Budget Cuts, Payment Freezes, and Tariffs In an attempt to continue tracking the latest actions of the federal government’s legislative and executive branches affecting the healthcare industry since the last article was released in March, this article summarizes recent events in Washington and the impact of these changes on providers and patients. During the early months of the Republican Party’s government trifecta (controlling the White House, Senate, and House of Representatives), both the Trump Administration and Congress have laid the groundwork for seismic change to the U.S. healthcare industry. In an attempt to continue tracking the latest actions of the…
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RAND Corporation 2022 Study Published in JAMA A study conducted by the RAND Corporation and published in the January 2022 issue of the Journal of the American Medical Association (JAMA) seeking to determine whether health systems primarily incentivize volume or value in their physician compensation models found that almost all physicians are still compensated through a volume-based model that rewards productivity over the value of care provided. This article summarizes the results of the study. A study conducted by the RAND Corporation and published in the January 2022 issue of the Journal of the American Medical Association (JAMA) seeking to…
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This article briefly discusses the current trends in the practice management industry, as these trends may directly and indirectly affect both the management company and the healthcare entity. This overview of the services provided by practice management groups, is followed by a discussion of the competitive, reimbursement, regulatory, and technological environments in which practice management groups operate.
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Healthcare Regulatory Environment (Part III of VI) In the March/April 2018 issue of The Value Examiner, the author underscores the importance of undertaking rigorous due diligence to better understand the regulatory burdens and operational risks notwithstanding efforts to repeal and replace.
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Guidelines Released for Employee Wellness Programs The Equal Employment Opportunity Commission has released guidelines for structuring employee wellness programs that adhere to health privacy regulations and anti-discrimination rules. Employers should notify workers about how their health data will be used and encrypt sensitive information to ensure confidentiality. Bertha Coombs, CNBC reporter, also suggests that wellness screening programs should be voluntary. To read the full article in CNBC, click: Obama Administration Issues Rules for Employee-Wellness Plans.
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Among many legal challenges to the validity of the Affordable Care Act (ACA), is Halbig vs. Burwell. The challenge concerns a passage in the statute, when literally read as worded, makes federal tax credits for insurance programs available only to those enrollees in states that have created a state-designed and operated healthcare exchange. Read as it currently exists, the statute does not allow for such tax credits in states that did not set up their own exchanges, but instead chose to allow residents to purchase insurance through a system created by the federal government. This distinction was part of…
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Compensation for PCPs is increasing The increasing supply shortage of primary care physicians (PCPs) will have a significant impact on physician compensation. In turn; this will have an equally powerful effect on the valuation of PCP practices.
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Value metrics and capital formation Robert Cimasi serves as chief executive officer of HEALTH CAPITAL CONSULTANTS (HCC). Mr. Cimasi’s firm is a nationally recognized healthcare financial and economic consulting agnecy headquartered in St. Louis, MO, serving clients in 49 states since 1993. He is author of a three-volume set that offers a comprehensive reference guide to the factors involved in consulting with and valuing healthcare practices. In this article, Mr. Wandtke reviews Volume Two, Professional Practices. See http://www.healthcapital.com/advisersguide.
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Healthcare revenue planning challenges Beware of valuing a healthcare practice based on 2012 revenue. Reimbursement rates are lower in 2013, and penalties are being assigned by Medicare. This could further reduce a healthcare practice’s value.
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Pay-for-Performance Provisions are a “Triumph of Theory Over Experience,” Writes Bill Keller in “Carrots for Doctors.” “Pay for performance, or P4P in the jargon, is embraced by right and left. It has long been the favorite egghead prescription for our absurdly overpriced, underperforming health care system. The logic . . . If only it worked,” writes former New York Times executive editor Bill Keller, here writing for the Times’ opinion page. More:
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Some Schools Cut Hours of Hard-Pressed Adjuncts to Avoid Rules on Insurance Mark Peters and Douglas Belkin at the Wall Street Journal report that the federal health-care overhaul is prompting some colleges and universities to cut the hours of adjunct professors, renewing a debate about the pay and benefits of these freelance instructors who handle a significant share of teaching at U.S. higher-education institutions:
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Ahead of the new health-care law, small firms worry about crossing the crucial 50-person threshold — and about rising premium rates Emily Maltby at the WSJ Law blog reports on increasing concerns about the forthcoming healthcare laws among small business owners. This seems to be a prominent issue and concern among small business owners, and has been noted in most every major media outlet in recent weeks, from the New York Times to Forbes, CNN, US News & World Report, FoxNews, The Economist, The Hill, the Washington Post, and more:
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2013 California Filings: Aetna: 22 percent. Anthem Blue Cross: 26 percent. Blue Shield of California: 20 percent. Reed Abelson at the New York Times reported last week that health insurance companies across the country are seeking and winning double-digit increases in premiums for some customers, even though one of the biggest objectives of the Obama administration’s health care law was to stem the rapid rise in insurance costs for consumers. More:
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Health Costs on His Mind, Small Factory Owner Looks for Ways to Cope With New Law Emily Maltby and Sarah E. Needleman at The Wall Street Journal talk with a small business owner outside of Chicago who’s considering ways to manage growth, preserve profit, and comply with the new healthcare law. Automation Systems, with with sales of about $1.6 million for 2012, currently employs 40 full-time workers, mostly low-paid employees who monitor the factory equipment. If sales were to continue to rise, the plant could, conceivably, employ 50 full-time workers in 2014. Under the new health-care law, the Affordable Care Act,…
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There’s Good Reason for Long-Term Concern, Uncertainty, and Fear. Here’s What To Do. James Doulgeris at Physicians Practice explains: “Everyone in the practice and allied health world should take the title of the legislation seriously — The Patient Protection and Affordable Care Act (ACA). It does not say physician protection nor does it say it will be affordable for you. Most practices will suffer serious consequences, or fail without proper planning.” More:
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Two New Taxes on Net Investment Income and Medicare Will Take Effect on January First At the Wall Street Journal’s Tax Report, Laura Saunders explains. The word is out: Two new taxes on the affluent and wealthy will take effect as scheduled next year as a result of the Supreme Court’s decision upholding the health-care overhaul. One is a new 3.8% tax on net investment income, and the other is a 0.9% increase in the Medicare tax on wages and self-employment income. Both levies apply to joint filers with adjusted gross incomes above $250,000 ($200,000 for singles). A recent…
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The Big Picture: Medicaid Impact, Patient Demand, Physician Pay, and More. Physicians Practice, a leading practice management resource, has examined the implications of the historic Supreme Court healthcare decision. Eschewing opinion about John Roberts or the impact on insurance company stock prices, the coverage helps physicians understand what it means for them. Offering commentary as well as analyzing the impact on practicing physicians, highlights from its analysis include:
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Mandate Survives as a Tax. Limits on How Widely Feds Can Control States Medicare. No Other Limits. Brent Kendall, Louise Radnofsky, and Jess Bravin of the Wall Street Journal report the news:
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Metropolitan Corporate Counsel interviews Monte I. Dube, Partner, and Elizabeth M. Mills, Senior Counsel, of Proskauer’s Health Care Department in Chicago. Excerpts: What are the current trends in M&A within the healthcare industry? Dube: Increasingly and for multiple reasons, U.S. hospitals and healthcare systems of all types are looking for potential partnerships or affiliations. Financially distressed organizations are seeking capital and expertise to help them weather the storm, and governmental hospitals are looking to privatize, often for the purpose of monetizing assets or balancing the budget. We’re also seeing strong and vibrant hospitals and healthcare systems conclude that they need…