Summary: What are metal plans? What distinguishes one from another? When do they go into effect?

Metal plans are the levels of plans that will be included in the health insurance exchanges. Health insurance exchanges are basically marketplaces designing for purchasing insurance. They are called metal plans because each level is a different metal: platinum, gold, silver, and bronze and were created as a result of the Affordable Care Act. The idea for the metal plans originated in Massachusetts.

Open enrollment for the exchanges begins October 1, 2013 and coverage will be effective January 1, 2014. While each metal plan offers the same essential benefits, they will vary based upon premiums and out of pocket expenses. Out of pocket expenses include deductibles, copayments and coinsurance.

All health plans in the exchanges are required to provide a minimum set of benefits which are termed essential benefits. These benefits include:

• Ambulatory patient services
• Emergency services
• Hospitalization
• Maternity and newborn care
• Mental health services
• Substance use disorder services
• Prescription drug coverage
• Rehabilitative and habilitative services and devices
• Preventative and wellness services
• Pediatric Services

Metal plans

Platinum

• Lowest out of pocket for enrollees – approximately 10%
• Highest premiums

Gold

• Out of pocket expenses – approximately 20%
• Must be offered by an insurance company in order to participate in the exchanges

Silver

• Out of pocket expenses – approximately 30%
• Must be offered by an insurance company in order to participate in the exchanges
• The standard plan in terms of tax credit eligibility

Bronze

• Highest out of pocket expenses – approximately 40%
• Lowest premiums

Within each of the different levels, premiums will vary depending upon which company insurance is purchased through. This is where the term marketplace comes into play. Consumers will have to shop around to find the plan that will best suit their needs in terms of out of pocket expenses, premiums charged, and whether their doctors are part of the particular network. Additionally, for those that opt not to have health insurance, there will be penalties assessed.  For 2014, the penalty will be the greater of $95 or 1% of adjusted annual household income. The penalties are expected to become steeper in later years.

Plans are beginning to release their premium schedules. They will vary from state to state. More detailed information will be released over the coming months so it will be important to remain current on the exchanges for your individual state.

About BHM Healthcare Solutions – www.bhmpc.com

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Contact Us :  results@bhmpc.com, 1-888-831-1171

Please click on the image below to learn more about Denial Management.

Click here to receive your presentation of valuable tips regarding denial management

It is no secret that many hospitals are struggling with less than stellar bottom lines.  Healthcare reform, ICD-10 implementation and shifting healthcare environments are making it more difficult to remain fiscally healthy and financially viable.  But some organizations are thriving during this complex time of changes and they all have one thing in common, despite changes and the heavy obligations of daily tasks they focus on continuous revenue cycle improvement utilizing 4 tried and true strategies that not only juice up the revenue cycle, but lead to sustained financial improvement over time.  Here is what they do:

1. Focus on Pre-Authorization and Pre-Certification

Revenue cycle optimization begins at point of entry, when a patient or client first presents for treatment.  This crucial step in the revenue cycle process eliminates a separation of the clinical and the business aspects of a practice, and can lead to improved patient satisfaction.  Determine multiple ways to obtain pre-certification for services, these can include online registration options such as email or web portal, but should also include personal service options to make sure that you serve all demographics.  Knowing that a patient is pre-certified for care can eliminate revenue cycle hassles down the road such as denials or appeals.  Pre-certification also allows the clinical side to be more informed regarding care options available to patients.  Part of making patient care successful, is having it focus on patient preferences, which for many, includes affordability.  Pre-certification can eliminate payment confusion down the road and will help the patient be informed regarding the care they are getting and the costs they can expect.

2. Set Revenue Cycle Benchmarks and Goals

Does your billing department have goals and benchmarks in place currently?  If not, now is the time.  Staff are more informed and perform better if they are aware of a goal that their department is trying to reach.  Common revenue cycle goals are % of clean claims submitted, or IBNR (invoiced, but not received) goals.  One practice has a goal of trying to ensure that all services are processed and payment is received within 180 days.  Here are some effective tips when setting Benchmarks and Goals for your Billing/Revenue Staff

• Make sure that staff are aware of the goals/benchmarks including where they currently stand
• provide up to date reporting on how effective staff are at reaching their goals at regularly scheduled intervals (such as weekly or monthly)
• Make the goal attainable, but challenging.  Start with a small goal and work your way up consistently to ensure buy-in and encourage morale
• Incentivize the goals – give staff greater motivation by creating an incentive program surrounding the goals and benchmarks you hope to achieve
• Involve staff in benchmarking and goal discussions.  Often someone who deals with the issue directly can provide greater insight into where the obstacles in your revenue cycle are.  Is there a bottleneck in communication?  Are there common processing errors?  Are front desk inefficiencies detrimentally impacting the revenue cycle?  Chances are your staff will have the answers and some bright ideas on how to correct the issue

3. Optimize Your Organizational Structure

Do you currently see a lack of communication between departments such as clinical and non clinical associates?  Are Billing and Collections handled by separate teams with little interface?  How is the flow from a front desk operations perspective?  These areas should be assessed and optimized as part of a plan to juice up your revenue cycle.

• Ensure that you are facilitating communication between all departments whether through flash meetings, newsletters, or dedicated leadership meeting
• Put in place tools that allow for effective communication and collaboration across departments
• send standard updates regarding the progress of the revenue cycle to teams/departments in other areas so that everyone is informed of performance and impacts
• look for duplication and waste in the processes regarding revenue cycle improvement

4. Manage Your Denials

Organizations can see a dramatic increase in their bottom line by simply managing denials more effectively.  BHM recommends a denial management strategy based on the following CORE Principles of Denial Management.  For full information on how to manage denials and recoup losses please click here: MANAGE DENIALS TODAY

What changes have you experienced? What changes do you recommend? How do you see healthcare 5 years from now? 10 years from now? Are we moving in the right direction?

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Contact Us :  results@bhmpc.com, 1-888-831-1171

1. Dedicated Resources Ensure Your Accreditation Progress Remains a Focus

Accreditation can be a daunting process, and most of your staff will be consumed with their day jobs.  Take the weight off of internal staff by having consultants do the heavy lifting when it comes to accreditation.  Accreditation consultants can help prep your organization, shape documentation, review criteria, and perform appropriate uploads while internal staff remain focused on their core competencies.

2. Project Planning with a Designated Lead Means that You Won’t Fall Behind

Allocation of project planning to an external firm will ensure that your accreditation process won’t lose momentum even when things get hectic at your practice.  Too often we see organizations who are applying for accreditation begin with a bang, and soon fall behind deadline.  A dedicated leader will keep things organized, and keep the project progressing.  Allocation of a designated project manager will also ensure that all of your accreditation requirements are accounted for, and that nothing falls through the cracks.  Accreditation often touches many parts of an organization, a project planner will keep everything in synch as your accreditation progresses.

3. Consultants Make Accreditation More Cost Effective

This may seem counter intuitive at first.  How can hiring a consulting firm save you money? The answer is through efficiency.  Accreditation consultants know what it takes to achieve successful accreditation in tight time frames.  They can guide your organization toward achieving requirements, make more effective utilization of time, and many firms have their own tools developed that they allow your organization to utilize cutting costs by eliminating the need to create materials from scratch.  Heavy experience allows accreditation consultants to pinpoint what works and what doesn’t allowing you to create a laser focus on problem issues and find quick efficient solutions.

4. Independent Reviews Highlight Issues and Identify Resolution

It can help to get an outside perspective, especially the perspective of a firm that knows what accreditation organizations are looking for.  When prepping for accreditation this independent review of your organization against accreditation standards can be critical to identifying potential issues early, and providing recommended resolution for those issues.  Accreditation consultants know where the majority of organizations struggle through the process, they have an understanding of what meets standards and what falls short.  Having this valuable insight from an outsider can help your organization more truly gauge where deficiencies are so that there are no surprises at review time.

5. Prep Like It’s The Real Thing

So you think you are ready for review.  Your staff has compiled all of the documents that it takes to meet requirements, operations have been optimized to meet accreditation standards, and all that is left is the interview.  The problem is many organizations that don’t hire an accreditation consulting firm don’t spend time prepping for their review at all.  Accreditation consultants can help you prep like its the real thing.  From standard questions that reviewers ask, to ensuring that your staff knows what is expected of them during the interview process, prepping for review is crucial for accreditation success.  Additionally, many organizations don’t realize where there are hiccups in their review unless they do a walk through of the interview process.  A mock review can ensure that your staff feel confident during the onsite portion of the review.

To See How BHM Can Help Make Your Accreditation Painless, Efficient, and Successful Call

1-888-831-1171 or email us at results@bhmpc.com

Summary: Did you know that one in 5 children are diagnosed with a mental disorder? Did you know that childhood ADHD is tied to obesity later in life? Do you know the symptoms,  causes, and treatments for ADHD?

What exactly is ADHD?  ADHD stands for Attention-Deficit Hyperactivity Disorder. According to recent studies, 1 out of 5 children suffer from some sort of mental disease such as ADHD. That is a pretty amazing statistic – 20% of our children. To convert this figure in terms of healthcare costs, this equates to almost $250 billion. This is another shocking statistic. Mental disorders are “serious deviations from expected cognitive, social and emotional development”. In addition to having mental disorders during childhood which may continue into adulthood, these children are also more likely to be diagnosed which chronic conditions such as diabetes. So, mental health is a real issue that deserves real attention. Early detection can lead to early treatment and hopefully reduce the severity of the symptoms.

According to the Centers for Disease Control and Prevention (CDC), there are several symptoms in children which can indicate the presence of ADHD:

• Have a hard time paying attention
• Daydream a lot
• Not seem to listens
• Be easily distracted from schoolwork or play
• Forget things
• Be in constant motion or unable to stay seated
• Squirm and fidget
• Talk to much
• Not able to play quietly
• Act and speak without thinking
• Have trouble taking turns
• Interrupt others

While the causes of ADHD are not currently known, there is evidence to support the following may be contributing causes:

• Genetics
• Brain injury
• Environmental exposures
• Alcohol and tobacco use during pregnancy
• Premature delivery
• Low birth weight

Diagnosis of ADHD

One of the issues with diagnosing ADHD is there isn’t a single test to diagnose. It is a multi-step process. The symptoms may be similar to those attributed to other mental illnesses such as anxiety and depression. Therefore treatment can be tricky. Diagnosis of ADHD is more of an elimination of other diseases to arrive at ADHD as the most probable. The process currently used to diagnose ADHD involves 1.  Medical exam which includes hearing and vision. 2. Checklist for rating ADHD symptoms and taking a history of the child from parents, teachers and the child.

Treatment of ADHD

There is no one treatment that is prescribed for each child diagnosed with ADHD. In general, treatment involves a combination of medication and behavior therapy. The key to treatment is a good follow up plan to monitor progress and make sure the treatment is working according to plan.

Some ADHD facts and theories:

• ADHD is more prevalent in boys than girls.
• Those who have ADHD as a child are more likely to be obese as adults. Obesity can lead to issues such as diabetes and heart attacks. The link comes from impulsivity, poor planning and the difficulty to make decisions.
• ADHD has been linked to issues with drug and alcohol abuse.
• Those with ADHD are less likely to pursue post high school education.
• Those with ADHD may be more likely to become arrested.
• Childhood ADHD has been linked to higher unemployment rates and poorer work productivity.
• ADHD is tied to lower socioeconomic status on average.

ADHD is certainly of major concern. It is also a disease which is difficult to diagnose. Diagnosis comes from eliminating or ruling out other diseases to diagnose as the most probable mental illness. The symptoms are similar to other diseases such as anxiety and depression. Treatments are based upon the individual so there isn’t a one cure fits all. These issues make ADHD difficult to diagnose and therefore difficult to quantify and measure.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Contact Us :  results@bhmpc.com, 1-888-831-1171

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Summary: Well here we are again – the 37^th time to be exact. The House of Representatives is working diligently to repeal the PPACA in its entirety.

Well, you have to hand it to the House of Representatives. They are quite persistent. This is the 37^th time an appeal of the Patient Protection Affordable Care Act (PPACA) aka Obama Care aka Healthcare Reform has gone before the House of Representatives. As of yesterday, yet another vote was held and the results were 229-195 in favor of the repeal.

In favor

House Speaker John Boehner was quoted “A full repeal is needed to keep this law from doing more damage to our economy and raising healthcare costs. It’s going to raise the price of health care, raise the cost of health insurance, reduce access to the American people and continues to get in the way of employers hiring new workers”.

Opposed

Opposition to the repeal comes from Representative Steny Hoyer “Apparently the Republicans are opposed to Obamacare. I know that comes as a shock to America, so we need to tell them one more time. Or 37 times, or maybe 38^th or a 39^th or a 40^th or a 100^th time”.

House Minority Leader Nancy Pelosi stated “Americans want Congress to focus on creating jobs. Instead we are wasting time once again on the Republican repeal of the patients’ rights”.

The White House has stated point blank that this will never pass.

Appeal #36

As you may recall, the PPACA repeal was last voted on in 2012. The crux of the issue was the mandate which required all Americans to carry health insurance. This is still a hot topic and one which continues to be debated.

Where do we go from here?

The PPACA is of major concern at this juncture as this will have a major effect on the next Presidential election. It seems to be more about which party has a majority in a tug of war than about the actual legislation itself. To move forward with an all or nothing motion seems time consuming and an expensive proposition. So, where do we go from here?  What if we took a few sections/related topics at a time and worked to repeal rather than the entire legislation? List out the topics which are of controversy, prioritize, and appeal in a structured logical fashion. This would provide an avenue to address the most important aspects and smaller wins might provide a sense of accomplishment.

What do you think?

Are you in favor of the PPACA? Do you think it should be repealed? Do you think it should be repealed in pieces? Do you think too much time, money, and effort are being dedicated to this cause?

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Contact Us :  results@bhmpc.com, 1-888-831-1171

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Obama Announces New Incentive Program for Healthcare Innovation

The Money Is On the Table

The Obama Administration announced yesterday that they will be kicking off an initiative to provide funding for “innovations” in federal healthcare programs which cut costs and improve patient outcomes.  As reported by Devin Dwyer the initiative will “reward the most “compelling new ideas” for lowering costs and improving care through the utilization of lucrative federal grants.  Specifically the money will be utilized to award projects that conduct testing and/or utilize new payment and delivery models.  The government is looking to discover programs which are able to quickly and effectively cut healthcare costs.  But many are questioning the efficacy and rationale behind this initiative.

• The Application period will run from June 14 to August 15
• Projects must be able to be implemented within six months to qualify for funding
• Special consideration will be given to project which generate jobs
• Selected Projects will be announced in March 2013

This Isn’t the First Time, and the Results are Questionable

In fact this isn’t the first round of federal grants awarded for Healthcare Innovation.  A round one kick off of Health Care Innovation Awards occurred in May and June 2012 with 107 organizations receiving between $1 million dollars and $30 million dollars per “innovative” initiative.  But some of the initiatives, while aimed at improving healthcare, do not appear to be expected to yield savings.  Here is a snapshot of entities who received grants which are in excess of the expected savings they are going to produce

There are many projects which do anticipate yielding large savings vs. the amount invested, but an overall look at the viability of this largely experimental incentive plan warrants examination.  In fact, according to CMS in their project profile document “project data (e.g. gross savings estimates, population served, etc.) are three year estimates provided by each organization…[and] while all projects are expected to produce cost savings beyond the three year period, some may not achieve net cost savings until after the initial three year period..”

Though certainly the data does not reflect a net savings for each project vs. what the initial funding amount was (click here for the full CMS report) and some opponents of the initiative question the efficacy and the aims.

Is the Issue about Healthcare Innovation or Job Creation?

Some have questioned whether the incentives are around Healthcare Innovation, or a governmental push for job creation.  Indeed, those applicants who address job creation are favored during the submission phase for round two, but let’s take a look at the amount awarded and the jobs created.  In fact, the announcement of the upcoming initiative was couched as part of Obama’s “Can’t Wait” campaign, and slated an emphasis on job creation, though round one of the Innovations in Healthcare grants produced less than stellar results, and even these are tentative based on estimates.

Funding Granted in Round One: ~$893 Million Dollars

Estimated Jobs Created Through Funded Projects:  2,723.82 (thousand)

Cost per created job: $327,947

The verdict is out on whether this push for federal funds marked toward improving efficacy, efficiency, and care in the newly shaped healthcare arena will prove beneficial, or, is just as one republican critic called it, a “$1 billion dollar experiment”

We would love to hear what you think, send us an email at newideas@bhmpc.com or connect with us on Linked In!

Summary: BHM has recently formed guest blog and publication relationships. Guest blogging provides a wonderful way to network with our peers, while contributions to the leading healthcare newsletters and journals work toward sharing BHMs knowledge of the healthcare industry.

BHM Healthcare Solutions (BHM) is excited to announce our recently formed publication partnerships. These partnerships are extending across a variety of media and allow experts in their fields to share content and knowledge with a broader audience. In addition to this BHM consultants are frequent guest bloggers, allowing for virtual networking by expanding beyond the boundaries of one’s own site, and allowing expert content to reach a broader audience.

BHM is pleased to share our recently formed professional writing partnerships.

Dorland Health is “a leading integrated media publisher in the healthcare business information industry”. Dorland Health provides publications, directories, webinars and business information services. BHM was fortunate to partner recently with Dorland Health to present a webinar titled Newsflash: CMS Now Reimbursing for Care Coordination. This webinar explained the new medical home codes which became effective January2013. Additionally, BHM published an article titled The Cause-Effect Relationship of Substance Abuse and Depression, a valuable read with the latest news on depression and its associated impacts, which appeared in Dorland Health’s Case in Point

Medical Home News is a newsletter dedicated to the topic of Medical Homes, sometimes referred to as Patient Centered Medical Homes or Patient Centered Health Care Homes. BHM has shared their expertise by publishing Overcoming Barriers to Medical Home Implementation.  Another publication that BHM consultants recently appeared in was Accountable Care Today which featured an article entitled Pitfalls for Managed Care Organizations- A Cautionary tale for the ACO.  Another article is due to be released related to ACOs in late summer 2013.

Advance Magazine is a national healthcare magazine with a mission to “enhance the careers of healthcare professionals everywhere by publishing a series of free news magazines”. Advance was created in 1985 and serves as a wonderful healthcare resource. BHM is releasing in May 2013 an article regarding ICD-10 code changes entitled ICD-10: Understanding the Financial Ramifications.

M2 Multimedia Communications “creates award-winning videos, animation and internet platforms for science and technology-oriented companies, organizations and agencies”.  BHM has been fortunate to be guest contributors for M2Inspired. The most recent contribution was an excellent article titled Quantified Self – Self Knowledge through Numbers. This article explored the use of personal data to track health and fitness goals and measures. Additionally, we posted an article titled 2012’s Nobel Prize Winners in Chemistry which talked about the accomplishments and the many years of research attributed to both Robert Lefkowitz and Brian Kobilka for their discovery in G-Protein Couple Receptors.

Telvox is a company that provides “high tech human touch” to clients such as dentists, doctors, hospitals and health plans. Televox was created in 1992. Scott Zimmerman is the President of Televox and has published articles on our BHM site such as Reducing Healthcare Costs with Increased Communication  and Digital Disclosing is Saving Lives.

The Profitable Practice is a blog which is associated with Sound Advice. Brittany Richards published a wonderful article on our BHM site titled 4 Best Practices for Collecting Out Of Pocket Patient Fees.

Finally, two of BHMs consultants, Linda Ringquist, and Danyell Jones have been selected as frequent contributors to HealthworksCollective, one of the best healthcare blogs online which highlights “the world’s best thinkers in healthcare.”  Frequent contributions from both authors can be found on the site, and we encourage you to visit and join this fast growing community.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting (i.e. URAC accreditation, NCQA accreditation), healthcare financial analysis, physician advisor/peer review, and organizational development.

There is most often not one singular course of treatment for a patient that offers a clearly superior outcome, but a variety of treatment choices each with their own advantages and disadvantages.  However, until now, care has been prescriptive rather than interactive.  A patient would typically present with a healthcare issue, the physician would provide a diagnosis and assign a treatment plan, case closed.  Furthermore, there is evidence that may suggest that when it comes to making appropriate decisions regarding their care, and what choices may be available, most patients may be uninformed.

 A recent study highlighted in The Journal of New England Medicine entitled “Shared Decision Making to Improve Care and Reduce Costs” indicated that “of more than 1000 office visits in which more than 3500 medical decisions were made, less than 10% of the decisions met the minimum standards for informed decision making.  Similarly, a study showed that only 41% of Medicare patients believed that their treatment reflected their preference for palliative care over more aggressive interventions.”

In fact, most experts agree that there should be an increased movement toward shared decision making.  Benefits of shared decision making are:

How The Affordable Care Act Comes Into Play

Section 3506 of the Affordable Care Act directly relates to Shared Decision Making.  Specifically it would offer funding resources to an independant organization to develop standards for Shared Decision Making, and tools to assist in the implementation of Shared Decision Making.  Additional funding in the form of grants may be available to providers who are willing and able to show effective implementation of these tools in the practice setting.  Finally, there is authorization from the Center of Medicaid and Medicare to begin testing the impact of Shared Decision Making Models across metrics that take into account both cost, quality and satisfaction.

Studies Show that Patients Have a Preference for Shared Decision Making

With the benefits extolled by a variety of groups, and patients hoping to gain greater control over their care in the era of ACOs, and MCOs shared decision making could be an important tool in increasing satisfaction, and decreasing the feeling of little to no personal control over healthcare decisions.  In a study conducted by the Group Health Cooperative in 2011, patients were asked the question:

How important is it that provider make programs like this (shared decision making) available?

Identifying the Obstacles

So, we have patients that appear to be wholly in support of shared decision making, a governmental environment that is ripe for shared decision making implementation and funding of shared decision making tools and standards…..what is the obstacle to implementation?  The answer is simple, overstretched physician resources and lack of a formalized system to track and document the process.  In a recent post on the MediMedia Sponsored Managed Care Magazine Blog it was stated that

• “physicians are too overwhelmed to introduce shared decision making to patients”
• “physicians are already overworked and have insufficient training to make shared decision making work”
• “information systems cannot prompt or track patients through the decision-making process”; and
• “adding any new process to a physicians office workflow will be a challenge”

Despite these barriers Shared Decision Making is a Trend that will continue to gain in popularity and momentum, and those early adopters who will be shaping the processes, protocol, and adoption strategies may have a strategic healthcare advantage in shaping the movement and reaping the rewards.

Summary: What is the latest news for Medicare Advantage plans? What is the debate on the age in which Medicare system changes should affect?

Medicare is in the perils of many changes. Reimbursement was cut as part of the sequestration. Medicare changes are proposed and it is a matter of which age group will see the most effects. Medicare Advantage plans are due receive an increase as opposed to the original cut which was slated. Proposals are on the table to combine Medicare Part A and B.

Medicare is certainly a hot topic these days. It is such a large healthcare expense as it relates to the federal deficit. In order to try to curb some of these expenses, Medicare is being scrutinized from all angles. The difficult part is balancing cutbacks to the Medicare program without making it completely unaffordable for the average beneficiary. One proposal on the table is to combine Medicare Part A and B. This would reduce 2 deductibles to one. It sounds good in theory, but in actuality the proposal would  increase the amount of out of pocket expenses, especially those that don’t currently have hospital expenses.  President Obama has stated he would agree to this combination as long as it was part of a balanced deal on deficit reduction.

Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.

On a more positive note, there was supposed to be a 2.2% reduction in Medicare payments to Medicare Advantage plans, but this has actually been reversed to include a 3.3% increase. Medicare Advantage plans are basically an alternative to Medicare Part A and Part B. They are purchased from private health plans such as Cigna and Humana. These companies are reimbursed currently at 114% of the Medicare amount. This excess is costing the federal government a lot of money. I believe that is why they are trying to bring this back in house and physically combine Part A and B and offer that through Medicare.

As you can see, Medicare is a hot topic. There are a lot of proposals on the table. Medicare is a very expensive government initiative and efforts are being made to try to curb some of this expense. It would be nice if they could accomplish without severely affecting both current Medicare beneficiaries and those that are approaching eligibility. Be on the lookout for many more proposals in the in upcoming months.

About BHM Healthcare Solutions

BHM is a healthcare management consulting firm whose specialty is optimizing profitability while improving care in a variety of health care settings. BHM has worked both nationally and internationally with managed care organizations, providers, hospitals, and insurers. In addition to this BHM offers a wide breadth of services ranging including managed care consulting, strategic planning and organizational analysis, accreditation consulting, healthcare financial analysis, physician advisor/peer review, and organizational development.

Contact Us :  results@bhmpc.com, 1-888-831-1171

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