The Real Health Care Reform Isn't Waiting Until 2014

Sarah Kliff of the Washington Post reports:

There are two big parts of the health reform law going into effect today. One penalizes hospitals if patients are re-admitted to the hospital within one month of a visit for a condition that should have been dealt with on the first trip. The other seeks to redistribute higher Medicare payments to the hospitals that are delivering better care.

Both are part of an effort to fundamentally transform the health-care system in the United States by moving it from a system that pays for value rather than volume. If efforts like these succeed, hospitals will become more concerned with delivering higher quality health care. If they don’t, health providers will continue to earn a living the way they have for decades: By earning a fee for every service they deliver.

via www.washingtonpost.com

When most of us talk about the health care reform law, we tend to focus on the insurance changes -- the exchanges, the individual mandate, the essential health benefits, and so on. Arguably, however, the more important changes are reforms like the ones described here.

The health care economists that I read uniformly cite America's traditional fee-for-service model as one reason for runaway health care costs. The equation is simple: The health care provider performs a test or procedure, and someone pays him for it. It doesn't take a great deal of thought to realize that performing more procedures and tests produces more payments to the provider.

I am not so cynical as to think that doctors perform unnecessary tests and procedures just to boost their incomes. They order these things because they believe there are sound medical reasons for doing so. However, the medical-only perspective may not necessarily contemplate a cost-benefit analysis of a test or an operation.

The goal behind these reforms is to get hospitals and doctors to ask, at least more often: How much good will this (test/procedure/treatment) do? How much will it cost? Given the cost and the odds of failure, does it make sense to go forward with it? What will the outcome be for the patient of going forward vs. not going forward?

Whether these changes will result in slowing down the growth of costs while improving patient outcomes is anyone's guess. If it works, look for a lot of similar changes to come over the next 10 years. It should be interesting to see.

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Comments

[Barb]

I think another reason Dr.'s order additional tests is to cover their butts for fear of being sued for malpractice.

[Tim Dodge]

Barb,

That is undoubtedly true. One glance at the malpractice insurance premium bills they get will drive that point home in a hurry. If there is a health care reform part two bill, malpractice reform should be one component of it.

[Jim Maiella]

I think another question a doctor asks himself before ordering a test is: Will I get sued if I don't order the test, and it turns out - no matter how remote - that the patient might have been better off if I had ordered it.

[Darrell Schapmire]

The so-called "reform" known as Obamacare moved us much closer to a European-style healthcare system . . . with the exception of robust measures to control frivolous malpractice suits. This will leave us with the worst of all worlds . . . fewer physicians, higher medical costs and loss of access to care.

[Tim Dodge]

Jim,
No question. Doctors need at least limited immunity from malpractice suits in order to do their jobs properly and cost-effectively. It will be interesting to see if that becomes part of future health care reform efforts.

[Tim Dodge]

Darrell,

I hope it doesn't work out that way. As I've stated above, we have to consider some kind of protection for physicians against lawsuits so they can practice effectively and cost-efficiently. I don't think anyone wants to let incompetent physicians off the hook, but the 90 plus percent who are good ones shouldn't have to worry about getting sued because they didn't order an unnecessary test. Thank you for the comment.

[Jeff White]

I agree, If The Health Care Reform works, we will have to look for a lot of similar changes to come over the next 10 years.

[candida treatmen]

Starting in 2014, insurers can’t reject you for coverage based on your health status. For now, a high-risk insurance pool will be created on a temporary basis to make sure that those who have been rejected and uninsured for at least six months can get access to health coverage. Also starting this year, insurance companies have to cover pre-existing conditions in children. This could make it more affordable for some parents to get help for chronic diseases and other problems affecting their children.
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Starting in 2014, Medicaid will be expanded so that more people qualify, including low-income adults without children. For those who still don’t qualify for Medicaid, and can’t afford health insurance, there will be state-based insurance exchanges. If you can’t afford health insurance, you could be eligible for sliding-scale subsidies to help you pay your premiums.
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[Tonsil Stones Treatment]

Since the Affordable Care Act was signed into law in 2010, health insurance plans have started covering more preventive care and women's health care services with no out-of-pocket cost, and lifetime coverage limits no longer exist for most services. Expect benefits to improve in the next year, too, as coverage for things like maternity care becomes standard, but keep in mind that higher benefits may also mean higher monthly premiums. No one can say exactly what your health insurance costs will look like in 2014, but unless you qualify for subsidies, you may face an increase in what you pay for monthly premiums. Start budgeting for that possibility now, and consider opening a tax-advantaged Health Savings Account if your current health plan is qualified for use with one.
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[Penic Away]

Medicaid is an even bigger source of uncertainty. In January state legislatures will meet for the first time since the Supreme Court ruling. They must decide whether to expand Medicaid for 2014. Obamacare promises to pay for 100% of costs from 2014 to 2016, inching down to 90% in 2020 and after. This is a good deal for states, according to scholars at the Urban Institute. An extra 21.3m people would enroll in Medicaid by 2022.

Panic Away

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The biggest change is that most Americans will be required to purchase health insurance. This provision doesn’t kick in until 2014, so you have some time to consider your health insurance options, including a high deductible plan paired with a Health Savings Account. You can be exempted from the requirement to purchase health insurance if you can show financial hardship, that the health insurance goes against religious beliefs, or if you are American Indian. There will be financial penalties starting in 2014 for those who don’t purchase insurance. The penalty starts at 1% of income and rises to 2.5% of income by 2016.

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[vimax extender]

Health insurance companies, state regulators and consumer advocates have eagerly awaited these rules since Obama enacted the health care overhaul in March 2010.

The details contained within the 331 pages of regulations are crucial for health insurance companies and states preparing for the new options that will be available to uninsured people and small businesses starting in 2014. The health insurance exchanges, online marketplaces where consumers can shop for plans and determine whether they qualify for tax credits to pay for private insurance coverage or Medicaid benefits, are slated to be open for business on Oct. 1, 2013.

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[candida treatment]

Since the Individual Mandate and the Affordable Care Act (Obama Care/Health Care Reform) have been upheld by the Supreme Court (6/28/2012), I thought it would be a good idea to sell the features of the law. President Obama has done a great job of crafting the law and navigating through all the opposition.
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