CT Won’t Reinstate Canceled Plans

Governor Malloy has decided that insurers in Connecticut won’t be able to offer their customers the option of continuing their canceled plans under the ACA. There will also be no requirement that the plans have the same pricing. Malloy has stated that insurers in Connecticut were against the idea of reinstated plans, believing they would contribute to the destabilization of the insurance market. State officials are now pushing for people who need insurance to use the Access Health CT Exchange.

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Breaking News: Connecticut to Make Decision on Health Plan Change Today

A few states including California, New York, and Massachussetts have decided that they will not allow consumers with canceled plans keep their insurance under the ACA. Governor Malloy will decide today whether he will follow their lead or let Connecticut residents keep theirs. In the past, he has been critical of President Obama’s decision to allow consumers to keep their insurance.  Malloy will announce his decision outside the car show at the Connecticut Convention Center later today.

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What Can We Do About the Physician Shortage?

It is estimated that by 2020, there will be a national shortage of 91,500 physicians-45,400 primary care physicians and 46,100 sub-specialists and advances in healthcare will only add to this growing problem.  There have been numerous reports suggesting what the reasons for this shortage may be including population health issues, decreasing physician reimbursements, workforce problems, and residency training issues.  Some have suggested a push towards mid-level providers such as advanced nurse practitioners but even with that, there will still be a significant shortage of physicians.  With an increasing aging population, it’s critical that we find a solution.

Due to this growing shortage, states and schools have worked towards increasing their numbers of medical student but that alone will not fix the problem.  Also, the unwillingness of Congress to fund additional Medicare GME positions may lead to medical school graduates with less opportunities to finish their residencies. Medicare has been the largest supporter of graduate medical education programs since 1965.

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New Quality Measure Needed to Track Hospital Admissions

According to a new report from the Department of Health and Human Services Office of Inspector General, one in four nursing home residents on Medicare was hospitalized in 2011, costing Medicare $14.3 billion.  The OIG has recommended a new quality measure for tracking hospital admissions.  Quality measures (QMs) are normally used in the government’s Five-Star Rating System and are correlated to hospitalization rates; low staffing levels, especially, are related to higher hospitalization rates.  CMS was urged to create a QM for hospitalization rates and is now developing a 30 day readmissions measure for skilled nursing facilities to submit to the National Quality Forum by the end of the year.

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Bundled Payments Reduce Costs, Boost Transparency

Bundled payments have “generated increasing momentum across the healthcare industry as a way to reduce costs and boost transparency” according to surveys of insurers, patients, providers, and employers.  Bundled payments are known to improve outcomes and reduce costs, benefiting patients and employers, as well as payers and providers.  A survey by Booz & Company found 31 percent of the 58 participating insurers are pursuing them while 47 percent are interested in the payment model.

Click here for our series on bundled payments!

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What’s the Future Payment Model for Healthcare Delivery?

According to the American Medical Association (AMA), physician-led team-based care is the future of healthcare delivery in America.  Recently, AMA members suggested physicians receive payment for services and then make the decisions about how other team members get paid.  These “disbursement decisions” would be based on factors such as volume and intensity of services and care quality. Believing that physicians are crucial to optimal patient care, the AMA has been outspoken about their concerns for nurse-led practices.  Nurse practitioners have fought back stating that have the required skills to help areas where there are primary-care shortages.

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HMS Exclusive: What Happens if a Privately Insured Individual Doesn’t Pay His/Her Premium Under the ACA?

We’ve been hearing a lot about the insurance exchange and the enrollment process.  But, there has been very little discussion regarding insurance premiums and the privately insured, specifically, the consequences of a privately insured individual who is unable to pay his/her premium on time.  Of course, this isn’t an important matter for people insured through their employer since most employers tend to pay premiums on time (or it’s automatically deducted from employees’ paychecks).   So, what happens when an individual buys insurance through the exchange but then does not pay the premium?

According to experts, insurance companies have “contract language” with hospitals and physicians which allows for a 90 day grace period for a patient who has an exchange plan and then suddenly stops paying his or her premium.  For the first 30 days, the insurer is required to continue to pay claims but in the last 60 days, payment can be withheld.  What does that mean? If a patient fails to pay the premium, they’ll lose coverage at the end of 90 days and physicians will not get paid!

This will significantly impact doctors and hospitals so it is extremely crucial that providers have a plan in place to prevent nonpayment.

HMS recommends your practice does the following to help ensure you get paid for your services:

  • Accept major credit cards
  • Collect all applicable copays and applicable deductibles at the time of service
  • Have strict financial policies in place that clearly outline practice expectations with regards to patient responsibilities. These should be signed by patients acknowledging that they understand the policy and all obligations related to it
  • Payment plan options
  • A collection agency relationship
  • Financial hardship policies

HMS emphasizes that you communicate with your patients the importance of them understanding their policy/contract so that they can be prepared to meet their responsibilities (i.e. co-pays, deductibles, premium dude dates, and the terms of which they can be terminated).

If you have questions and/or concerns, please contact HMS at (203) 294-6659.