HEALTH CARE REFORM by chenmeixiu

VIEWS: 4 PAGES: 39

									     JEROME W. THOMPSON MD, MBA
CHAIRMAN OTOLARYNGOLOGY HEAD AND NECK
          SURGERY UT, MEMPHIS
  TMA INSURANCE COMMITTEE CHAIRMAN
Rectal smoke insufflator
                           J Thompson
Tobacco Smoke Enema (1750s-1810s)The
tobacco enema was used to infuse tobacco
smoke into a patient's rectum for various
medical purposes, primarily the
resuscitation of drowning victims. A rectal
tube inserted into the anus was connected to
a fumigator and bellows that forced the
smoke towards the rectum. The warmth of
the smoke was thought to promote
respiration, but doubts about the credibility
of tobacco enemas led to the popular phrase
"blow smoke up one's ass."




http://medgadget.com/archives/the_good_old_days/
                                                   J Thompson
       HEALTH CARE REFORM


 MEDICINE WILL CHANGE DRAMATICLY
 BIGGEST CHANGE SINCE MEDICARE IN THE 60’S
 Very similar to Massachusetts plan
 This is an attempt at a neutral presentation of facts
 Both sides were not always accurate

                                                     J Thompson
       HEALTH CARE REFORM

 Patient Protection and Affordable Care Act (PPACA)
 Reconciliation: Health Care and
  Education Affordability Act of 2010 (HCEAA).
 A major redistribution of wealth
 Quality of health care may improve
       HEALTH CARE REFORM
 Approximately 25 slides with 100 pieces of data
 Attempts to introduce you to the vocabulary
 Points out the major aspects
 Makes no judgments. Not exhaustive or authoritative
 Five major sources: New York Times (NYT), Kaiser
  Family Foundation (KFF), Sonnenschein Consulting
  (SC), CMS.GOV, Crain’s Chicago Business News
  (CCBN)
 Makes several recommendations to survive
                                                    J Thompson
       HEALTH CARE REFORM
 STARTING IN 2014, MOST AMERICANS WILL BE
 REQUIRED TO BUY HEALTH INSURANCE OR PAY A
 PENALTY.
   32 million reduction in # uninsured (94% insured rate
    SC)
   The penalty will be phased in, starting at $95 or 1 percent
    of income in 2014, whichever is higher, and rising to
    $325/2015, then $695 or 2.5 percent of income in 2016.
   But families would not pay more than $2,085/yr.

                                                       J Thompson
        HEALTH CARE REFORM
 EXEMPTIONS:
    Those with religious objections or a financial hardship
     can also avoid the requirement.
    And if you would pay more than 8 percent of your
     income for the cheapest available plan, you will not be
     penalized for failing to buy coverage.
    Those who are exempt, or under 30, can buy a policy that
     only pays for catastrophic medical costs.
    American Indians don’t have to buy insurance. (NYT)

                                                       J Thompson
      HEALTH CARE REFORM

 BENEFITS:
   ANNUAL & LIFETIME LIMITS OF HEALTH CARE
     EXPENSES ARE PROHIBITED
   DEPENDENTS ARE COVERED TILL AGE 26
   GUARANTEED ISSUE OF INSURANCE & RENEWAL




                                         J Thompson
          HEALTH CARE REFORM

 BENEFITS:
        NO LIFETIME LIMITS
        FAIR MARKETING PRACTICES
          MAY NOT DISCOURAGE PERSONS WITH HEALTH
           PROBS, NO DISCRIMINATION FOR ANYTHING
        FED PROGRAM FOR THE UNINSURED
          (A HIGH RISK POOL) (A public option)


                                                  J Thompson
      HEALTH CARE REFORM

 BENEFITS:
  IT MUST ALLOW FOR THREE PRIMARY CARE VISITS
   A YEAR AS WELL
  PRE-EXISTING CONDITIONS IGNORED
  CAN NOT RESCIND COVERAGE (after 6 MONTH)
  NO WAITING PERIODS
           HEALTH CARE REFORM

       BENEFITS:
         PLANS MUST PAY FOR PREVENTIVE CARE
         MUST HAVE QUALITY REPORTING
         MUST PUBLISH MEDICAL LOSS RATIO (MLR)
         COMPANIES MUST CREATE REINSURANCE FOR
          RETIREES’ BENEFITS:


                                             J Thompson
         HEALTH CARE REFORM

       BENEFITS:
        MAX. RISK RATING TOBACCO = 1.5X, AGE 3X
        HEALTH PROBS AND GENDER NOT RATED
        RATE INCREASE JUSTIFICATION
        MUST PROVIDE MINIMAL ESSENTIAL
         COVERAGE


                                               J Thompson
      HEALTH CARE REFORM

 STATES REQUIRED TO ESTABLISH EXCHANGES
    EXCHANGES ARE FEDERALLY REGULATED
     INSURANCE COMPANIES
    MUST CREATE SHOPS (SMALL BUSINESS OPTIONS
     PROGRAMS)
    MAY BE REGIONAL (multi state) BY 2014,
    FACILITATES THE PURCHASE OF HEALTH CARE INS



                                            J Thompson
HEALTH CARE REFORM

 EXCHANGES’ Benefit package
    Mandates a basic package, and tiers of coverage
        Premium based on actuarial cost and level benefits
          Bronze=60% value

          Silver=70% value

          Gold=80% value

          Platinum=90% value




                                                      J Thompson
         HEALTH CARE REFORM

 EXCHANGE ELIGIBILITY
    ALL QUALIF. INDIVIDUALS
    EMPLOYERS
       SMALL BZ 100 OR LESS
       BIG BZ > 100 COVERAGE AT DISCRETION OF STATE
        EXCHANGES (2017)



                                                       J Thompson
      HEALTH CARE REFORM

 EXCHANGE ELIGIBILITY
    EMPLOYERS > 200 EMP MUST AUTOMATICALLY
     ENROLL ALL NEW EMPLOYEES, (>50 MUST OFFER A
     PLAN)
    HHS WILL GIVE GRANTS TO ESTAB EXCHANGES
     AND UNDERWRITE LOSSES, BUT MUST BE SELF
     SUPPORTING BY 2015
    LARGE GROUPS CAN HAVE HIGHER DEDUCTABLES

                                            J Thompson
      HEALTH CARE REFORM

 EXCHANGES MUST MEET FED. QUALIFICATIONS
    GOV. SPONSERED, EMPLOYER SPONSORED,
    GRANDFATHERED PRIVATE PLANS EXCLUDED
    INCLUDES CATASTROPHIC COVERAGE, SPECIFIED
     BENEFITS PACKAGE, LIMITS ON ANNUAL COST
     SHARING, LIMITS DEDUCTABLE TO
     $2000/INDIVIDUAL, AND $4000/FAMILIES FOR
     SMALL GROUP PLANS.

                                           J Thompson
       HEALTH CARE REFORM
 You can obtain coverage through Medicaid
 Starting in 2014, anyone with an income below 133
  percent of the poverty level — or about $29,327 in
  2009 for a family of four — will be eligible for a
  rejuvenated Medicaid program.
 Invests $15 billion in wellness programs



                                                  J Thompson
       HEALTH CARE REFORM
Dramatically subsidizes Medicaid, ”Medicaid’s often
 anemic reimbursements will be increased to the same
 level as Medicare, making more doctors willing to
 accept it.” (NYT)
   Req. State to cover all below 133% of FPL
   Fed Gov pays 100% initially then drops to 90% @ 2020
   Increase drug rebate from 15.1% to 23.1%
   Creates a new plan for people with 2 chronic conditions
    to receive Integrated Home Health (Medical Home)
   Physicians must receive 100% of Medicare payment
                                                      J Thompson
        HEALTH CARE REFORM

 HOW IS IT GOING TO BE PAID FOR?
   EXCISE TAX ON “CADILLAC PLANS”
      40% IF COVERAGE EXCEED $10,200/PERSON AND $27,500
       FOR FAMILY
   FLEX PLANS CAPPED @ $2,500/YR
   2.3% EXCISE TAX ON MEDICAL DEVICES




                                                   J Thompson
        HEALTH CARE REFORM

 HOW IS IT GOING TO BE PAID FOR?
   INSURER TAX OF
       $8 BILLION/2014,
      $13.9 BILLION/2017,
      $14.3 BILLION/2018, THEN
      $14.3 BILLION + EXCESS PREIUM GROWTH FORWARD




                                                 J Thompson
        HEALTH CARE REFORM

 HOW IS IT GOING TO BE PAID FOR?
   INDIVIDUAL INCOME TAX
      0.9% IF EARNING OVER $200K/ INDIVIDUAL
      OR $250K/ FAM (NYT EST $2K MORE TAX/ INDIV)
   PREMIUM CREDITS FOR THOSES BELOW 400% FPL
   ($79K /YR)



                                                     J Thompson
HEALTH CARE REFORM
 ANNUAL FEE ON BRAND NAME DRUG
 MAKERS
  $2.5 BILLION 2011,
  $2.8 BILLION 2012-13,
  $3.0 BILLION 2014-15,
  $4.0 BILLION 2017-18,
  $2.8 BILLION THEREAFTER




                              J Thompson
        HEALTH CARE REFORM

 TAX EXEMPT HOSPITALS SHALL
    Implement financial assistance policy,
    limit charges to certain patients to general billed
     amounts (no padding)
 Prohibits physician ownership in hospitals (SC)
 INCREASES MEDICARE RISK TO HOSPITALS


                                                           J Thompson
       HEALTH CARE REFORM
 Small bz. (<10 emp.) get tax credits = 50% of amt paid
  for HC-INS if ave. wage is <$25K/yr
 Smaller credits for medium size Bz. (<25 emp.) if avg.
  wage is between $25-$50K
 Eliminates gov. subsidy to employers for providing RX
  drug coverage (big deal) 2013
   $100-million non-cash accounting charge Caterpillar
    says it will suffer because of tax-law changes limiting its
    ability to deduct government subsidies for providing
    retiree drug coverage. (may save them $300 million)
    CCBN

                                                       J Thompson
          HEALTH CARE REFORM
 Medicare
   Increase # of GME positions but only in those states
    with lowest resident to patient ratios
   Decrease in clin. lab reimburs. by 1.5%,
        Home health agencies by 1%,
        Hospice by 0.3%
   Unspecified adjustments in surg. centers, durable
    medical equip, dialysis center

                                                      J Thompson
    HEALTH CARE REFORM
 MEDICARE
   Decrease hospitals reimburs. by
    .25%,0.1%,0.3%,0.2%, and 0.75% by 2019
   Decrease hospital payment if they
       Don’t have p4p, or quality improvement plans
       Have high readmission rates,
       Have high acquired hosp conditions (inf.)
   Hospitals may need to have more control of MDs
       Cooperative medical staff or ownership
                                                       J
         HEALTH CARE REFORM
 Medicare Advantage reductions vary depending on
  area. (require a MLR of 85%)
 No change is SGR (21% CUT PENDING) (KFF)(SC)
 Tests concept of medial home FOR MEDICARE
 $250 Million for Fraud and Abuse investigations/5yrs
 Decrease reimbursement for imaging
       Very complex (some areas a 47% decrease) (CMS)
 More cuts coming (THE CRUNCH: FOR DOCs &
 HOSPITALS)
         HEALTH CARE REFORM

 MEDICARE
   Budget neutral rewards
       Adjust mis-valued RVUs (redistribute $)
       Increase PQRI incentives by 0.5%
       Increase payments to physicians with low costs
       Pay for quality care (2015)
          ACOs (accountable care orgs) share in Medicare savings they
           generate


                                                                 J Thompson
         HEALTH CARE REFORM
 MEDICARE
   Budget neutral rewards

   ACOs (accountable care orgs) share in Medicare
    savings they generate
       May be only viable way to SURVIVE THE CUTS from the new
        HEALTH CARE REFORM
       EXCHANGES may also seek out the ACOs to save costs
         Expect limited panels of physicians to those who are in an ACO
          and save the EXCHANGES MONEY
       HEALTH CARE REFORM
 Establishes a new National Health Care Workforce
  Commission
 Loans and scholarships for med students to address
  workforce shortages, and serve underserved, rural,
  minorities and uninsured populations (?)
 Grants for training programs in Fam. Med, Gen
  Internal Med, General Peds, and PAs
 Invests $15 billion in wellness programs

                                                 J Thompson
        HEALTH CARE REFORM
 THINGS NOT DONE
    ANTITRUST EXEMPTION NOT TOUCHED
    No public option
      Will have two national exchanges (same thing)
   NO DENTAL
   NO GLASSES
   No over the counter meds covered
   No SGR fix ($243 BILLION) medpagetoday.com



                                                       J Thompson
       HEALTH CARE REFORM
 TWENTY STATE ATTORNEY GENERALS HAVE
 JOINTLY FILED A CONSTITUTIONAL CHALLENGE
 TO THE HEALTH CARE LAW
   REASONS
      COSTS TO STATES
      AND STATES RIGHTS
        BASED UPON THE COMMERCE CLAUSE OF THE
         CONSITUTION
    HEALTH CARE REFORM
                               From Wikipedia,
 The Commerce Clause is an enumerated power
  listed in the United States Constitution (Article I,
  Section 8, Clause 3). The clause states that the
  United States Congress shall have power "To
  regulate Commerce with foreign Nations, and
  among the several States, and with the Indian
  Tribes".
   HEALTH CARE REFORM
 Is health-care reform constitutional?
 The Washington Post
 By Randy E. Barnett, Sunday, March 21, Can Congress
  really require that every person purchase health
  insurance from a private company or face a penalty?
  The answer lies in the commerce clause of the
  Constitution, which grants Congress the power "to
  regulate commerce . . . among the several states."
  Historically, insurance contracts were not considered
  commerce, which referred to trade and carriage of
  merchandise. That's why insurance has traditionally
  been regulated by states.
       HEALTH CARE REFORM
 But the Supreme Court has long allowed Congress to regulate and
  prohibit all sorts of "economic" activities that are not, strictly speaking,
  commerce. The key is that those activities substantially affect interstate
  commerce, and that's how the court would probably view the regulation
  of health insurance.But the individual mandate extends the commerce
  clause's power beyond economic activity, to economic inactivity. That is
  unprecedented. While Congress has used its taxing power to fund Social
  Security and Medicare, never before has it used its commerce power to
  mandate that an individual person engage in an economic transaction
  with a private company. Regulating the auto industry or paying "cash for
  clunkers" is one thing; making everyone buy a Chevy is quite another.
  Even during World War II, the federal government did not mandate that
  individual citizens purchase war bonds.
         HEALTH CARE REFORM
 What you must do
   Become fully electronic, EMR
   Consolidated into larger groups; Consider ACOs
       Better negotiating power with exchanges
   Get help now
   Stay in organized medicine (only legal way to Challenge)
   If you merge beware of the fine print
       Joint ventures are better when the crunch comes
           HEALTH CARE REFORM
                references
 NEW YORK TIMES: March 21, 2010 How the Health Care Overhaul
  Could Affect You; Major ways the overhaul will affect those who
  currently have health insurance and those who do not.
 KAISER FAMILY FOUNDATION –Web page leads to a gateway of in
  depth data healthreform.kff.org/
 SONNENSCHEIN, NATH & ROSENTHAL LLP Key Provisions of
  Health Care Reform Legislation (senate bill and reconciliation)
 CRAIN’S CHICAGO BUSINESS NEWS
 CMS.GOV
 WIKIPEDIA
 THE WASHINGTON POST
 medpagetoday.com

                                                          J Thompson

								
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