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Tag: Affordable Care Act

Emergency Care Visits Continue to Rise Since Implementation of Affordable Care Act

Three-quarters of emergency physicians report that emergency visits are going up, according to a new poll. This represents a significant increase from just one year ago when less than half reported increases. Rather than trying to keep people out of emergency departments, policymakers need to recognize the value of this model of medicine that people want and clearly need, according to the American College of Emergency Physicians (ACEP).

Most of the respondents to the poll report little or no reductions in the volume of emergency visits due to the availability of urgent care centers, retail clinics and telephone triage lines. About 90 percent of more than 2,000 respondents also say the severity of illness or injury among emergency patients has either increased (44 percent) or remained the same (42 percent).

“The reliance on emergency care remains stronger than ever,” said Michael Gerardi, MD, FAAP, FACEP, president of the ACEP. “It’s the only place that’s open 24/7, and we never turn anyone away. Rather than trying to put a moat around us to keep people out, it’s time to recognize the incredible value of this model of medicine that people need.”

More than one-quarter (28 percent) report significant increases in all emergency patients since the requirement to have health insurance took effect. In addition, more than half (56 percent) say the number of Medicaid patients is increasing.

These data correlate with another new report issued by Health Policy Alternatives, which found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments and into primary care are not working. More than half of providers listed by Medicaid managed care plans could not offer appointments to enrollees, despite a provision in the ACA boosting pay to primary care physicians treating Medicaid patients. The median wait times was 2 weeks but over one-quarter of providers had wait times of more than a month for an appointment.

“There is strong evidence that Medicaid access to primary care and specialty care is not timely, leaving Medicaid patients with few options other than the emergency department,” said Orlee Panitch, MD, FACEP, chair of EMAF and emergency physician for MEPHealth in Germantown, Maryland. “In addition, states with punitive policies toward Medicaid patients in the ER may be discouraging low-income patients with serious medical conditions from seeking necessary care, which is dangerous and wrong. ”

The report — commissioned by the Emergency Medicine Action Fund (EMAF) — is titled “Review of the Evidence on the Use of the Emergency Department by Medicaid Patients and the Evolving Role of Emergency Medicine Physicians.”

Read the full report here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Americans Slightly More Positive Toward Affordable Care Act

Americans’ views about the Affordable Care Act are more positive now than they were last fall, although overall attitudes remain more negative than positive. Half of Americans now disapprove of the 2010 law, while 44% approve — the narrowest gap since October 2013. By comparison, last November, just after the strong Republican showing in the midterm elections, 56% of Americans disapproved and 37% approved.

Americans’ support of the Affordable Care Act has fluctuated substantially in recent years, reaching as high as 48% in November 2012, just after President Barack Obama was re-elected, and dropping to as low as 38% in January 2014 and 37% last November. The latest update, based on interviewing conducted April 1-4, shows that Americans have returned to the more positive evaluation of a year and a half ago — albeit one that remains net negative. The shift in attitudes over the past four months may reflect the public’s awareness of data showing that the percentage of Americans who are uninsured has dropped substantially since the ACA-mandated open enrollment periods for obtaining insurance began to take effect.

Although opinions of the ACA have become somewhat more positive, Americans’ attitudes about the law’s impact on their own personal healthcare have not shown much change. The majority of Americans continue to say the law has had no effect on their healthcare so far, while the percentage who say it has hurt their situation continues to be marginally higher than the percentage who say it has helped.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Workplace Wellness Programs: Federal Agencies Weigh In

On April 15, 2015, Supreme Court Justice Alito stayed the final order of the federal Court of Appeals for the Third Circuit in Zubik v. Burwell. The Third Circuit had denied rehearing of its order denying relief in a case in which two Catholic dioceses, among other religious organizations, had challenged the administration’s latest accommodation of religious objections to compliance with the contraceptive coverage mandate issued under the Affordable Care Act. The administration had proposed the accommodation, which merely requires religious organizations to notify the government of an objection to compliance and then leaves the government responsible for ensuring compliance, in response to an earlier Supreme Court order which had indicated this approach was acceptable. Justice Alito gave the government until April 20 to respond. The contraceptive issue is now again before the Supreme Court.

Workplace wellness programs are very controversial. Employers believe that they improve employee health, reduce absenteeism, and cut the cost of employee health benefit programs. They are encouraged in this belief by wellness program vendors, who aggressively tout the benefits of their programs. Disability advocates, on the other hand, are concerned that wellness programs are perpetuating discrimination against the disabled and health status underwriting. Privacy advocates worry about who has access to the sensitive medical information that wellness programs demand of participants. Others worry about the control that employers assert over their employees’ lives through wellness programs, as employees spend hours of off-the-clock time every week meeting the demands of wellness programs while wearable devices track their footsteps.

Wellness programs are a product of the Health Insurance Portability and Accountability Act of 1996, which outlawed health status underwriting in group health benefit programs, but allowed group health plans to offer incentives to employees for participation, or penalties for nonparticipation, in wellness programs that met certain requirements. The Affordable Care Act extended HIPAA’s prohibition against health status underwriting to the individual and small group markets, but reaffirmed the wellness program exception, in fact increasing the size of incentives or penalties that employers could offer or impose. Final ACA wellness program regulations were promulgated by the Departments of Labor, Health and Human Services, and Treasury in June of 2013, defining the conditions under which wellness programs could be offered.
Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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FAQs About Affordable Care Act Implementation (Part XIX)

Set out below are additional Frequently Asked Questions (FAQs) regarding implementation of various provisions of the Affordable Care Act. These FAQs have been prepared jointly by the Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, the Departments). Like previously issued FAQs (available at http://www.dol.gov/ebsa/healthreform/ and http://www.cms.gov/cciio/resources/fact-sheets-and-faqs/index.html), these FAQs answer questions from stakeholders to help people understand the new law and benefit from it, as intended.

Updated Department of Labor Model Notices

In general, under the Consolidated Omnibus Budget Reconciliation Act (COBRA), an individual who was covered by a group health plan on the day before the occurrence of a qualifying event (such as a termination of employment or a reduction in hours that causes loss of coverage under the plan) may be able to elect COBRA continuation coverage upon that qualifying event.(1) Individuals with such a right are referred to as qualified beneficiaries.

Under COBRA, group health plans must provide covered employees and their families with certain notices explaining their COBRA rights. A group health plan must provide each covered employee and spouse (if any) with a written notice of COBRA rights “at the time of commencement of coverage” under the plan (general notice). A group health plan must also provide qualified beneficiaries with a notice which describes their rights to COBRA continuation coverage and how to make an election (election notice).

General Notice: The general notice must be furnished to each covered employee (and their spouse if covered under the plan) not later than the earlier of: (1) 90 days from the date on which the covered employee or spouse first becomes covered under the plan or, if later, the date on which the plan first becomes subject to the continuation coverage requirements; or (2) the date on which the administrator is required to furnish an election notice to the employee or to his or her spouse or dependent. The general notice is required to include:

The name of the plan and the name, address, and telephone number of someone whom the employee and spouse can contact for more information on COBRA and the plan;
A general description of the continuation coverage provided under the plan;
An explanation of what qualified beneficiaries must do to notify the plan of qualifying events or disabilities;
An explanation of the importance of keeping the plan administrator informed of addresses of the participants or beneficiaries; and
A statement that the general notice does not fully describe COBRA or the plan and that more complete information is available from the plan administrator and in the plan’s summary plan description (SPD).

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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Open Payments: Early Impact And The Next Wave Of Reform

The Physician Payments Sunshine Act, a provision in the Affordable Care Act, seeks to increase the transparency of the financial relationships between medical device and drug manufacturers, physicians, and teaching hospitals. Launched on September 30, 2014 by the Centers for Medicare & Medicaid Services (CMS), the Open Payments database collects information about these financial relationships and makes that information available to the public.

As of early February, the Open Payments database includes documentation of 4.45 million payments valued at nearly $3.7 billion made from medical device and pharmaceutical manufacturers to 546,000 doctors and 1,360 teaching hospitals between August 2013 and December 2013. This included 1.7 million records (totaling $2.2 billion) without the names of physicians or teaching hospitals who received the payments.

These records were intentionally de-identified by CMS because the records had not been available for review and dispute for 45 days, or because the records were not matched by CMS to a single physician or teaching hospital due to missing or inconsistent information within the submitted records. Future reports will be published annually and will include data collections from a full 12 month period.

In a back-of-the-envelope calculation, however, one can infer that the $3.7 billion over five months would translate to about $8 billion annually. By our calculation, that’s a lot of money: more than one dollar for every person on Earth. It’s more money than was spent campaigning during the 2012 U.S. election cycle. If that spending was divided evenly over the roughly 1 million physicians in the U.S. it would yield more than $8,000 each. And if distributed to each American, it would be about $25 each. So, if nothing else, the Sunshine Act is useful in illustrating the full scope of the phenomenon. It turns out that industry side-payments to physicians are an important part of health care finance in America.

The law requires disclosure of all “transfers of value” worth more than $10, and the database breaks down payment categories such as royalties, meals, promotional speaking, and consulting fees, which may be concerning to patients, alongside those payments linked to research and physician ownership interests of stocks, stock options, and any other ownership investments in medical device and drug manufacturing companies, which may be less concerning.

Early scholarly analyses show that the largest payments, often in the millions of dollars, went to orthopedic surgeons in the form of royalties for inventing surgical products. However, most payments (84 percent) were small and the most frequent type were for meals and beverages. Another scholarly analysis suggests that consulting fees (42 percent) made up the largest category of expenditures, by amount.

Recent Developments

On December 19, 2014, CMS disclosed an additional 68,000 new records documenting $200 million in payments that were previously not included in the initial September 30th database launch, as some of these records were still under dispute as of September 11, 2014, and because some records were “inadvertently excluded” from the publication of the database.

A total of 190,000 records representing $514 million in payments were not initially published for proprietary concerns, and another 9,000 records were not initially published due to unresolved disputes by the publication date. These $200 million newly disclosed payments reflect close to half of the previously withheld payment information.

The data currently available online reflect 2013 payments. Beginning this month, physicians and teaching hospitals, as well as applicable manufacturers and group purchasing organizations, are now able to register or recertify their registration in the Open Payments system and begin data submission for any payments or transfers of value that occurred in the 2014 calendar year and submit corrected 2013 data (if needed).

March 31, 2015, is the deadline for all submissions of 2014 data. Last year, only 4.8 percent of physicians and 29.8 percent of hospitals vetted the Open Payments information published about them, despite strong encouragement from the American Medical Association and other medical trade groups to do so.

Starting June 2015, CMS will refresh the 2013 data publication, removing de-identified files, and replacing them with corrected, identified files representing 2013 data representing all reported payments and transfers of value from 2014. Thus, by June 2015, Open Payments will include 1.7 million additional identifiable records reflecting previously de-identified data from 2013, corrected 2013 records that were previously under dispute, and another 10 million records from the 2014 data.

Read the full article here.

Contact Steven G. Cosby, MHSA with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

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