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Updates from Washington & Key Strategies to Succeed

The document outlines the Republican Party's intentions and actions regarding healthcare policy changes under the Trump administration, focusing on the contrast between the Affordable Care Act (ACA) and the proposed American Health Care Act (AHCA). It details the potential impacts on insurance coverage, costs, and various healthcare provisions, while also highlighting the mixed reactions from leaders and healthcare professionals. The discussion reflects on the significant challenges and uncertainty surrounding the future of healthcare legislation in the U.S.

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©2015 UPDATES FROM WASHINGTON LHE HFMA Joint Event April 21, 2017 St. Louis West Cora Butler, JD,RN,CHC
THE CONTENT OF THIS PRESENTATION IS INTENDED FOR EDUCATIONAL PURPOSES ONLY, NOT LEGAL ADVICE OR THE INSIGHTS OF A CRYSTAL GAZER
AGENDA Discuss what seems to be the current posture of the Trump Administration and Republican Party leadership relative to expected healthcare policy changes. Identify key distinctions between the Affordable Care Act (ACA aka ObamaCare) and the American Health Care Act (AHCA aka TrumpCare). Recognize key strategies for future success regardless of changes to US healthcare policy and law.
Why Repeal? The Republican Rationale
True Impact on employment: 2 million FTE will be out of work force by 2025- Congressional Budget Office Increased health care premiums by 25% in 2017- New York Times True 19.2 million taxpayers chose to pay a penalty/seek exemption rather than enroll in ACA exchange- IRS True Lack of options- ⅓ of US Counties have only 1 insurer- Time.com True Individual Mandate- American taxpayers paid $3 billion for individual mandate penalties affecting 8 million people in 2016- Investor’s Business Daily True ACA cost Americans over $1 trillion in taxes- Congressional Budget Office Penalty for a family- Maximum $2085- Healthcare.gov CLICK HERE Source: QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/obamacare-fails-quiz/
Washington, What’s going on! Glimpse of the Rollercoaster ride
Jan 12, ‘17 Jan 20, ‘17Nov 9, ‘16 ’ Donald Trump wins the election (304-227) Senate voles allowing the repeal of the ACA through the budget reconciliation process; disallows a filibuster Noon: Trump takes the Presidential Oath of Office 2:00 pm: Trump signs the Executive Order ‘Minimizing the Economic Burden of the PPACA Pending Repeal’ Source: Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act
Mar 23, ‘17 Mar 24, ‘17Mar 6, ‘17 Scheduled vote for the GOP bill, later postponed to March 24,2017 House Republicans publicly release ‘The American Health Care Act’ Introduced the ‘Phase One’ of the 3- phase plan to repeat ACA The AHCA bill was withdrawn- failure to gain sufficient House Republican support
Apr 4, ‘17 Apr 6, ‘17Mar 28, ‘17 House Speaker Paul Ryan- “still moving forward with health care” with no scheduled timeline House Speaker Paul Ryan- “Proposal under conceptual stages” Republicans add a new amendment to the AHCA- ‘Federal Invisible Risk Sharing Program’ adding $15 billion fund to help insurers pay claims for the sickest customers
Apr 24, ‘17 FutureApr 7, ‘17 WHO (Donald Trump) picks up the healthcare policy ball and throws it to WHAT (Paul Ryan). WHAT throws it to I DON’T KNOW (House Republicans) and I DON”T KNOW (House Republicans) throws it to Spring Recess A bona fide triple play!
#RepealAndReplace The American Health Care Act
AIMS Dismantle the Obamacare taxes Eliminate the individual and employer mandate penalties Prohibit health insurers from denying coverage/charging more money Help young adults access health insurance and stabilize market place- allow coverage until age 26 Modernize and strengthen Medicaid- Transition to ‘per capita allotment’ Establish a Patient and State Stability Fund- provide states with $100 billion to design programs that meet their unique population Empower individuals and families- enhance and expand Health Savings Accounts Help access affordable, quality health care- providing a monthly tax credit between $2000 and $14,000 APPROACH Step I- RECONCILIATION The American Health Care Act: Introduction of the Bill, Consideration by the House, Pass legislation through regular order Step II- ADMINISTRATIVE ACTION HHS Secretary Tom Price will deregulate the marketplace to stabilize it, increase choices and lower costs Step III- ADDITIONAL LEGISLATION Pass conservative-minded bills to allow shopping across state lines, medical liability reform, and more. Source: Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/healthcare/#top
ACA vs AHCA Differences & Similarities
ACA AHCA Insurance Mandates Individual mandate Employer mandate on larger companies No individual or employer mandate Insurers can impose a one year 30% surcharge on consumers with a lapse in coverage Aid for insurance consumers Income-based subsidies for premiums that limit after-subsidy cost to a percent of income Tax credits for out-of-pocket expenses Age-based refundable tax credits for premiums, phased out for higher incomes No tax credit for out-of-pocket expenses Medicaid Matching federal funds to states for anyone who qualifies Expanded eligibility to 138% of poverty level income Federal funds granted to states based on a capped, per-capita basis starting in 2020 States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons Premium age differences Insurers can charge older customers up to three times as much as younger customers Insurers can charge older customers up to five times as much as younger customers Health Savings Accounts Individuals can put $3,400 and families can put $6,750 into a tax- free health savings account Individuals can put $6,550 and families can put $13,100 into a tax- free health savings account Source: American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017
ACA AHCA Cadillac tax Cadillac tax on high-cost employer plans implemented in 2020 Cadillac tax on high-cost employer plans implemented in 2025 Other taxes 3.8% tax on investment income 0.9% tax on individuals with an income higher than $200,000 or families with an income higher than $250,000 Repeal of both taxes Essential Health Benefits Insurers are required to offer ten essential health benefits Private plans are required to offer the ten essential health benefits. Some Medicaid plans are not required to offer mental health and substance abuse benefits Pre- existing conditions Insurers are banned from denying coverage for pre-existing conditions Dependents staying on plan Dependents can stay on health insurance plan until age 26 Annual and lifetime limits Insurers are prohibited from setting annual and lifetime limits on individual coverage Risk sharing Federal risk sharing program Source: American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017
Congressional Budget Office Estimates about AHCA
Federal Budget (2017-2026) • Federal deficits: Reduce by $337 billion • Outlays: Reduce by $1.2 trillion • Revenues: Reduced by $0.9 trillion Health Insurance Coverage • 2018: 14 million more people would be uninsured due to penalty repeal • 2020 to 2026: 21 million and 24 million respectively would be uninsured due to the changes in subsidies for insurance purchased in the nongroup market and to Medicaid program • 2026: 52 million people would be uninsured compared to 28 million under ACA Health Insurance Market: Key factors to maintain stability under AHCA • Subsidies to purchase insurance: maintain sufficient demand for insurance by low health care expenditures • Grants to states from Patient and State Stability Fund: reduce the costs to insurers of people with high health care expenditures Source: American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486
Premiums • 2018 and 2019: Average premiums for single policyholders in the non group market would be 15-20 percent higher than under ACA • 2020: increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of grants to states from the Patient and State Stability Fund, elimination of the requirement for insurers to offer plans covering certain percentage of the cost of covered benefits, and a younger mix of enrollees • 2026: Average premiums for single policyholders in the non group market would be 10 percent lower than under ACA • Although, changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules Uncertainty • Estimates are difficult to predict • Depends on the ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by legislation • These estimates are in the middle of the distribution of the potential outcomes, and hence still uncertain Source: American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486
Remarks: Republican Leaders Before Vote, After AHCA Pulled
Donald Trump President Paul Ryan House Speaker Tom Price DHHS Secretary Seema Verma CMS Administrator “After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!” March 24, 2017 “That’s called a death spiral.“- talking about soaring premiums and fewer choices under Obamacare “This is the closest we will ever get to repealing and replacing Obamacare. It really comes down to a binary choice.” March 9, 2017 “Coverage is not the measuring stick we should be using. What we should be using is care.” “ Obamacare just destroyed the individual market. Don’t listen to me, listen to the insurers.” March 17, 2017 “One-third of counties and five states only have one choice of health plan. And so that tells us we are not getting the choices that Americans deserve.” “The other thing that concerns me is hearing from providers. Many providers are faced with dealing with regulations and mandates instead of focusing on high-quality care and spending time with their patients.” March 22, 2017 Before Vote
Donald Trump President Paul Ryan House Speaker Tom Price DHHS Secretary Seema Verma CMS Administrator “If the Democrats — when it explodes, which it will soon — if they got together with us and got a real health-care bill, I’d be totally open to it, and I think that’s going to happen.” March 27, 2017 “Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.” April 2, 2017 “We’re not going to just all of a sudden abandon health care and move on to the rest. We are going to move on with rest of our agenda, keep that on track, while we work the health-care problem. It’s just that valuable, that important.” March 27, 2017 After AHCA Pulled
Remarks: Democratic Leaders Before Vote, After AHCA Pulled
Bernie Sanders US Senator for Vermont Nancy Pelosi House Minority Leader for California Charles Schumer US Senator for New York “It is immoral. And it should not see the light of day. Let’s be clear — and I have no hesitation in saying this — if this legislation is passed, millions of people are thrown off of health insurance, not able to get to a doctor when they must. Thousands of Americans will die. That’s what this legislation is about.” March 13, 2017 “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across America. Republicans will force tens of millions of families to pay more for worse coverage- and push millions of Americans off of health coverage entirely“ March 07, 2017 “Don't repeal the Affordable Care Act and replace it with a threadbare health insurance plan that puts insurance companies back in charge. Keep the law and work with Democrats on reasonable fixes.“ February 27, 2017 Before Vote
Bernie Sanders US Senator for Vermont Nancy Pelosi House Minority Leader for California Charles Schumer US Senator for New York “The defeat of the disastrous Trump-Ryan health care bill is a major victory for working families and everyone who stood up in opposition.” "Nobody really cares that it's a failure of Trump or a failure of Ryan. What the American people are asking is how does it happen that we are the only major country on Earth not to guarantee health care to all people as a right?“ March 24, 2017 “Today is a great day for our country, it's a victory -- what happened on the floor is a victory for the American people, for our seniors, for people with disabilities, for our children, for our veterans” March 24, 2017 “Ultimately the #Trumpcare bill failed because of two traits that have plagued the Trump presidency: incompetence & broken promises.“ “They can’t get their story straight, and today we’ve learned they can’t count votes and they can’t close a deal.” March 24, 2017 After AHCA Pulled
Reactions: Primary Care Physicians On Introduction of AHCA
• Raju Patnam MD, Family Medicine, Greenville SC “ It is not addressing tort reform, cost of medications or payments to PCPs” • Vikki Stefans MD, Pediatrics, Little Rock AK “We need to go single payer or we need the individual mandate that would have made the ACA easily able to stand on its own two feet without skyrocketing premiums from some people.” • Scott Helmers, MD, Family Medicine, Spirit Lake IA “Trump-Ryan care is quite a step backward… If there is any value to Trump-Ryan care it will be that in its crashing we may see the country move to single payer, national healthcare.” • Jeffrey Kagan, MD, Internal Medicine, Newington CT “ Providers who took in many Medicaid patients under the ACA will be left with deciding to continue caring at a big discount or dumping them and then having many empty patient slots.” • Sue Osborne, DO, Family Medicine, Floyd VA “This is my simple request: whatever the reconstructionist design, they have the same healthcare policy options, and pay the same premiums as the rest of us, with no exceptions for the wealthy or the elected.” Source: Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react-ahca?page=0%2C9
Road Ahead Is AHCA Dead?
House Republicans- Renew efforts for repeal Senate Republicans may take charge May shift focus to non-ACA legislation Potential administrative actions may include: • Reduced enforcement of Individual Mandates • Delay Cadillac tax • Eliminate, delay or modify innovation models (e.g. Comprehensive Joint Replacement) • Limit special enrollment period • End cost- sharing reduction payments • Narrow scope of essential health benefits • Allow some Medicaid work requirements and premiums (1115 waivers) • Eliminate contraception requirements Resurrection mode is ON! Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care- advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook
What seems certain?
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Strong bipartisan support Delay would be tied to budgetary implications Bending the Medicare cost curve is not a partisan issue Move from FFS to value- based care April 10, 2017 “I believe all options should be on the table to ensure MACRA is implemented in a way that benefits patients and keeps providers— particularly those in small practices—in the Medicare program.” US Rep. Phil Roe, MD, (R-Tennessee) Source: Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/physician-practice- roundtable/members/expert-insights/2016/nine-faqs-on-provider-payment-under-macra
MACRA: Tracks & Scores Source: Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options [SLIDESHOW]. Retrieved April 11, 2017, from https://www.slideshare.net/MedisolvMarketing/the-basics-of-macra-and-2017-reporting-options-slideshow
Performance: The first performance period opens January 1, 2017 and closes December 31, 2017. During 2017, record quality data and how you used technology to support your practice. Send in performance data: To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In order to earn the 5% incentive payment by significantly participating in an Advanced APM, just send quality data through your Advanced APM. Feedback: Medicare gives you feedback about your performance after you send your data. Payment: You may earn a positive MIPS payment adjustment for 2019 if you submit 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019. MACRA: Reporting Timeline
MACRA: Payment Adjustments Source: E. (2016, May 18). How MIPS, APMs Work Under MACRA to Improve Value-Based Care. Retrieved April 20, 2017, from https://ehrintelligence.com/news/how-mips-apms-work-under-macra-to-improve-value-based-care
Anytime between January 1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018. You can also begin participating in an Advanced APM. The first payment adjustments based on performance go into effect on January 1, 2019. Not participating in the Quality Payment Program: If you don’t send in any 2017 data, then you receive a negative 4% payment adjustment in 2019. On choosing the MIPS path, you have three options. • Test: If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment. • Partial: If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment. • Full: If you submit a full year of 2017 data to Medicare, you may earn a positive payment adjustment. MACRA: When to start? Expected outcomes? Source: MACRA. (n.d.). Retrieved April 20, 2017, from https://www.thenationalcouncil.org/macra/
Key Strategies How can I succeed, no matter what changes!
Reduce cost structure Establish sustainable Medicare risk strategy Establish a consumer loyalty platform Elevate Physician network performance Adapt to New Market Realities Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care- advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook NOTE: The success of these four elements depend heavily on an appropriate and scalable Health IT platform
Raw Data • Clinical systems • Billing/Claims • Patient generated (e.g., wearables, portals) • External data (e.g. social, financial) BI Capabilities • Data acquisition, aggregation • Coherent architecture • Governance • Tools, staff skills • Culture, organizational data literacy Goal Optimization • Clinical outcomes • Patient experience • Referral performance • Financial efficiency • Regulatory metrics • Market share Cut down administrative costs Clinical Decision Support (Evidence based) Better Care Coordination Improved patient wellness Eliminate Fraud and Abuse Risk Performance based referrals Your data is your best friend! Source:Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-it- advisor/events/webconferences/2017/top-ten-health-it-challenges-for-2017/ondemand
NorthShore University Health System Who Identify patients at risk for hypertension and control risk of heart attack and stroke Why Through a BI tool which: How • Linked practicing physicians with research and quality improvement- eliminate undiagnosed/at risk hypertension patients • Flagged patients for additional follow up through algorithms Identified, tested and diagnosed more than 500 patients with previously undiagnosed hypertension Results Success Story: Business Intelligence Source:The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10, 2016. http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf
Define goals for yourself and your practice Collect performance standards relevant to the goals Perform a gap analysis between the existing performance with the goals/ benchmark with competitors Use basic lean six sigma principles, root cause analysis, and other similar methods to identify and reduce variation Establish a continuous quality assurance and performance improvement program to foster high quality in all areas of care and services Quality Assurance & Performance Improvement
Sample PI Tool: Readmissions Performance Tracking
Washington University Physicians at Barnes Who ‘Percutaneous Intervention’- Improving outcomes What Tailoring the following to patient needs: How • Equipment • Access- Brachial vs Femoral • Dosage of Contrast Media • Anti-coagulant type- Bivalrudin vs Heparin ($547 vs <$1.22-2009) Impact seen on: Results • Patient Safety & Outcomes • Costs • Readmissions Success Story: Performance Improvement Source:Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention: A Single-Center Experience. J Am Coll Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015.
Do not wait for the legislative changes Focus of your strategy should be on accessibility, affordability and reliability Value based payment is here to stay! Plan NOW to win tomorrow Key Takeaways Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care- advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook
• QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/obamacare-fails-quiz • Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act • Bryan, B. (2017, March 29). House Republicans might take another swing at repealing Obamacare. Retrieved April 11, 2017, from http://www.businessinsider.com/ahca-trumpcare-obamacare-replacement- bill-2017-3 • Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/healthcare/#top • American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017 • American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486 • Dinan, S. (2017, March 09). Ryan works to save GOP’s Obamacare repeal. Retrieved April 11, 2017, from http://www.washingtontimes.com/news/2017/mar/9/paul-ryan-works-save-gops-obamacare-repeal/ • Geraghty, J. (2017, March 17). Tom Price: The Benchmark for Success Is Care, Not Coverage. Retrieved April 11, 2017, from http://www.nationalreview.com/corner/445880/hhs-secretary-tom-price-benchmark- success-care-not-coverage • Remarks by President Trump and Administrator Seema Verma in Women in Healthcare Panel Meeting. (2017, March 22). Retrieved April 11, 2017, from https://www.whitehouse.gov/the-press- office/2017/03/22/remarks-president-trump-and-administrator-seema-verma-women-healthcare References
• DeBonis, M. (2017, March 27). Paul Ryan: House Republicans will continue their push for health-care reform this year. Retrieved April 11, 2017, from https://www.washingtonpost.com/powerpost/paul-ryan- house-republicans-will-continue-their-push-for-health-care-reform-this-year/2017/03/27/8e331e86-130c- 11e7-833c-503e1f6394c9_story.html?utm_term=.8af16aabf415 • Weigel, D. (2017, March 14). Sanders and Manchin, at opposite ends of Senate caucus, call ACA replacement ‘immoral’. Retrieved April 11, 2017, from https://www.washingtonpost.com/news/powerpost/wp/2017/03/14/sanders-and-manchin-at-opposite- ends-of-senate-caucus-call-aca-replacement-immoral/?utm_term=.6bf6824b0c32 • Account, N. P. (2017, March 06). The GOP plan to #MakeAmericaSickAgain will do massive damage to millions. https://t.co/r14nQmKHlI https://t.co/dQGtP9xcSK. Retrieved April 11, 2017, from https://twitter.com/NancyPelosi/status/838915022176849921/photo/1 • Carney, J. (2017, February 27). Schumer blasts leaked GOP ObamaCare repeal bill. Retrieved April 11, 2017, from http://thehill.com/blogs/floor-action/senate/321344-schumer-blasts-leaked-gop-obamacare- repeal-bill • Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react- ahca?page=0%2C9 • Hansler, J. (n.d.). Democrats react to collapse of GOP health care bill: 'So much for "The Art of the Deal"' Retrieved April 11, 2017, from http://abcnews.go.com/Politics/democrats-react-collapse-gop-health-care- bill-art/story?id=46361649 • Lima, C., Pollack, H., Glasser, S. B., & Grunwald, M. (n.d.). Sanders: Public outcry helped derail GOP health care bill. Retrieved April 11, 2017, from http://www.politico.com/story/2017/03/bernie-sanders- obamacare-public-outcry-236493 References
• The proposal under discussion among conservative House Freedom Caucus members, & The White House would allow states to opt out of two key Affordable Care Act provisions: essential health benefits. (n.d.). Revived GOP health care talks could hurt those with pre-existing conditions. Retrieved April 11, 2017, from http://money.cnn.com/2017/04/04/news/economy/obamacare-freedom-caucus-pre-existing- conditions/ • What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-advisory-board/events/webconferences/2017/what-you- need-to-know-about-the-post-ahca-health-policy-outlook • Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/physician-practice-roundtable/members/expert-insights/2016/nine- faqs-on-provider-payment-under-macra • Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options [SLIDESHOW]. Retrieved April 11, 2017, from https://www.slideshare.net/MedisolvMarketing/the- basics-of-macra-and-2017-reporting-options-slideshow • Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-it-advisor/events/webconferences/2017/top-ten-health-it- challenges-for-2017/ondemand • The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10, 2016. http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf • Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention: A Single-Center Experience. J Am Coll Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015 References
Cora Butler, JD,RN,CHC cbutler@healthcorevalue.com 573-864-9430 Mobile 573-443-1645 Office www.healthcorevalue.com

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Updates from Washington & Key Strategies to Succeed

  • 1.
    ©2015 UPDATES FROM WASHINGTON LHEHFMA Joint Event April 21, 2017 St. Louis West Cora Butler, JD,RN,CHC
  • 2.
    THE CONTENT OFTHIS PRESENTATION IS INTENDED FOR EDUCATIONAL PURPOSES ONLY, NOT LEGAL ADVICE OR THE INSIGHTS OF A CRYSTAL GAZER
  • 3.
    AGENDA Discuss what seemsto be the current posture of the Trump Administration and Republican Party leadership relative to expected healthcare policy changes. Identify key distinctions between the Affordable Care Act (ACA aka ObamaCare) and the American Health Care Act (AHCA aka TrumpCare). Recognize key strategies for future success regardless of changes to US healthcare policy and law.
  • 4.
  • 5.
    True Impact onemployment: 2 million FTE will be out of work force by 2025- Congressional Budget Office Increased health care premiums by 25% in 2017- New York Times True 19.2 million taxpayers chose to pay a penalty/seek exemption rather than enroll in ACA exchange- IRS True Lack of options- ⅓ of US Counties have only 1 insurer- Time.com True Individual Mandate- American taxpayers paid $3 billion for individual mandate penalties affecting 8 million people in 2016- Investor’s Business Daily True ACA cost Americans over $1 trillion in taxes- Congressional Budget Office Penalty for a family- Maximum $2085- Healthcare.gov CLICK HERE Source: QUIZ: How has Obamacare failed? (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/obamacare-fails-quiz/
  • 6.
    Washington, What’s goingon! Glimpse of the Rollercoaster ride
  • 7.
    Jan 12, ‘17Jan 20, ‘17Nov 9, ‘16 ’ Donald Trump wins the election (304-227) Senate voles allowing the repeal of the ACA through the budget reconciliation process; disallows a filibuster Noon: Trump takes the Presidential Oath of Office 2:00 pm: Trump signs the Executive Order ‘Minimizing the Economic Burden of the PPACA Pending Repeal’ Source: Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act
  • 8.
    Mar 23, ‘17Mar 24, ‘17Mar 6, ‘17 Scheduled vote for the GOP bill, later postponed to March 24,2017 House Republicans publicly release ‘The American Health Care Act’ Introduced the ‘Phase One’ of the 3- phase plan to repeat ACA The AHCA bill was withdrawn- failure to gain sufficient House Republican support
  • 9.
    Apr 4, ‘17Apr 6, ‘17Mar 28, ‘17 House Speaker Paul Ryan- “still moving forward with health care” with no scheduled timeline House Speaker Paul Ryan- “Proposal under conceptual stages” Republicans add a new amendment to the AHCA- ‘Federal Invisible Risk Sharing Program’ adding $15 billion fund to help insurers pay claims for the sickest customers
  • 10.
    Apr 24, ‘17FutureApr 7, ‘17 WHO (Donald Trump) picks up the healthcare policy ball and throws it to WHAT (Paul Ryan). WHAT throws it to I DON’T KNOW (House Republicans) and I DON”T KNOW (House Republicans) throws it to Spring Recess A bona fide triple play!
  • 11.
  • 12.
    AIMS Dismantle the Obamacaretaxes Eliminate the individual and employer mandate penalties Prohibit health insurers from denying coverage/charging more money Help young adults access health insurance and stabilize market place- allow coverage until age 26 Modernize and strengthen Medicaid- Transition to ‘per capita allotment’ Establish a Patient and State Stability Fund- provide states with $100 billion to design programs that meet their unique population Empower individuals and families- enhance and expand Health Savings Accounts Help access affordable, quality health care- providing a monthly tax credit between $2000 and $14,000 APPROACH Step I- RECONCILIATION The American Health Care Act: Introduction of the Bill, Consideration by the House, Pass legislation through regular order Step II- ADMINISTRATIVE ACTION HHS Secretary Tom Price will deregulate the marketplace to stabilize it, increase choices and lower costs Step III- ADDITIONAL LEGISLATION Pass conservative-minded bills to allow shopping across state lines, medical liability reform, and more. Source: Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/healthcare/#top
  • 13.
  • 14.
    ACA AHCA Insurance MandatesIndividual mandate Employer mandate on larger companies No individual or employer mandate Insurers can impose a one year 30% surcharge on consumers with a lapse in coverage Aid for insurance consumers Income-based subsidies for premiums that limit after-subsidy cost to a percent of income Tax credits for out-of-pocket expenses Age-based refundable tax credits for premiums, phased out for higher incomes No tax credit for out-of-pocket expenses Medicaid Matching federal funds to states for anyone who qualifies Expanded eligibility to 138% of poverty level income Federal funds granted to states based on a capped, per-capita basis starting in 2020 States can choose to expand Medicaid eligibility, but would receive less federal support for those additional persons Premium age differences Insurers can charge older customers up to three times as much as younger customers Insurers can charge older customers up to five times as much as younger customers Health Savings Accounts Individuals can put $3,400 and families can put $6,750 into a tax- free health savings account Individuals can put $6,550 and families can put $13,100 into a tax- free health savings account Source: American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017
  • 15.
    ACA AHCA Cadillac taxCadillac tax on high-cost employer plans implemented in 2020 Cadillac tax on high-cost employer plans implemented in 2025 Other taxes 3.8% tax on investment income 0.9% tax on individuals with an income higher than $200,000 or families with an income higher than $250,000 Repeal of both taxes Essential Health Benefits Insurers are required to offer ten essential health benefits Private plans are required to offer the ten essential health benefits. Some Medicaid plans are not required to offer mental health and substance abuse benefits Pre- existing conditions Insurers are banned from denying coverage for pre-existing conditions Dependents staying on plan Dependents can stay on health insurance plan until age 26 Annual and lifetime limits Insurers are prohibited from setting annual and lifetime limits on individual coverage Risk sharing Federal risk sharing program Source: American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017
  • 16.
  • 17.
    Federal Budget (2017-2026) •Federal deficits: Reduce by $337 billion • Outlays: Reduce by $1.2 trillion • Revenues: Reduced by $0.9 trillion Health Insurance Coverage • 2018: 14 million more people would be uninsured due to penalty repeal • 2020 to 2026: 21 million and 24 million respectively would be uninsured due to the changes in subsidies for insurance purchased in the nongroup market and to Medicaid program • 2026: 52 million people would be uninsured compared to 28 million under ACA Health Insurance Market: Key factors to maintain stability under AHCA • Subsidies to purchase insurance: maintain sufficient demand for insurance by low health care expenditures • Grants to states from Patient and State Stability Fund: reduce the costs to insurers of people with high health care expenditures Source: American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486
  • 18.
    Premiums • 2018 and2019: Average premiums for single policyholders in the non group market would be 15-20 percent higher than under ACA • 2020: increase in average premiums from repealing the individual mandate penalties would be more than offset by the combination of grants to states from the Patient and State Stability Fund, elimination of the requirement for insurers to offer plans covering certain percentage of the cost of covered benefits, and a younger mix of enrollees • 2026: Average premiums for single policyholders in the non group market would be 10 percent lower than under ACA • Although, changes in premiums relative to those under current law would differ significantly for people of different ages because of a change in age-rating rules Uncertainty • Estimates are difficult to predict • Depends on the ways in which federal agencies, states, insurers, employers, individuals, doctors, hospitals, and other affected parties would respond to the changes made by legislation • These estimates are in the middle of the distribution of the potential outcomes, and hence still uncertain Source: American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486
  • 19.
    Remarks: Republican Leaders BeforeVote, After AHCA Pulled
  • 20.
    Donald Trump President Paul Ryan HouseSpeaker Tom Price DHHS Secretary Seema Verma CMS Administrator “After seven horrible years of ObamaCare (skyrocketing premiums & deductibles, bad healthcare), this is finally your chance for a great plan!” March 24, 2017 “That’s called a death spiral.“- talking about soaring premiums and fewer choices under Obamacare “This is the closest we will ever get to repealing and replacing Obamacare. It really comes down to a binary choice.” March 9, 2017 “Coverage is not the measuring stick we should be using. What we should be using is care.” “ Obamacare just destroyed the individual market. Don’t listen to me, listen to the insurers.” March 17, 2017 “One-third of counties and five states only have one choice of health plan. And so that tells us we are not getting the choices that Americans deserve.” “The other thing that concerns me is hearing from providers. Many providers are faced with dealing with regulations and mandates instead of focusing on high-quality care and spending time with their patients.” March 22, 2017 Before Vote
  • 21.
    Donald Trump President Paul Ryan HouseSpeaker Tom Price DHHS Secretary Seema Verma CMS Administrator “If the Democrats — when it explodes, which it will soon — if they got together with us and got a real health-care bill, I’d be totally open to it, and I think that’s going to happen.” March 27, 2017 “Talks on Repealing and Replacing ObamaCare are, and have been, going on, and will continue until such time as a deal is hopefully struck.” April 2, 2017 “We’re not going to just all of a sudden abandon health care and move on to the rest. We are going to move on with rest of our agenda, keep that on track, while we work the health-care problem. It’s just that valuable, that important.” March 27, 2017 After AHCA Pulled
  • 22.
    Remarks: Democratic Leaders BeforeVote, After AHCA Pulled
  • 23.
    Bernie Sanders US Senatorfor Vermont Nancy Pelosi House Minority Leader for California Charles Schumer US Senator for New York “It is immoral. And it should not see the light of day. Let’s be clear — and I have no hesitation in saying this — if this legislation is passed, millions of people are thrown off of health insurance, not able to get to a doctor when they must. Thousands of Americans will die. That’s what this legislation is about.” March 13, 2017 “Tonight, Republicans revealed a Make America Sick Again bill that hands billionaires a massive new tax break while shifting huge costs and burdens onto working families across America. Republicans will force tens of millions of families to pay more for worse coverage- and push millions of Americans off of health coverage entirely“ March 07, 2017 “Don't repeal the Affordable Care Act and replace it with a threadbare health insurance plan that puts insurance companies back in charge. Keep the law and work with Democrats on reasonable fixes.“ February 27, 2017 Before Vote
  • 24.
    Bernie Sanders US Senatorfor Vermont Nancy Pelosi House Minority Leader for California Charles Schumer US Senator for New York “The defeat of the disastrous Trump-Ryan health care bill is a major victory for working families and everyone who stood up in opposition.” "Nobody really cares that it's a failure of Trump or a failure of Ryan. What the American people are asking is how does it happen that we are the only major country on Earth not to guarantee health care to all people as a right?“ March 24, 2017 “Today is a great day for our country, it's a victory -- what happened on the floor is a victory for the American people, for our seniors, for people with disabilities, for our children, for our veterans” March 24, 2017 “Ultimately the #Trumpcare bill failed because of two traits that have plagued the Trump presidency: incompetence & broken promises.“ “They can’t get their story straight, and today we’ve learned they can’t count votes and they can’t close a deal.” March 24, 2017 After AHCA Pulled
  • 25.
    Reactions: Primary CarePhysicians On Introduction of AHCA
  • 26.
    • Raju PatnamMD, Family Medicine, Greenville SC “ It is not addressing tort reform, cost of medications or payments to PCPs” • Vikki Stefans MD, Pediatrics, Little Rock AK “We need to go single payer or we need the individual mandate that would have made the ACA easily able to stand on its own two feet without skyrocketing premiums from some people.” • Scott Helmers, MD, Family Medicine, Spirit Lake IA “Trump-Ryan care is quite a step backward… If there is any value to Trump-Ryan care it will be that in its crashing we may see the country move to single payer, national healthcare.” • Jeffrey Kagan, MD, Internal Medicine, Newington CT “ Providers who took in many Medicaid patients under the ACA will be left with deciding to continue caring at a big discount or dumping them and then having many empty patient slots.” • Sue Osborne, DO, Family Medicine, Floyd VA “This is my simple request: whatever the reconstructionist design, they have the same healthcare policy options, and pay the same premiums as the rest of us, with no exceptions for the wealthy or the elected.” Source: Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react-ahca?page=0%2C9
  • 27.
  • 28.
    House Republicans- Renewefforts for repeal Senate Republicans may take charge May shift focus to non-ACA legislation Potential administrative actions may include: • Reduced enforcement of Individual Mandates • Delay Cadillac tax • Eliminate, delay or modify innovation models (e.g. Comprehensive Joint Replacement) • Limit special enrollment period • End cost- sharing reduction payments • Narrow scope of essential health benefits • Allow some Medicaid work requirements and premiums (1115 waivers) • Eliminate contraception requirements Resurrection mode is ON! Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care- advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook
  • 29.
  • 30.
    Medicare Access andCHIP Reauthorization Act of 2015 (MACRA) Strong bipartisan support Delay would be tied to budgetary implications Bending the Medicare cost curve is not a partisan issue Move from FFS to value- based care April 10, 2017 “I believe all options should be on the table to ensure MACRA is implemented in a way that benefits patients and keeps providers— particularly those in small practices—in the Medicare program.” US Rep. Phil Roe, MD, (R-Tennessee) Source: Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/physician-practice- roundtable/members/expert-insights/2016/nine-faqs-on-provider-payment-under-macra
  • 31.
    MACRA: Tracks &Scores Source: Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options [SLIDESHOW]. Retrieved April 11, 2017, from https://www.slideshare.net/MedisolvMarketing/the-basics-of-macra-and-2017-reporting-options-slideshow
  • 32.
    Performance: The firstperformance period opens January 1, 2017 and closes December 31, 2017. During 2017, record quality data and how you used technology to support your practice. Send in performance data: To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In order to earn the 5% incentive payment by significantly participating in an Advanced APM, just send quality data through your Advanced APM. Feedback: Medicare gives you feedback about your performance after you send your data. Payment: You may earn a positive MIPS payment adjustment for 2019 if you submit 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019. MACRA: Reporting Timeline
  • 33.
    MACRA: Payment Adjustments Source:E. (2016, May 18). How MIPS, APMs Work Under MACRA to Improve Value-Based Care. Retrieved April 20, 2017, from https://ehrintelligence.com/news/how-mips-apms-work-under-macra-to-improve-value-based-care
  • 34.
    Anytime between January1 and October 2, 2017. Whenever you choose to start, you'll need to send in your performance data by March 31, 2018. You can also begin participating in an Advanced APM. The first payment adjustments based on performance go into effect on January 1, 2019. Not participating in the Quality Payment Program: If you don’t send in any 2017 data, then you receive a negative 4% payment adjustment in 2019. On choosing the MIPS path, you have three options. • Test: If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment. • Partial: If you submit 90 days of 2017 data to Medicare, you may earn a neutral or positive payment adjustment. • Full: If you submit a full year of 2017 data to Medicare, you may earn a positive payment adjustment. MACRA: When to start? Expected outcomes? Source: MACRA. (n.d.). Retrieved April 20, 2017, from https://www.thenationalcouncil.org/macra/
  • 35.
    Key Strategies How canI succeed, no matter what changes!
  • 36.
    Reduce cost structure Establish sustainable Medicare risk strategy Establisha consumer loyalty platform Elevate Physician network performance Adapt to New Market Realities Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care- advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook NOTE: The success of these four elements depend heavily on an appropriate and scalable Health IT platform
  • 37.
    Raw Data • Clinicalsystems • Billing/Claims • Patient generated (e.g., wearables, portals) • External data (e.g. social, financial) BI Capabilities • Data acquisition, aggregation • Coherent architecture • Governance • Tools, staff skills • Culture, organizational data literacy Goal Optimization • Clinical outcomes • Patient experience • Referral performance • Financial efficiency • Regulatory metrics • Market share Cut down administrative costs Clinical Decision Support (Evidence based) Better Care Coordination Improved patient wellness Eliminate Fraud and Abuse Risk Performance based referrals Your data is your best friend! Source:Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-it- advisor/events/webconferences/2017/top-ten-health-it-challenges-for-2017/ondemand
  • 38.
    NorthShore University HealthSystem Who Identify patients at risk for hypertension and control risk of heart attack and stroke Why Through a BI tool which: How • Linked practicing physicians with research and quality improvement- eliminate undiagnosed/at risk hypertension patients • Flagged patients for additional follow up through algorithms Identified, tested and diagnosed more than 500 patients with previously undiagnosed hypertension Results Success Story: Business Intelligence Source:The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10, 2016. http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf
  • 39.
    Define goals foryourself and your practice Collect performance standards relevant to the goals Perform a gap analysis between the existing performance with the goals/ benchmark with competitors Use basic lean six sigma principles, root cause analysis, and other similar methods to identify and reduce variation Establish a continuous quality assurance and performance improvement program to foster high quality in all areas of care and services Quality Assurance & Performance Improvement
  • 40.
    Sample PI Tool:Readmissions Performance Tracking
  • 41.
    Washington University Physiciansat Barnes Who ‘Percutaneous Intervention’- Improving outcomes What Tailoring the following to patient needs: How • Equipment • Access- Brachial vs Femoral • Dosage of Contrast Media • Anti-coagulant type- Bivalrudin vs Heparin ($547 vs <$1.22-2009) Impact seen on: Results • Patient Safety & Outcomes • Costs • Readmissions Success Story: Performance Improvement Source:Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention: A Single-Center Experience. J Am Coll Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015.
  • 42.
    Do not waitfor the legislative changes Focus of your strategy should be on accessibility, affordability and reliability Value based payment is here to stay! Plan NOW to win tomorrow Key Takeaways Source: Webinar: What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care- advisory-board/events/webconferences/2017/what-you-need-to-know-about-the-post-ahca-health-policy-outlook
  • 43.
    • QUIZ: Howhas Obamacare failed? (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/obamacare-fails-quiz • Efforts to repeal the Patient Protection and Affordable Care Act. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/Efforts_to_repeal_the_Patient_Protection_and_Affordable_Care_Act • Bryan, B. (2017, March 29). House Republicans might take another swing at repealing Obamacare. Retrieved April 11, 2017, from http://www.businessinsider.com/ahca-trumpcare-obamacare-replacement- bill-2017-3 • Pass the American Health Care Act. (n.d.). Retrieved April 11, 2017, from https://housegop.leadpages.co/healthcare/#top • American Health Care Act of 2017. (2017, April 07). Retrieved April 11, 2017, from https://en.wikipedia.org/wiki/American_Health_Care_Act_of_2017 • American Health Care Act. (2017, March 23). Retrieved April 11, 2017, from https://www.cbo.gov/publication/52486 • Dinan, S. (2017, March 09). Ryan works to save GOP’s Obamacare repeal. Retrieved April 11, 2017, from http://www.washingtontimes.com/news/2017/mar/9/paul-ryan-works-save-gops-obamacare-repeal/ • Geraghty, J. (2017, March 17). Tom Price: The Benchmark for Success Is Care, Not Coverage. Retrieved April 11, 2017, from http://www.nationalreview.com/corner/445880/hhs-secretary-tom-price-benchmark- success-care-not-coverage • Remarks by President Trump and Administrator Seema Verma in Women in Healthcare Panel Meeting. (2017, March 22). Retrieved April 11, 2017, from https://www.whitehouse.gov/the-press- office/2017/03/22/remarks-president-trump-and-administrator-seema-verma-women-healthcare References
  • 44.
    • DeBonis, M.(2017, March 27). Paul Ryan: House Republicans will continue their push for health-care reform this year. Retrieved April 11, 2017, from https://www.washingtonpost.com/powerpost/paul-ryan- house-republicans-will-continue-their-push-for-health-care-reform-this-year/2017/03/27/8e331e86-130c- 11e7-833c-503e1f6394c9_story.html?utm_term=.8af16aabf415 • Weigel, D. (2017, March 14). Sanders and Manchin, at opposite ends of Senate caucus, call ACA replacement ‘immoral’. Retrieved April 11, 2017, from https://www.washingtonpost.com/news/powerpost/wp/2017/03/14/sanders-and-manchin-at-opposite- ends-of-senate-caucus-call-aca-replacement-immoral/?utm_term=.6bf6824b0c32 • Account, N. P. (2017, March 06). The GOP plan to #MakeAmericaSickAgain will do massive damage to millions. https://t.co/r14nQmKHlI https://t.co/dQGtP9xcSK. Retrieved April 11, 2017, from https://twitter.com/NancyPelosi/status/838915022176849921/photo/1 • Carney, J. (2017, February 27). Schumer blasts leaked GOP ObamaCare repeal bill. Retrieved April 11, 2017, from http://thehill.com/blogs/floor-action/senate/321344-schumer-blasts-leaked-gop-obamacare- repeal-bill • Martin, K. L. (2017, March 16). Primary care physicians react to AHCA. Retrieved April 11, 2017, from http://medicaleconomics.modernmedicine.com/medical-economics/news/primary-care-physicians-react- ahca?page=0%2C9 • Hansler, J. (n.d.). Democrats react to collapse of GOP health care bill: 'So much for "The Art of the Deal"' Retrieved April 11, 2017, from http://abcnews.go.com/Politics/democrats-react-collapse-gop-health-care- bill-art/story?id=46361649 • Lima, C., Pollack, H., Glasser, S. B., & Grunwald, M. (n.d.). Sanders: Public outcry helped derail GOP health care bill. Retrieved April 11, 2017, from http://www.politico.com/story/2017/03/bernie-sanders- obamacare-public-outcry-236493 References
  • 45.
    • The proposalunder discussion among conservative House Freedom Caucus members, & The White House would allow states to opt out of two key Affordable Care Act provisions: essential health benefits. (n.d.). Revived GOP health care talks could hurt those with pre-existing conditions. Retrieved April 11, 2017, from http://money.cnn.com/2017/04/04/news/economy/obamacare-freedom-caucus-pre-existing- conditions/ • What you need to know about the Post-AHCA. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-advisory-board/events/webconferences/2017/what-you- need-to-know-about-the-post-ahca-health-policy-outlook • Your questions about the MACRA final rule–answered. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/physician-practice-roundtable/members/expert-insights/2016/nine- faqs-on-provider-payment-under-macra • Medisolv, Inc. Follow. (2016, September 16). The Basics of MACRA and 2017 Reporting Options [SLIDESHOW]. Retrieved April 11, 2017, from https://www.slideshare.net/MedisolvMarketing/the- basics-of-macra-and-2017-reporting-options-slideshow • Top Ten Health IT Challenges for 2017. (n.d.). Retrieved April 11, 2017, from https://www.advisory.com/research/health-care-it-advisor/events/webconferences/2017/top-ten-health-it- challenges-for-2017/ondemand • The Impact of Business Intelligence on Healthcare Delivery in the USA. (n.d.). Retrieved October 10, 2016. http://www.ijikm.org/Volume9/IJIKMv9p117-130Ashrafi0761.pdf • Sheikh IR, Ahmed S, Mori N, et al. Comparison of Safety and Efficacy of Bivalirudin Versus Unfractionated Heparin in Percutaneous Peripheral Intervention: A Single-Center Experience. J Am Coll Cardiol Intv.2009;2(9):871-876. doi:10.1016/j.jcin.2009.06.015 References
  • 46.
    Cora Butler, JD,RN,CHC cbutler@healthcorevalue.com 573-864-9430Mobile 573-443-1645 Office www.healthcorevalue.com

Editor's Notes

  • #6 True or False: 2 million full-time equivalent workers will be out of the workforce as a result of Obamacare by 2025 How much did health care premiums, on average, increase in 2017? True or False: 19.2 million taxpayers chose to pay a penalty or seek an exemption rather than enroll in an Obamacare exchange. How many counties in the US have only a single insurance provider? True or False: American taxpayers paid $3 billion for individual mandate penalties. How much did Obamacare cost in taxes? How high is the penalty that a family can be charged for not obtaining health insurance under Obamacare?
  • #32 Note: MU and PQRS still needs to be reported till 2019
  • #38 Financial efficiency: Realities of Patient Payments- Ways to grow patient responsibility amid a new coverage environment Front office measures for better patient experience and getting ahead of AR days Set up payment plans on the spot for any money you cannot collect up front ‘Self pay’ may not be self pay: It costs twice to collect from patients as it does from payers Hidden Coverage?: ER visits, confusion over insurance status, retroactive Medicaid, charity problem, transported by ambulance, disability patients, workers compensation After the fact financial communications