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David Brooks

David Brooks

Election Aftermath: What Effect on ASC’s & Health Care?

The recent Presidential election and subsequent Inauguration clearly had serious implications for the field of health care and ASC’s regardless of one’s political leanings. The liberal wing of the Democratic Party was concerned that a Romney administration would put an end to one of the most noteworthy pieces of social legislation in recent memory. At the same time, the Conservative arm of the Republican Party believed that a second term for President Obama would prove to be the catalyst for the implementation of a monstrous entitlement program. For those in the field of health care though, the biggest source of anxiety as Election Day drew near was the thought that this issue would leave the system in total chaos.

Some Reform but More to Come

Even though the Affordable Care Act will not be fully operational until 2014, there has already been a massive amount of money exchanged since the first phase of reform was put in place in 2010. For example, many young adults who are up to 26 years of age have been added to their parent’s health insurance policies. Another new option available was that people under the age of 65 who are covered by private health insurance have now been offered an array of free wellness benefits; and in 2012 a report from HHS showed about 54 million had taken advantage of them. Also, some states have already begun to set up consumer assistance bureaus for the benefit of consumers and to create the infrastructure for an exchange that will facilitate the purchase and sale of private health insurance options. Putting an end to what had already been set in motion would very likely have created a sense utter pandemonium.

But when the Supreme Court upheld the constitutional nature of the health reform in 2012, the challenge of legitimacy was effectively squelched. With the re-election of President Obama, Administration officials will now be in place during the full-scale implementation of the law, which should imply that patients and providers alike can expect the Affordable Care Act to be put into effect methodically in the coming years. It has also been reported recently that new regulations regarding reform were held back prior to the election to avoid added controversy. Because of this, it can be expected that a stockpile of regulations will be quickly released in the near future; with some of them possibly addressing the question of what expenses and services will be required under the new reform.

The governors of many states will now have to make the choice of whether or not they wish to create an insurance marketplace to regulate small business and individual health plans. If a state chooses not to set up such an exchange, the federal government will step in instead. Governors and legislatures on the state level will also have to decide whether they wish to allow wider eligibility for the public option insurance program. It has also been reported that some Republicans are expected to get on board with certain aspects of the law now that it has firmly been set in place.

Leaders of Ambulatory Surgery Centers across the country seem to be in agreement that the currently divided Congress should prevent any further funding by the Government. Some suggest that ASC lobby efforts should be promoted. Others ponder whether or not the new Act could be good for ASCs, since it will require that a greater number will be insured. Will a greater number of insured patients increase the volume at ASC facilities? If so, will these facilities find a way to prosper even though the reimbursement level has decreased? A majority of the leaders in the ASC world appear to agree that whatever adversities arise; they can be overcome once the rules have been fully revealed. What the rules are and how they will be carried out should become ever clearer in the near future.

Final Rule Increases Payments to Hospitals

On Aug. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates fiscal year (FY) 2013 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs), and builds on the Obama Administration's work to slow growth in future health care costs by improving patient care.

The final rule also implements key elements of the Affordable Care Act's hospital value-based purchasing and hospital readmissions reduction programs. The rule advances Administration efforts to tie Medicare payments to quality health care across the delivery system, with new quality reporting measures for general acute care hospitals in FY 2015 and FY 2016; new measures for long-term care hospitals in FY 2016, and new quality reporting programs for psychiatric hospitals and cancer hospitals. In addition, the rule establishes new reporting and other requirements for the Ambulatory Surgical Center Quality Reporting (ASCQR) Program.

Under the final rule, payment rates to general acute care hospitals will increase by 2.8 percent and LTCH payments are expected to increase by $92 million or 1.7 percent in FY 2013.

To provide hospitals with an incentive to reduce hospital readmissions and improve care coordination, the Affordable Care Act created a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 (for discharges on or after October 1, 2012) to certain hospitals that have excess readmissions for three selected conditions: heart attack, heart failure and pneumonia. The rule finalizes a methodology and the payment adjustment factors to account for excess readmissions for these three conditions.

For further information, please visit http://www.cms.gov/apps/media/press_ releases.asp.

Written by Pulse

New Rules Could Save $9 Billion Over Ten Years

Health and Human Services (HHS) announced the release of a new rule on Aug. 7, 2012 that aims to cut red tape for doctors, hospitals and health plans. The regulation adopts operating rules for making health care claim payments electronically and describing adjustments to claim payments.

Studies have found that the average physician spends three weeks a year on billing and insurance related tasks, and, in a physician's office, two-thirds of a fulltime employee per physician is necessary to conduct these tasks. Many physician practices and hospitals receive and deposit paper checks, and manually post and reconcile the health care claim payments in their accounting systems. By receiving payments electronically and automating the posting of the payments, a physician practice and hospital's administrative time and costs can be decreased.

The operating rules build upon industry-wide health care electronic fund transfer (EFT) standards that HHS adopted in January of this year. Together, the previously issued EFT standards and the EFT and electronic remittance advice (ERA) operating rules are projected to save between $2.7 billion and more than $9 billion in administrative costs over ten years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans.


Written by Pulse

Growth in Family Health Premiums Outpaces Growth in Wages and Inflation

Annual premiums for employer-sponsored family health coverage reached $15,745 this year, with workers on average paying $4,316 toward the cost of their coverage, according to a recent survey from the Kaiser Family Foundation/Health Research & Educational Trust. This reflects a 4-percent increase in premiums from last year.

Although this year's rise in premiums is low compared with other years, it has outpaced the growth in workers' wages (1.7 percent) and general inflation (2.3 percent).

The survey also revealed significant differences in the benefits and premium contribution of workers in lower-wage firms (at least 35 percent of workers earn $24,000 or less per year) versus higher-wage firms (at least 35 percent of workers earn $55,000 or more per year).

According to the survey, workers at lower-wage firms on average pay $1,000 more each year out of their paychecks for family coverage than workers at higher-wage firms ($4,997 and $3,968, respectively), despite the fact that lower wage firms pay less on average in total premiums.

In addition, the survey found that workers at lower-wage firms are more likely to face high deductibles than those at higher-wage firms. Specifically, 44 percent of covered workers at lower-wage firms face an annual deductible of $1,000 or greater, compared with 29 percent of workers at higher-wage firms.


Written by Pulse

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