Health insurance law changes and how could it affect your practice

Introduction
Medical insurance coverage is directly related to the amount of billing activity done by a practice. The better the coverage the more likely patients come and the more you can bill. There have been many changes to the insurance law in the last year and several regulations are set to be in effect in the years to come. Some of these are on off-shoot of the Affordable Care Act signed into law by President Obama. In this article, I will describe some of these changes and how it may affect your practice.

Examples of insurance law changes due to healthcare reform
For those who already have health insurance:
•Insurers will not be allowed to take away your coverage if you get sick-effective 2010
•Insurers will not be allowed to limit how much they will pay for medical benefits over your lifetime – effective 2010
•Policies will now have to pay for tests to detect chronic diseases (ie. cancer) at earlier stages but not require any deductibles, co-pays or co-insurances -effective 2010
•Insurers will not be allowed to limit how much they will pay for medical benefits during a year-effective 2014
For those who can’t afford insurance or have trouble finding coverage for 1 or more persons:
•Your children may be on your policy or be added to your family policy until they turn 26-effective Sept 2010
•Temporary coverage to those with pre-existing conditions till health insurance exchanges are set up (in 2014)- effective Sept 2010
•Insurers can no longer charge you excessively more because of past medical history age or sex. But, they can charge up to 50% more if you smoke –effective 2014
•The HIEs will be set-up for those who can’t get insurance through work or lost their job. -effective 2014. (Those who qualify for one and don’t sign up will be penalized)

What does this mean to you?
If you are a small practice, particularly in primary care, these changes may provide you increased financial viability as more people likely will seek medical care. Small practices often don’t get as much reimbursement as a larger practice for the level of work and need to make the make up the different by seeing more patients. Also, if you serve an area with a lot of uninsured patients, then you may be able to accept them soon, as nearly everyone will have health insurance by 2014. Oftentimes, patients may hesitate to seek medical care because of all the limitations on what is covered as dictated by their insurance policy. But, with changes such as no limits of benefits over a lifetime or year, coverage of illnesses excluded by pre-existing condition clauses, etc. more patients will be able to get their treatment paid for.

Conclusion
It is that apparent that there are major changes to insurance coverage as result of healthcare reform. However, if you ask Dr. Chawla this is a crucial trial period. This is just the beginning and there are many more changes expected to come over the years. Those having insurance and not having insurance are the 2 categories used as examples. But, the insurance law changes also affect people on Medicare exclusively, in long term care and small business owners. As patient volume increases, logically it becomes more and more important to have a very efficient, structured billing process in place.

What do you think about this topic? Do you think these changes will affect you? We would love to hear from you.

Patient Portals: What are they and how can they be important?

A Patient Portal is a software functional feature that enables patients to view or to send their own health data without the need of medical provider or staff. Screens are available where patients can see their medication list, allergy list, labs and schedule appointments. It can be described as a "window looking into their electronic patient chart" Some portals allow patients to also see their visit bill, fill out of their initial intake form, email their providers and send data from medical devices (ie. glucose, BP values, etc).

Patient portals can be part of an EMR or be used standalone or be linked to an EMR, PM system, etc. This a tool that has been important in getting patients engaged in their own care. Also, it helps organizations cut costs. For example, lab results don't need to be mailed, staff time is not wasted to help patients schedule appointments or answer simple questions about their bill.

Patient benefits include cutting down time filling paperwork on a new patient visit, more freedom in accessing certain health data (ie. labs, med list) on demand and an ability to contact their medical provider directly without having to depend on the practice staff.

One study revealed that 75% of patients wanted to email their physicians, 2/3 rds wanted to lab results online and at least were very to upload data from their home monitoring device into the EHR. These days it is easy for a practice to get a patient portal. In fact, Meaningful Use certified EMRs come with patient portals. Some have basic features only (results viewing), while others allow you to schedule appointments, refill meds and send messages.

Screenshot of a patient portal

(reference: omedix blog)

However, there are a few important points to what features to make available.

1. Consider the implication that the patient portal feature will have on practice workflow. For example, you may want to include lab results as a feature as most are normal and don't take away time from the provider to explain (as an abnormal result would do).

2. Getting reimbursed for the work it creates. For example, in some organizations providers don't get paid for responding to emails from patients or the pay may not be worth the time it takes. Therefore, you may not want to offer a secured messaging feature to your patients.

3. IT issues may take time or expense. Being software, patient portals are amenable to technical problems. You must decided if your practice or organization has the resources to deal with that. Once you introduce a new service to your patients, it's too late to back out. Especially, if people like using it and patient portals are becoming more and more popular.

If you want Jitesh Chawla's advice, set up a trial period with your patients in which you ask them all to utilize the patient portal for certain funcationalities such as booking appointments, requesting med refills.

I hope this has given you some basic information about patient portals and how they can be used.
Patient portals have a tremendous potential from improving practice efficiency to exchanging data with health information exchanges.Will patient portals stay or suffer the fate of some of the PHRs (like Google Health)? I am not sure and only time will tell. But, one thing is for sure - healthcare consumers want more charge of their health and health information. Patient portals serve as one of these tools.