The Problems Obamacare is Trying to Solve

The Problems Obamacare is Trying to Solve

Obamacare was designed to solve four problems within the healthcare arena. The legislation sought to increase access, benefits and efficiency, while reducing costs. It’s a law that will affect virtually every American and will certainly affect each healthcare provider.

ObamacareObamacare sought to extend benefits to an estimated 45 million patients with no healthcare plan, but an estimated 26 million still won’t have coverage under the new law.

The poorest segment of the population is the most likely not to have insurance.

To remedy the problem, Obamacare expanded the overall Medicaid program, but many states chose not to participate, further limiting access to those who need it most.

Other Medicaid patients found themselves without coverage when Obamacare changed income eligibility guidelines.

For practitioners to compete effectively in an era of Obamacare, clinicians will need to review the type of insurance they accept, and the way they treat patients.

EMR technology and billing systems must be employed to increase efficiency and secure timely reimbursements.

Gaining Access

Obamacare provided access to healthcare to more people by prohibiting insurance companies from denying coverage to those with pre-existing conditions and allowing children to remain on their parent’s policies until they’re 26.

Medicaid eligibility was expanded and federal subsidies provided to help patients purchase insurance.

The downside to providing increased access is more patients flooding into an already overcrowded system.

Multiple surveys of clinicians indicate a full 40 percent will sell their practices because they won’t be able to survive financially.

Reducing Costs

Obamacare wants to reduce the overall cost of healthcare with a goal of saving more than 700 billion between now and 2022. To do that, Obamacare reduces Medicare reimbursements, establishes accountable healthcare organizations (ACOs) and reduces hospital stays.

It’s also leaning more toward home healthcare solutions.

There will be serious repercussions for private practices.

To survive, clinicians must be more efficient through the use of EMR technology, hiring better people and getting more referrals. Billing systems are essential for the little guy to get paid quickly and accurately.

Increasing Benefits And Services

Obamacare gives patients a large range of free screenings, tests and services for free and closes the donut hole for seniors on Medicare.

It limits the amount people can put in their flexible spending account (FSA) and focuses on prevention rather than treating.

Patients will now know how much their healthcare actually costs and makes them responsible for a greater out-of-pocket amount. Consumers are already seeing the difference through higher co-pays and deductibles.

Obamacare assumes that if individuals are aware of and responsible for more of the financial burden, it will end the over utilization of services. Essentially, patients will have to accept responsibility and penalties for taking control of their health and using preventative services.

Increasing Efficiency

The overall delivery of healthcare must change to be more efficient.Obamacare

It can be done by using an EMR to streamline patient encounters and by using billing systems that get clinicians paid faster.

Practitioners will have to change the way they accept insurance, treat patients, document and bill. They’ll also face greater marketing challenges.

The use of ACOs marks a departure from traditional care models.  ACOs are teams of healthcare providers that work together as a group to provide and manage patient care.

If ACOs become the standard for healthcare delivery, clinicians will have to be in one to survive.

No one knows if Obamacare will produce a nation of healthier patients, but it’s the law of the land. Practitioners have to accept that and look for ways to work within the Obamacare system. It’s far better for patients’ lifestyle, and less expensive to focus on prevention rather than spending money, time and effort on a cure.

How Obamacare Supports Affordable Care Organizations

How Obamacare Supports Affordable Care Organizations

Accountable Care Organizations (ACOs) are groups of healthcare professionals and facilities that work within a network to deliver services and coordinate care for Medicare patients. They attempt to deliver the best care that stays within a specified “pre-paid” dollar amount.

ObamacareUnder Obamacare, ACOs are tasked with saving billions for Medicare.

ACOs accomplish that goal through eliminating duplication of services, utilizing in-home care when appropriate, reducing the use of costly tests, and eliminating long-term hospital stays.

When an ACO succeeds in its goals, every member of the team shares in the savings achieved for the Medicare program through a bonus system.

Participating in an ACO is voluntary, but in an Obamacare economy, many clinicians are faced with a loss of revenues if they don’t become part of an ACO network.

ACOs were designed as a means of providing better care instead of more care to patients.

Providers are paid more if they keep their patients well.

Many practitioners are concerned about the financial viability of their practice should they choose not to participate in an ACO.

Funding ACOs

The federal government has money to fund ACO startups and incentive programs to assist providers and facilities that want to participate.

Meaningful use incentives can be accessed and programs specifically developed for rural areas can receive money up front to develop and implement a Medicare Shared Savings Program to cover costs ranging from staff to infrastructure.

Continuing operation costs would be financed through Medicare and Medicaid, along with insurance premiums from patients and/or employers.

Healthcare Communication

To provide the level of care expected of ACO members, each individual and facility must be able to communicate seamlessly and electronically with each other.

That requires the availability of comprehensive software functionalities available in the In Touch EMR. Billing is a prime consideration and can be addressed through the In Touch Biller PRO software.

Clinician And Patient ConcernsObamacare

The fear for clinicians and many patients is that a lower level of care will become standard as providers try to retain a greater part of the money saved by not ordering tests that are deemed as too expensive.

The current trend is to utilize preventative tests and screenings to prevent health problems before they occur, but it leaves many who already have health concerns wondering what direction their healthcare will take.

Obamacare takes from Medicare with the ultimate goal of giving back through an extensive array of cost cutting measures achieved through the managed care of ACOs. A key element is making patients accept responsibility for the state of their health, a segment of the population that’s traditionally one of the costliest to treat.

Bundled Medicare Patients for Obamacare

Bundled Medicare Patients for Obamacare

Obamacare seeks to reduce medical costs by 700 billion between 2013 and 2022. One of the ways the federal government plans to do that is through bundled Medicare payments.

ObamacareThe system removes the fee for service model and replaces it with a bundled plan for inpatient hospital stays and post discharge services.

Clinicians who don’t participate in bundled payment options will lose patients and revenues to competitors who do.

Bundling For Savings

One-fifth of the funding for Obamacare comes through savings obtained by reducing Medicare reimbursements, reducing the length of hospital stays and readmission rates, and bundling payments.

There’s also a push for in-home care to reduce expenses.

The Bundled Payment for Care Improvement Initiative was launched on Jan. 31, 2013 to grade the financial and treatment performance for patient care episodes utilizing a team care model.

With bundled payments, a team of healthcare professionals oversee a patient’s care and a dollar amount for reimbursement is assigned. The team is responsible for providing the patient with needed treatment, while remaining within the monetary target.

Teams are rewarded financially for accomplishing their goals. Clinicians that don’t choose to participate will lose the most as fees are cut.

Working With IPAB

The Independent Payment Advisory Board (IPAB) is a 15-member panel appointed by the president and charged with the task of finding ways to reduce medical costs. Any recommendations made by the board automatically become law unless Congress chooses to overrule.

The board is a more powerful version of the Medicare Payment Advisory Commission.

There’s a big push by Obamacare to identify and evaluate treatment methods that are efficient and cost-effective. One of those techniques is by providing in-home care that employs technology to monitor a patient’s state of health in the home instead of at a hospital or care facility.

Depending on the type of monitoring being conducted, readings could be transmitted to a practitioner’s office electronically or could include home visits by a healthcare professional.

ObamacareThe bundled care initiative was designed to reduce costs among Medicare patients.

Unfortunately, it will also limit reimbursement revenues for clinicians who choose to offer independent care at their practice and not participate in a physician team for bundled care.

As the pressure to reduce costs associated with Medicare patients continues to increase, many medical professionals will find their choices are limited.

There are options, but all are untenable for those in private practice.

Clinicians can choose not to join a healthcare team, lose patients to competitors who are part of a team, become resigned to a reduction in Medicare payments, accept bundled payments and reduced revenues, or stop seeing Medicare patients at all. The choices clinicians make will have a dramatic and long lasting impact on their patients and practice.

Obamacare and the Investment Income Tax

Obamacare and the Investment Income Tax

There are many ways that have been structured into the Affordable Health Care Act (Obamacare) to fund the legislation. One of those methods is the investment income tax (unearned income). Wealthy individuals will pay a 3.8 percent surcharge on capital gains and dividends.

ObamacareThe tax went into effect in 2013 for many, but some may have avoided the initial financial pain due to the economic climate and losses.

Who Is Subject to the Tax?

The tax represents a 3.8 percent increase on the already existing tax and affects individuals with an adjusted gross income of $200,000 or more and $250,000 for couples filing jointly.

The tax increase affects a comprehensive range of stocks, bonds, commodities, trusts, annuities and specialized derivatives.

The increase also affects royalties, rentals, self-employment income, and home sales for people who have owned the property for more than five years.

Accounting firms have been hard at work searching for ways their clients can avoid a major jump in their taxes.

Many taxpayers haven’t seen an appreciable difference yet due to an array of economic factors and personal considerations, but will through a combination of the investment tax and mandatory insurance requirements.

The Internal Revenue Service can begin withholding funds through the Individual Mandate Tax on those who have failed to purchase healthcare insurance.

A charge of $95, or 1 percent, whichever is greater, will be levied on anyone without healthcare insurance and the tax increases depending upon how many uninsured individuals are in the household.

The tax increases through 2016 to top out at 2.5 percent or $695. The IRS can withhold the amount from any refund taxpayers might have coming, but can’t garnish wages or present taxpayers with a bill for the amount.

The Changes That Will Affect Taxes

Understanding the tax or seeking the assistance of an account is particularly important for those who fall near, but below the $200,000-$250,000 and suddenly come into a substantial amount of money.

Selling a second home, an increase in come or a bonus could quickly land individuals in the position of paying additional taxes.

ObamacareChanges in family size can also affect their portion of taxes. 

Those who qualify for a federal subsidy to purchase insurance and experience an increase in income would have to pay back the subsidy.

The good news is that virtually everyone can now deduct up to 10 percent of their medical expenses People can still utilize a flexible spending account (FSA) to save on medical costs, Social Security, Medicare and income taxes, though they’re limited to a $2,500 personal contribution.

The investment income tax increases the rate from 15 percent to 18.8 percent on unearned income and is expected to affect only the wealthiest 2 percent of Americans. Money raised through the tax will be placed in federal coffers to help fund Obamacare.

The bottom line is that taxpayers who earn more than $200,000-$250,000, have unearned income or spend a significant amount on healthcare will see their taxes increase.

Obamacare and the Medical Device Tax

Obamacare and the Medical Device Tax

Known as Obamacare, the Affordable Health Care Act places a tax on a variety of services, items and businesses. The Medical Device Tax has come under fire from a variety of companies and individuals who claim it will accomplish everything from the loss of jobs to the stagnation of innovation, and take away medical devices from the elderly and infirm.

ObamacareThe truth is somewhere in the middle.

Obamacare does place a tax on medical devices, but the tax is levied against companies that make them, not against the people that use them.

The 2.3 percent excise tax is on the sale of the devices, not profits, and was actually cut in half from an original figure of 4.6. The tax went into effect on Jan. 1, 2013.

Who Pays the Tax And Why?

The tax affects devices that include defibrillators, dialysis machines, heart monitors and pacemakers. Fearing outsourcing of production and a loss of potential revenue, the Act covers all device manufacturers, regardless of where the equipment is actually made.

The law is only supposed to apply to devices that require the approval of, or referral by, a physician.

Those include many high-dollar tests conducted with MRIs, lasers and similar equipment.

Selling Devices Over-The-Counter

The Act says devices sold over-the-counter directly to consumers are exempt. Those devices include common items like contact lenses, eyeglasses and hearing aids.

Even though some devices can be sold directly to consumers, such as blood pressure and glucose monitors, many insurance companies won’t cover the cost unless it’s accompanied by a doctor’s prescription.  

Patients would have to pay for the equipment out of their own pocket and the cost wouldn’t count toward the individual’s deductible.

Obamacare’s device tax may not be applied when patients purchase any of the devices, but individuals will most likely experience overall increases on retail prices.

In medical facilities, patients will be billed more to use the machines.

Insurance companies may or may not pay the increased costs, but will most likely pass it on to patients in the form of deductibles.

Efforts to Repeal The Tax

Many in the House have voiced their intent to repeal the tax.

ObamacareThey cited the law as economically harmful, with the potential for a loss of life if device manufacturers reduced production or if medical facilities refused to purchase devices due to cost increases.

House officials claim the tax would stifle research and development, and would adversely affect start-up companies that might not be able to afford another tax as the cost of doing business.

Confusion surrounds many of the Obamacare taxes and many individuals were highly concerned that they would be denied medical devices they count on through the inability to afford another tax.

Only the makers of medical equipment will be forced to pay taxes on their products, but patients will likely experience the tax through higher retail prices, increased costs to use the equipment in medical facilities, and fewer referrals to obtain tests using high-dollar equipment.

The Impact of Obamacare on Medicare and Medicaid Patients

The Impact of Obamacare on Medicare and Medicaid Patients

Obamacare is changing Medicare and Medicaid in many ways. Some are good for patients, but not for practitioners. One of the main objectives of Obamacare is to reduce healthcare expenses.

ObamacareThe economic reality for some patients is healthcare where none existed before, while others will see more out-of-pocket expenses.

Obamacare taps Medicare funds heavily to support the legislation, while reducing reimbursement amounts to clinicians.

Becoming more efficient in treating patients and office processes is critical and there are cost effective software programs that will increase efficiency and save money.

Software programs like In Touch EMR and In Touch Biller PRO have tools to automate and accelerate marketing, documentation, billing and reimbursements.

Clinical Contact and Therapy Newsletter software provides practitioners with done-for-you solutions to increase referrals and retain established patients.

Medicare Ups And Downs

Obamacare is closing the donut hole in Medicare for prescription drugs and reduced the cost of many medications. Patients can now obtain a lot of free wellness services, screenings, tests and vaccines.

Patients with Medicare Advantage programs will see increases in their co-pays, deductibles or both. Obamacare reduces expenses by reducing payments.

Medicare won’t go away, but patents will wake up to the reality of higher costs and fewer practitioners willing to treat them.

Expanded Medicaid

Under Obamacare, states that agree to do so will expand Medicaid eligibility requirements. That means people making $15,800 in 2013 will be able to get Medicaid.

However, states don’t have to participate in the program, which could lead to a substantial number of people still without coverage.

The Congressional Budget Office estimates that 12 million new patients will be added by 2015. That’s a lot of additional patients and the problem is that in 2011, one out of four clinicians refused to take Medicaid patients.

Finding a practitioner that accepts Medicaid is already a problem.

Now there will be more patients competing for fewer practitioners, along with overcrowding in hospitals and practices that do take Medicaid. Many clinicians have said they’re going to close their practices or refuse to treat those on Medicaid and Medicare due to reduced reimbursements, and no one wants that.

Making Opportunities

This is an opportunity for clinicians to ask themselves what they can do to be part of the solution instead of the problem. More patients and less reimbursement provide an incentive to get patients well faster, which is another goal of Obamacare.

Clinicians can present patients with programs that will help them get better quicker and save them money.

ObamacareFor example, consider group wellness and preventative programs.

Charging patients $30 per session incurs less cost for patients, while increasing the number of individuals that can be treated at one time.

Be creative in identifying opportunities that benefit the practice that also provides an environment that’s financially appealing to patients.

Clinicians must be aware of the changes in the Obamacare economy and be prepared for them with alternatives that generate more referrals and retain established patients.