A fond farewell to San Francisco Business Times reporter Chris Rauber, who is retiring at the end of October. I will miss his tongue in cheek style of writing when covering the Bay Area medical scene.
Insurers want the administration to amend the grace period rules. Tey state that people can pay for 9 month and then not pay. They get 90 days grace and at the end they can buy new insurance. The 90 day grace period can not be changed as it is part of the law but the details can be changed. When people fail to pay premiums they get a 90 day grace period. The first 30 days falls on the insurer and the next 60 on the providers. This is made worse by the special sign up periods.
The left wing Urban Institute has published something that states the Ocare average unsubsidized premium is about 10% lower that the full average employer plan in 2016. They state the average employer plan premiums is about $516 per month compared to $464 for the individual plans. They adjusted premiums for aged of enrollees and the different value of coverage in the marketplace plans. There are about 10 million in the individual market versus 155 million via employer plans.
Modern Healthcare reports that bundled payments are becoming the status quo but there has been no data to show if it is good or not. The current initiatives showed the payment scheme was successful in reducing costs and improving outcomes in ortho but no others have shown any changes. The ortho reduction in cost for joint replacement came from a reduction in post-acute care at the institution. There was an increase in cost for spine surgery.
California has asked Obama to go back on all his promises regarding illegals and Obamacare. The Dems of the blue state say that 30% of the illegals in the state could be eligible. The law also says no illegal immigrants get to participate. The illegals are the largest share of uninsured in the state. This would be a pure state run program without federal funds.
Covered California will average increase rates of Ocare policies for small business but only at a 5.9% basis. That is very small, less than the 7.2% raise last year. All six carriers will participate. About 28,000 are insured via the program. There is also a tax credit for businesses under 25 employees that can be used for two years and the business gets to decide which two years they wish to use it.
The "bedless hospital" is starting to rear its head. Treatments are getting safer and recovery times are much less leading to hospitals doing procedures and sending the patient home the same day. This helps the patient as they have less chance of infection and lessens cost. The hospitals do have EDs and helipads in some cases but no beds. The usual naysayers fear that these progressive institutions are diverting resources away from patients that require more complex treatment. Changes of reimbursement by the feds and private insurers are driving the changes. Insurers will not pay for some procedures in regular hospitals. CMS is pushing for more outpatient care done cheaply.
The Physicians Foundation released a survey that is frightening for the future of medicine. They surveyed over 17,000 physicians and found that almost half are accelerating their time frame to retirement. About 80% felt they are at full capacity with their patient rosters. About half rate their morale as somewhat or very negative and they are either often or always feeling burnt out. The half that plan or getting out will either to to concierge, non-clinical positions or retire. All these will drastically cut access. This is basically the same survey as has happened since 2008 but steady declining results. The physicians main complaints are the usual regulatory burdens and loss of autonomy with severe problems with off clinical time spent on paperwork. Physicians continue to like patient contact but of course the employers are getting rid of that. Interestingly, only 43% had their compensation tied to value and of those only 20% of their pay is pegged to value. Also only 20% knew about the new payment structures or MACRA. Physicians surveyed say that the new ICD 10 codes and EMR are fairly useless in their practices. Another interesting tidbit came out of the survey is that employed physicians are not as efficient as private ones. They see 19% less patients than the private doctors.
The Doctor's Company, the largest malpractice carrier in the country, has reported that total claims are down. The majority were related to diagnosis, treatment and med errors. Most were in physician offices or hospital. There are less claims against internists and hospitalists. It is expected to have communication issues grow due to increased patient load and EHR.
DISCLAIMER: Although this
article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the