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Insurers Slash Specialty Hospitals to Keep Premiums Low

Health insurers under pressure to keep premiums low are eliminating some hospitals from coverage in a cost-cutting strategy that threatens to freeze out centers that provide specialized care, limiting patient options.

Left out are hospitals such as Seattle Children’s, excluded from five of seven plans on Washington’s state insurance exchange. The hospital, which has sued the state to be included in more plans, is struggling to get paid for care given to about 125 children since Jan. 1, when Obamacare coverage took effect, said Sandy Melzer, the facility’s strategy officer.

In January, “we made the decision to see all the children,” Melzer said by telephone. “Maybe we’ll be paid, maybe we won’t. It’s completely done on faith.” If the insurers refuse to cover their services, the hospital will pick up costs that go beyond the standard deductible, he said.

The insurers’ strategy, outlined in a report last month by the McKinsey Center for U.S. Health System Reform, is an unexpected consequence as the 2010 Patient Protection and Affordable Care Act, known as Obamacare, kicks into gear.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

CBO Finds ACA Will Cause 2.5 Million To Leave The Workforce Over Ten Years

A Congressional Budget Office report released Tuesday touched off a partisan debate over how to interpret its conclusion that the Affordable Care Act will spur more than two million full-time workers to leave the labor force in the coming years. That debate played out across the media, garnering several front-page stories in major newspapers, over four minutes of airtime on the nightly news broadcasts, and many more print and online accounts.

Two of the network newscasts that devoted full segments to the report mostly echoed the White House’s interpretation of the CBO’s projections. On the CBS Evening News (2/4, story 3, 2:10, Pelley), Scott Pelley said the report had been “widely misunderstood,” and added that there “aren’t necessarily jobs being lost.” On ABC World News (2/4, story 3, 1:45, Sawyer), Jonathan Karl reported that the CBO “actually” concluded that “two million fewer people will choose to work full-time – their choice, not because of a lack of jobs.”

Brian Williams covered the CBO analysis in a brief segment for NBC Nightly News (2/4, story 7, 0:35, Williams), saying, “The nonpartisan [CBO] says this new healthcare law is going to cause more than two million Americans to reduce their work hours or leave the workforce all together.” Still, Williams added that the White House responded by saying “those departures are more a result of workers’ flexibility to leave their job and still have health insurance.”

Read a full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Americans’ Familiarity With Healthcare Law Unchanged

Nearly a third of the country not too or not at all familiar with the law

Americans’ familiarity with the Affordable Care Act has remained static since last August, even after new provisions of the law have taken effect and the Obama administration has tried to promote understanding of it. A majority of Americans (68%) are very or somewhat familiar with the law, while a third of the country is not too or not at all familiar with it. Gallup found nearly identical familiarity numbers last August.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

5 Requirements For Wellness Programs

What are the five requirements for wellness programs which base a reward on satisfying a standard related to a health factor

1. The total reward for all the plan’s wellness programs that require satisfaction of a standard related to a health factor is limited – generally, it must not exceed 20 percent of the cost of employee-only coverage under the plan. If dependents (such as spouses and/or dependent children) may participate in the wellness program, the reward must not exceed 20 percent of the cost of the coverage in which an employee and any dependents are enrolled.
2. The program must be reasonably designed to promote health and prevent disease.
3. The program must give individuals eligible to participate the opportunity to qualify for the reward at least once per year.
4. The reward must be available to all similarly situated individuals. The program must allow a reasonable alternative standard (or waiver of initial standard) for obtaining the reward to any individual for whom it is unreasonably difficult due to a medical condition, or medically inadvisable, to satisfy the initial standard.
5. The plan must disclose in all materials describing the terms of the program the availability of a reasonable alternative standard (or the possibility of a waiver of the initial standard).

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.

Congress Plans to Overhaul Doctor Payments

Something weird is happening on Capitol Hill right now.

Something just about unprecedented: Republicans and Democrats are agreeing on a multibillion-dollar health policy proposal.

Last week, legislators released a plan to overhaul how Medicare pays doctors, one that would do away with the “doc-fix” ritual and more closely tether the amount that providers make to the quality of care they provide.

The plan — which you can read in full here — would repeal the sustainable growth rate, the formula that Congress has used since the mid-1990s to set Medicare rates. The problem with the sustainable growth rate is it isn’t sustainable at all: The rates that it sets, which were meant to hold down Medicare costs, would result in a double-digit pay cut for doctors. So each year — or sometimes, every few months — Congress appropriates additional funding to keep doctor salaries constant.

Read the full report here.

Contact Steven Cosby with questions or to request more information and to schedule a healthcare plan evaluation, savings analysis or group plan solution for your company.