High Risk Insurance Pools

Did you know that about 30 states already had high risk insurance pools? Some of these policies were well developled, others were not. What does this tell you about the current debate about healthcare..... the Federal government tends to do tasks that others are already doing. Yet, when the Federal government passes a massive legislation that is already be done at the state level, it is seen as a massive accomplishment. Doing something is seen as more useful that not doing something at all in Washington. Here were states that had high risk insurance pools already because PPACA.

http://www.npaf.org/images/pdf/hipai/High-RiskTable.pdf

More Time for the Regulator to Find overpayments

In case you missed it....

PPACA allows States a year to recover over-payments that are not related to fraud or abuse cases. Before, States had 60 days to find the refund from the healthcare provider before it billed the Federal share of the bill. With a longer time of recovery, States will probably increasingly thorough and detailed in any Medicare/Medicaid submission.

Here is the CMS Release.

What did we just pass?

There was a recent blog post on thehealthcareblog.com about a rebuttal that Obamacare has become increasingly unpopular as people know about it. The writer suggests that as people become more aware of PPACA that people have grown to like it.

There are two problems with her argument.

The first is that it is not true. If you look at the Realclear polling website. The support for the bill has gradually decreased. It is not significant but it is lower. I do not think it is a strong argument to say that the polling has leaned in any direction, expect to say that the polling has always shown that people are against Obamacare. There is clear disparity of individuals not liking Obamacare. The trend has always been, "opposition to Obamacare".

The second is that NO ONE knows what they passed a few months ago. Two shocking developments have come forward. One is that deep within the legislation that now gold coins are now being taxed. The other is that now you need a prescription to withdraw money from your health savings accounts. What else will come forward over the coming months? I am not sure people are growing in liking to the Bill because I am not sure anyone really knows what they passed.

Update to the HHS auditing

"That’s why in addition to law enforcement actions like the ones we’ve taken today, we’ve also launched an ambitious national effort to block criminals at every step of the fraud process – from making it harder for corrupt providers to participate in Medicare or Medicaid to helping law enforcement agents analyze claims data to find suspicious patterns that could indicate fraud."

From the HHS Secretary speech. The government is planning on increasing auditing Medicare payments. Healthcare providers should expect some sort of auditing bill to be on the Hill soon.

No more Health Insurance?

I was talking with my insurance professor a few months ago. We were chatting about PPACA. He mad a very interesting point. Since he is a insurance broker, his job is to find the best deal for his clients. He has been telling his clients that since the government prevents insurance companies from denying people because of prexisiting conditions, individuals can get sick and then go buy coverage. While this may be expensive, if you get very sick and have 500k in bills, the insurance companies must cover you in the high risk pools. Your deductible will be huge but the punishment for not having insurance is still a measly 600 dollars a year for a individual. This slight of hand some people will use just causes more headaches for insurance companies. Then again, they supported Obamacare; maybe they deserve it!

More Payment Cuts coming soon

This time, the cut are not official but through the auditor saying you don't need to charge this or that. Expect longer turn around in payments and more payment cuts. The 60 billion is going to some hospital or practice. It is not coming out of thin air!

CQ Healthbeat: Senators Thursday also urged Medicare officials to do more to stop the up to $60 billion a year that goes out the door in improper payments in the program. "CMS officials are in the process of implementing provisions in the health care overhaul that will broaden auditing efforts aimed at reducing fraud. Congress also sent President Obama additional legislation Wednesday aimed at reducing improper payments in federal agencies. But CMS also needs to finish fixing vulnerabilities found by the Government Accountability Office (GAO) in its system, senators and experts said" (Adams, 7/15).

Can Healthcare ever adapt to new social media?

There have been several interesting articles about the role social media has on healthcare. Most of the time the analysis focuses on the lack of penetration. I think social media is encountering a blockade within healthcare.

Medic 999, a popular doctor's blog in Britian, is closing shop. He writes,

"Some of the bloggers out here may want to continue the fight, and maybe I am being a coward, but I dont want to risk getting into a position where I cannot provide for my family and can no longer do the job that I love so much."

The issue of privacy for doctors is always been a complex subject. How much information can doctors share with the world about their patients or their practice?

I know that many individuals have faith in EHR and EMR to transform the healthcare industry. I am one of those people, but the battle will be over privacy. Just like the backlash from Facebook, healthcare will continue to face the issue of how to share information.

I am of the persuasion that individuals need to control their information better. The back lash against Facebook style exposure has been around the idea of "creeping", where people follow your every footsteps, and potential harm to your professional image by overexposure. The fact of the matter is that people who are Facebook addicts share way to much information and the risk is that you will loose control of your identity by being associated with Facebook addicts. Social media addicts are people who have no filter and no reconciliation of the consequences of over-sharing.

This relates to healthcare because the "Facebook effect" of oversharing might make inroads into healthcare. It is possible that individuals become looser with their information. The place to start is not social media but with EHR. Some libertarian minded individuals might be up in arms about this gradual slide, but the slippery slope argument is often considered a informal fallacy. The main problem with healthcare is the lack of information and complexity. EHR does have the potential to make care for efficient and effective, but it will rub against people's libertarian sensibilities about their health.

Social media can provide a way to education the general populus but is really not a way to revolutionize healthcare. The only reason I write is to share with everyone my experiences within the healthcare industry. I think social media provides a avenue to share information but is a huge liability for doctors. In the era of litigation, a new action is out lawed every week in the US, doctors need to be careful about social media and the "Facebook effect". Unless patients become more free with their information, social media is a lawsuit waiting to happen.