March Madness: Picking Your Health Care Plan

In the spirit of March Madness, our office is all a twitter with anticipation to see whose bracket will be the least destroyed after the National Championship game.  We were all like little kids on Christmas morning last week, finalizing our brackets and bragging to one another about who was going to be proclaimed master of the universe (read: the luckiest person in our office).  Alas, the first day of games left some certain Ohio fans (who shall remain nameless) crying at their desks and others laughing maniacally about their unforeseen success.

March is about more than just basketball around here though. As the month draws to a close, we’ll be chatting more and more about price shopping and health care coverage options with the deadline to select your coverage plan being March 31st.  Health care transparency isn’t all fun and games like March Madness, as a patient’s decision about their coverage plan carries much more weight.  However, there are a number of similarities in the decision making process.  With so many options, how is a person supposed to choose?! 

Do you pick your health care the way you pick your March Madness bracket?

The “Top Seed Snob”

You go with the most expensive option because you figure that high cost must equal quality. You’ve heard that a certain provider is top notch, so you pay their high costs without question. Your health is the number one priority after all. Bad news is, this might not be the best strategy. This is like everyone who had Duke going all the way because they’d heard they were basketball legends, only to realize that Mercer crushed their dreams.

The “Overly-Researched, Overly-Confused”

You look at the list and are overwhelmed by your options, so you start by reading everything you can about each provider. You become a wealth of knowledge regarding statistics and survival ratings, but the more you know, the more confusing your decision becomes. This is like the bracket player who picks winners based on rebound rates and average points per game, only to have their team lose in the first round to a team like Dayton.

The “Randomized Hopeful”

You figure there can’t really be a bad option, so you close your eyes and pick. You never know what’s going to happen or how much coverage you’ll need, so you just hope for the best. This is basically the same as filling out your bracket based on the team names you like the most or the mascots who sound most ridiculous.

The “The Sounds Familiar”

You’ve seen the commercials or recognize a logo from your newspaper, magazine or that billboard on your way to work, so you pick that provider without much research.  It’s essentially the same as picking your cousin’s alma mater as the champions just because you visited during spring break one time.

The “Cinderella Story”

You decide your best option as far as health care coverage is to go without any plan. You’re healthy and young and don’t anticipate any high costs coming down the pipeline, plus you figure if you end up needing an expensive one time procedure like an MRI, you’ll just shop around to find the lowest self-pay price. This is kind of like FGCU last year, flying under the radar and crushing everyone’s brackets. Ultimately, a win wasn’t in their future, but they did better than anyone expected.

For a little chuckle, check out this Buzzfeed article about the many thoughts going through your head when picking your brackets. You could say that while picking your healthcare plan, you might have many of the same thoughts.

64 Thoughts You Have While Filling Out Your March Madness Bracket

Impact of Supreme Court Decision on Obamacare With Jeff Greenberg, Lead Health Care Counsel for Atlantic Health Solutions

After hearing about the Supreme Court’s decision to uphold President Obama’s Affordable Care Act, we were interested to learn what the historical decision means for healthcare professionals from a legal sense. We spoke with Atlantic Health Solutions’ in-house legal counsel Jeff Greenberg, to hear his predictions for what’s to come.

What does the Supreme Court’s decision to uphold the ACA mean for patients and their quality of care?

There will be a lot more patients in the health care system, as more will be covered with some type of health insurance. Some people have said that the quality of health care provided will suffer, because there will be so many more people with access to care and no increase in providers. Patients will likely see longer wait times and a difference in how quickly they can get appointments. It has been predicted that with more patients gaining access to care, patients could see the same scheduling issues typical of Canadian health care. Also, as lower reimbursement is expected, physicians might be led to be less motivated due to lack of revenue, leading to lower quality care. Fortunately, others say that providers have planned for this influx of volume, so the quality should remain the same.

What does the decision mean for Physicians from a stability and care standpoint?

For physicians, this decision is a double-edged sword. While they will see greater patient volume, at the end of the day, physicians’ reimbursement is going to be lowered even more. Because someone is going to end up paying for these patients’ care, they will be forced to examine other options such as being pushed into the ACO model and bundled payments. Unfortunately, these options do not benefit specialists as much as primary care health care providers.  Many hope that while they will be getting paid less, they might make up for it with volume; the question will be if they can truly make a profit off of patients with government supplied insurance. Physician’s main priority is to provide care to those in need, so many will accept lower paying insurance work, especially if their schedule needs to be filled, but many high quality providers will not be required to accept these patients, and if their schedule is full with high-revenue patients, there might not be room for others.

What can we expect to see happen in regards to hospitals purchasing IDTFs?

A lot more physicians may go work for hospitals as surviving as an outpatient facility is not necessarily easy or secure. Hospitals are also required to take all patients and they always have, so until now they have missed collecting from patients without means. Now they will collect from the government entities and be able to feed revenue to their hospital-owned providers.  This is good for those physicians comfortable with being an extension of the hospital, and fewer will see the benefits of being an IDTF (independent diagnostic testing facility) as oppose to being purchased to some.

What are the implications for patients who opt not to purchase insurance and continue to be uninsured?

If patients don’t purchase insurance, they can continue to be uninsured. Patients that cannot afford care and prefer to remain uninsured will not be penalized, however if you can afford insurance and decide to remain uninsured, you will pay a penalty each year. As for employers who are now required to provide insurance plans to their employees, many are determining whether purchasing the insurance or simply accepting the penalty is more affordable. Many believe that the penalty will be less expensive.  Businesses with less than 50 employees are not required to provide insurance and are presently unaffected by the Affordable Care Act.

So, is this the end of cash-pay?

This is absolutely not the end of self-pay and cash-pay patients will still be demand concierge services and other cash-pay procedures. It is predicted that even after the decision to uphold the ACA, 20 million Americans will remain uninsured and will continue to utilize cash pay options.  It is also important to remember that the mandate is still subject to being repealed.

How do you think this will affect our nation’s healthcare system long term?

Long term, it is too early to tell. If Romney gets elected, he will likely try to overturn the decision immediately and some states will still opt out of Medicaid Expansion, which could cause huge issues.  The conversation about Medicaid Expansion for states is still going on and the end result is still not clear. However, if everything remains as it is I would speculate cost and payment challenges, physicians being forced to work for hospitals/ACO’s, a larger patient population and some limited access to providers, with quality care and price transparency attempted to be driven.