2014: A Healthccare Year to Remember

This year is action-packed with policies, mandates and programs to keep physicians, hospitals and healthcare consumers all busy and wondering what they need to do or how they may be affected. In this article, Dr. Jitesh Chawla explores of the key programs and legislation that will start up in 2014.

Health Information Exchanges

One on-going problem has been that different healthcare institutions have different IT systems. The fact that the average patient in the US moves through various providers over the course their healthcare treatment life cycle poses a problem for continuity of care as information about their past is often not available in real-time to their current provider. Meaningful Use requires system to be able to exchange data with each other. Standards such as HL7and CCR/CCD have been created. In fact, national networks such as NHIN and programs such Direct Project enable a national information highway. However, it is also at the state level that such data transfer needs to happen and health information exchanges (link) have been setup. Dr.Chawla has the opinion that patient privacy and HIPAA compliance will be of paramount importance as patient data is sent and received through the cloud. For more information about the topic, please go to http://www.healthit.gov/providers-professionals/health-information-exchange.

Health Insurance Exchanges

You all have probably heard in the news for the last several months how the Affordable Care Act legislation has mandated that everyone sign up for health insurance or face penalties. This effort, dubbed Obamacare, will have profound effects on the population. For one, today is the first day that people are using these exchanges and must have signed up for them by end of Dec 2013. The idea is to offer plans that anybody can afford. The government wants even healthy individuals to take insurance so as this will ensure subsidies to finance the sick. Other stipulations include penalties for businesses that don't sign up their employees. The penalties varies depending on the size of the businesses. Jitesh Chawla, MD feels that without acheiving the individual mandate and a national healthcare insurance system, these efforts will be short-lived and lead to only minor curbing of the unfair advantage of patients that insurers are taking.  For more information about the topic, please go to http://www.dummies.com/how-to/content/healthcare-reform-2014-mandated-coverage-insurance.html.

Meaningful Use Stage 2

Meaningful Use is a term referring to the recording and reporting of certain data by providers and hospitals to CMS in order to get extra money in their Medicare or Medicaid payments or avoid penalties. The program is divided into 3 stages each of which run, on average 2-3 years in length. For this second stage, new requirements such as emailing directly with patients, bringing up radiology reports with the EMR and entering data into speciality registries (ie. cancer, etc.) may be challenging and new for many people. Furthermore, extra expense and re-training is needed because EMR systems will have to be upgraded to allow the extra features needed to perform these functions. Dr. Jitesh Chawla feels that MU 2 compliance will be low and the standards may be lowered or another year will be added to allow time for better compliance. More information about the topic can be found at http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html.



These are just some of the changes proposed to take place in 2014 that will affect provider, hospitals and patients. There are still other programs such as PQRS, MPPR, etc.that we won't have timeto discuss in this article but are important and you should know about. The best way to be ready is to understand what is expected of you through this article and links given and work with your local RECs, consultants or experienced office managers to devise a plan for compliance. Dr.Jitesh Chawla feels that though 2014 may be a year of many firsts for healthcare in the US, providers, hospitals and consumers will still be able to financially survive and make it work.

Health Insurance Exchanges - Working Through the Kinks

Dr. Jitesh Chawla feels that health insurance exchanges are a honest attempt to fix all the on-going problems with trying to provide the proper access and coverage to Americans that were created by insurance companies. But, like any new initiative, there are kinks that need to be worked out as this article explains.

The Health Insurance Exchanges, central pieces of the Patient Protection and Affordable Care Act (PPACA), opened as scheduled on October 1 amid debate in Congress and a government shutdown over the future of the law. The launch of the Exchanges along with open enrollment for Americans came just after the government released premium rates for 33 federal Exchanges.

Technical Problems in Accessing Exchanges

Consumers seeking online access to federally-facilitated Exchanges (FFE) faced intermittent outages and error messages throughout the first day of enrollment. Some state-based Exchanges, including those in California, New York, Maryland and Colorado had similar issues with their websites. Traffic to these sites was very high, leading many of the sites to slow down considerably. Similarly, those seeking assistance by phone also encountered long wait times.

Many proponents of the law, including those who are helping to develop the Exchange systems, have warned of glitches as the Exchanges roll out over the next several months. Many of these predictions proved accurate as large numbers of Americans logged on to the Exchange websites to browse coverage options. As initial curiosity over the Exchanges subsides in the coming weeks, it will be easier to more accurately assess the functionality of the websites.

Rates Announced

On September 24, the U.S. Department of Health and Human Services (HHS) released an issue brief outlining the premium rates in the 36 states with either an FFE or a partnership Exchange. Since data concerning premium rates is complex and ambiguous, supporters of PPACA hail the rates as a success for the health reform law, while opponents view them as a major failure.

The issue brief outlines the number of Qualified Health Plans (QHPs) offered in each state and the average premium rates that enrollees would pay for different plan tiers. Average premium rates are detailed for a 27-year-old (before and after tax credits are assessed), and a family of four with a specified income of $50,000 per year. Rates for the lowest bronze, silver, gold and catastrophic plans as well as the second lowest silver plans are described. The average number of QHPs offered in the 36 states is 53 with as many as 106 plans offered in Arizona and as few as seven in Alabama.

Update: On October 1, the U.S. Department of Health and Human Services posted premiums for over 17,000 plans being offered in the 36 states where the federal government is operating an Exchange. The premiums are listed for different geographic regions, age groups and different family sizes. Metal levels and plan type information is also provided.  This list provides people the ability to compare plans within and between states. Click here to access this resource.

To see the full article, please click this link.

Please join Jitesh Chawla, MD. in the discussion by posting your comments on this blog post.

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.