclusion criteria can be put as a separate rule. Furthermore, the patient reminders feature can cause a pop-up window to appear every time that rule is satisfied. Secondly, there is no better person than the patient’s provider to convince them that trying an experimental treatment might be the best option and that the benefits outweigh the risks. The relationship between provider and his or her patient is a unique one and cannot be replaced by any clinical trial staff member. EMRs have a patient education button that contains information about disease conditions and can be customized such that details about the clinical trial can be included.  Providers can go through the education sheet with their patients.

Conclusion

It is true that not all patients are suited for participating in clinical trials. Also, despite all the information and intelligence available at the point of care, some providers may choose not to use the EMR to help with trial recruitment. Nevertheless, the fact remains that clinical trial enrollment is a big issue and the EMR with its CDS and other features can help in this endeavor.

In the next article, I will go through an example of how a rule is set up in the CDS module of a typical EMR and give some real-life case study examples of organizations that have leveraged this technology to help them successfully recruit for their clinical trials.

References:

1) wikepedia

2) http://www.promodel.com/solutions/pharma/clinicaltrials.asp

3)  http://www.pdpipeline.org/2011/clinicaltrials/recruitretention.htm

What medical providers need to know about switch to ICD-10

Jitesh Chawla, MD. would be the first one to say this is a major "trial period" for fellow medical colleagues due to the ever increasing requirements from the governement.

Most providers of small practices don’t have the time or resource to fully understand how ICD-10 will impact them. In this article, I will explore this very important topic and provide suggestions for providers of how to prepare for ICD-10 compliance.

The intention behind ICD-10 is to provide a tool that would provide a more detailed, accurate code to match the actual diagnosis. As disease diagnosis has become more specific, ICD-9 codes appear to be obsolete and often don't describe the condition accurately.

The law states for all organizations covered under the 5010 electronic transactions version instead of the older 4010/4010A versions. If you are not familiar with this terminology, please check with your billing manger or practice management software vendor.

ICD-10 is divided into 2 areas: clinical modification (CM) and inpatient procedure coding system (PCS). Inpatient procedure codes are not affected. Outpatient codes are still represented under the current system. ICD-10 is more specific on anatomical location, specificity of diagnosis, etc. To put this into perspective, take for example, if a patient was had a furuncle (boil) on the face and went to the dermatologist. The same patient then returned a few weeks later and had a carbuncle. In ICD-9, the same code would be used which is 680.0. In ICD-10 (specificity of the condition) would be recorded. The furuncle would be L02.92 and carbuncle would be L02.93. Furthermore, ICD-10 would enable you to record which encounter (initial versus subsequent).

The basic structure of the ICD-10 code is:

Characters 1-3: the category, 4-6: cause of problem, body part affected, severity of illness, 7: Place for extension of the code

Some EMR systems have a connection with live database and so a switch to ICD-10 will not affect the users when picking a diagnosis for their note. However, with EMRs that don’t have this link to the live database, the issue is how to migrate the codes into the system. A strategy would be to use transition tables which provide the ICD-10 equivalent to the ICD-9 code since there is no way to convert the codes. ICD 10 Code Translator . Just plug in the ICD-9 code and it will convert it to the equivalent ICD-10 code. This provides enough relevant background for most people about ICD-10 and the issues surrounding it. Please be sure to examine the table below that compares ICD-9 and ICD-10 codes. For providers, health care staff

Bringing Wellness into the Doctor's Office

Wellness initiatives are generally administered by company physicians, wellness companies or disease management organizations.  However, one offshoot of the Accountable Care Act is the requirement of Medicare providers to devise a Personalized Prevention Plan for Part B Beneficiaries.  This is apparently in line with the law’s intent to foster greater preventative services for the population.  Prevention is a major theme in wellness.

The visit is coined as Annual Wellness Visit (AWV). Among the benefits include the fact that the provider will administer a HRA health risk assessment  which can uncover various risk factors that if addressed early enough can prevent disease.  

Sample HRA (link -www.prochange.com)

A second major benefit is that he or she will devise a 5 year schedule outlining which screenings and immunizations a patient needs. It can replace the Welcome to Medicare Visit as a requirement for Part B patients but you are not eligible for this until after 12 months of becoming a Part B beneficiary or within 12 months of IPPE (Initial Preventative Physical Exam). It appears that CMS has this because they want the first year to be a trial (Dr. Chawla's opinion). The only drawback is that the AWV doesn’t cover any physical exams.

This represents another step in empowering the provider to become the primary furnisher of preventative services and not someone who treats sicknesses.

The physician is in the optimum place to administer powerful tools such as the HRA, which when used with follow-up counseling, has been shown in studies to help providers pinpoint risk factors that are not found during routine visits.  Furthermore, prevention planning has been shown for years to help health departments and agencies such as the CDC improve outcomes for population. Government regulations or the lure of higher reimbursement from payers is often what it takes to start such transformation. In the next several years as health reform completely rolls out we will watching to see how “sick care” changes to “well care”

YouTube videos by Dr. Chawla site links -OpeEMR Scheduling and OpenEMR SOAP Note

Stakeholder implications of the Supreme Court decision on the Accountable Care Act

The upholding of President Barack Obama's healthcare reform bill has translated into important implications for various stakeholders. In this brief article, we will examine what these are and some strategies to deal with the impending changes.

Key Implications

Patients:

·        Must enroll by 2014 for health insurance coverage or face penalties on income tax by 2015 (doesn’t apply to individuals who aren’t required to pay taxes)

·        Ability to get insurance at affordable rates by having options offered by insurance exchanges

·        Children up to age 26 will be able to stay on parent’s plan. This can serve as a trial period giving youngsters time to find their own insurance.

Insurers:

·        Prohibit community rating for setting premiums

·        Can’t discriminate children based on pre-existing conditions

Employers:

·        Must subscribe to health insurance exchanges

·        Small business less than 100 employees can face penalties for not providing insurance to employees

·        Small businesses receive subsidies to help all employees get medical coverage

States:

·      Decide whether to participate in providing Medicaid expansion to their citizens which may imply that after 2014 must impose heavy taxation to keep it sustainable

·        Those that do decide to participate in the expansion must have a way of tracking individuals who do and do not enroll

·        States will still receive current Medicaid funding from feds even if opt not to participate in expansion program

·        Must set up health insurance exchanges by 2014




(reference- www.newsday.com - NY HIE article)

Strategies to prepare

Patients- Start inquiring and understanding about various plans offered, discuss with your employer benefit changes they may make, enroll children in plans

Insurers – re-structure plans and offerings; understand the impact that health insurance exchanges may have on their business model/financial strategy

Employers- make sure all employees are being enrolled, understand which plans to accept in benefit offerings, and comply with requirements for receiving subsidies (small businesses only)

States- work fast on setting up health insurance exchanges, re-examine risk/benefits in offering Medicaid expansion coverage, and develop adequate IT systems/process for tracking who in the population is in enrolled in Medicaid.

The full after-effects of the Accountable Care Act (ACA) law will only become
apparent in the next several years as various stakeholders take actions to
either comply or react to the coverage, access and quality of care initiatives
set in motion by Obama care. If you ask, Dr. Chawla this a trial period in which the country
will see whether we can fix our healthcare system.

In future articles, we will look more by in-depth by identifying which strategic options and tactics need to employed by organizations to remain compliant with ACA mandates.