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.

“In Plain English: The Affordable Care Act, including its individual mandate that virtually all Americans buy health insurance, is constitutional. There were not five votes to uphold it on the ground that Congress could use its power to regulate commerce between the states to require everyone to buy health insurance. However, five Justices agreed that the penalty that someone must pay if he refuses to buy insurance is a kind of tax that Congress can impose using its taxing power. That is all that matters. Because the mandate survives, the Court did not need to decide what other parts of the statute were constitutional, except for a provision that required states to comply with new eligibility requirements for Medicaid or risk losing their funding. On that question, the Court held that the provision is constitutional as long as states would only lose new funds if they didn’t comply with the new requirements, rather than all of their funding.”

— http://www.scotusblog.com/cover-it-live/

A look at what’s important to each side in politics… Yet there’s nothing about Health Care and the Affordable Care Act Mandate, learn what all the fuss is about in this blog post.

Physicians in Social Media: Twitter and How To Get Involved

Always wondered how to get started on social media? Take advantage of these tips from Ryan Madanick, M.D. in his posting on KevinMD.com!

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So you’ve decided to take the plunge (or at least, dip your toes) into the Twitterverse.  Congratulations! Welcome to a vibrant interactive community.  You’ll find plenty of different personalities here and lots of opinions.  But if you are like I was back in January 2011, you currently have no idea how to actually use Twitter, let alone how a physician might want to use it.

There are plenty of places to find information about how to start a Twitter account, so I am going to take a leap of faith and say that if you are reading this, you have already set one up.  If not, check out some online resources regarding starting your account and come back to this blog so you can figure out what you might want to do after the basic infrastructure is lay down (or, if you are just relatively adventurous, just head to Twitter and start your account without listening to any of the “pundits”).  This post is not meant to give you the ins-and-outs about Twitter.  I think they do a pretty good job explaining the basics on their help center.  There, you’ll find the “how’s” of Twitter, like how to post a tweet or how to follow others.

Instead, this post contains some of my basic recommendations about how you might first want to get involved in Twitter a professional manner.  As I have said before, getting involved means starting small.  I think you will quickly see why many people have stayed involved.

1. Consider starting with a private account. If you are still treading the water about getting involved for one reason or another, remember that you can have a private account.  No one can follow you unless you let them.  This means that your posts (or “tweets”) will be hidden from view of everyone except those whom you permit. I suggest using this feature really only as a place to test the waters to get the hang of writing in 140 characters and see if Twitter is for you. Be aware that with a private account, your voice will not be heard.  You are not really contributing your expertise; you can still listen to and follow anyone with a public account, but you limit your prospective audience.  You can always change from private to public once you’ve established your account, so this is often a good way to test the platform, but I do not recommend maintaining a private account unless you want to remain silent or limited in your interactions.
2. Start following some accounts. This is the key to finding out the power of Twitter.  The majority of the time, you will end up listening (i.e., reading) more than speaking (i.e., posting). Let me spend a few extra moments answering: Who should I follow and how do I find them?
   • Specialty societies and journals: By now almost all major societies and journals have Twitter accounts.  These are generally staffed by communications professionals who often tweet recent articles or news items you might find of interest.  You can try doing a search on Twitter for their accounts, or go to the societies’/journals’ home pages and find the place on the website where you can “Follow Them”.  If you are logged in to Twitter, you can usually just click that link or icon, and you will be taken right to their Twitter account where you can choose to follow them.  Once you’re there, check out who they are following.  Chances are, they follow accounts or people with whom you may have some common professional interests.
   • Let Twitter suggest some accounts: This tool might not give you the most interactive accounts, but at least you can continue to explore accounts that you may be interested in.
   • Search for accounts with similar interests: Do you have a particular area of interest? Maybe a disease or subspecialty? Do a search on Twitter to find people to see what people are saying about your area of interest.
3. Listen to what others are saying: Are you surprised I said this before I talked about what to tweet? For everyday folk (and by everyday folk, I mean those of use who aren’t “follower millionaires”), Twitter is often more about listening than anything else.  By listening, you will get the feel of how people tweet, what people tweet, the format of a tweet, etc.  Believe it or not, listening to the voices might lead you to the next step.
4. Decide what to tweet:  This is probably the most common question I get asked about Twitter. There are lots of people on Twitter saying many, many things all the time, but Twitter is not just about tweeting what you are just about to eat at the local diner.  Being on Twitter in a professional manner means you are starting to define your own digital footprint and your voice. Did you read a tweet that you liked? Retweet it.  That is one easy way to tweet, but that doesn’t create any new content of your own.  Are you an expert in one particular area? Start tweeting about it.  I strongly recommend avoiding tweets relating to patients directly. Use common sense when creating original tweets; remember that patient privacy is paramount.  However, you might find it easier though to get started by another common type of tweet: find an article or a news item about an important health issue or topic in your field and tweet it (or comment on it).  Any webpage can easily be tweeted nowadays with one of a number of tools that will shorten the web address to easily fit into the 140 characters of a tweet, like Tiny orbitly. Once you’ve shortened the link, you can import that into any tweet you’d like.  For an example, see the Twitter stream of Dr. Orlowski (@Myeloma_Doc), who tweets virtually exclusively about multiple myeloma.
5. Find a hashtag: OK, now we’re starting to get to “Twitter 102 for Docs”. But if you’ve come this far and you’re ready to explore a bit, you might want to head over to symplur.com’s Healthcare Hashtag Project to see what they’ve created.  Let me give you an example.  In the tweet below, “#GERD” acts as a tag for the tweet.  You can search for tweets by including the hashtag to increase the likelihood you’ll find something directly related to your topic of interest.

Blogger Spotlight: Price Transparency and Consumer-Driven Healthcare

With all the talk about consumer-driven healthcare plans, high-deductible plans and the need for price transparency in the health care industry, we wanted to highlight some of the less well-known bloggers that are contributing valuable information to price shoppers and their tools for educating the price sensitive patient population.  The following blog sites contribute helpful tips to patients looking for ways to save on medical expenses and become more active advocates for their own care.

1. Employee Benefit Research Institute

"While the link between health insurance coverage and employment has long been known, these data underscore the degree to which unemployment rates directly affect the levels of the uninsured in the United States,” said Paul Fronstin, director of EBRI’s Health Research and Education Program and author of the report. “

Read more posts like: Employment-based Health Coverage Rates Continue to Fall

2. US Bank: Healthcare Payment Insider

" One of the mistakes we often make in our benefits communications to employees is focusing on their addedresponsibility, rather than on the positives of that larger burden. You can’t make a case that it’s great to pay more money out of pocket. Instead, you can highlight what “having control” really means: greater understanding (resulting in less stress), greater savings (from lower-cost premiums and fewer non-essential tests and medications), and a greater say in their own care. That’s empowering. And that’s the advantage of consumer driven healthcare.”

Read more posts like: Let’s Call It What It Is: A Low-Premium Health Plan

3. HSA Guy- Scott Borden

"There are several exciting things about Consumer Driven Health Care plans that are proving to reduce costs. One of the best things is pricing transparency."

Read more posts like: More Employers Steer Towards Consumer-Driven Health Plans

4. Universal Specatator: Health Care

"A select portion of the population chooses to carry the risk of medical expenses themselves rather than buying into an insurance plan. This group tends to be younger and healthier than insured patients and, as such, accesses medical care much less frequently. Because this group has to pay for all incurred costs, they also tend to be much more discriminating in how they access the system. The result is that patients (now more appropriately termed "consumers") comparison shop for tests and elective procedures and wait longer before seeking medical attention. The payment method for this group is simple: the doctors and hospitals charge set fees for their services and the patient pays that amount directly to the doctor/hospital."

Read more posts like: Who’s Paying fro Health Care- Understanding the Payors

5. Statistic Brain

* Statistic Brain- Uninsured health statisitcs Source: U.S. Census Bureau 1/25/12

6. American Affairs Suite 101

"Another 10.1 million of the 46 million “uninsured” have incomes of more than more than 3X the poverty level. For a family of four, if the household income was more than 3X the poverty level in 2007, they had $62,000 of income or more, and well were above the national median. An additional 9.3 million are non-citizens. Of the remaining 15.6 million uninsured, 5 million are between ages 18 and 34 and without kids. This leaves 10.6 million people in the United States who have no health insurance and do not fit in any of the above categories."

Read more posts like: A Look Inside the Uninsured Numbers

7. E-News Site

“But what about the 43 million Americans who are uninsured and thousands more who are inadequately insured?”This was duly considered and discussed and then another member stated; “You are speaking to one, I only have major medical with a high deductable.”

Read more posts like: 43 Million Americans Do Not Have Health Insurance or are Inadequately Insured

8. The Dish: Biased and Balanced

"Price transparency seems like the kind of thing that everyone should be able to rally around. But you’d be wrong. Pretty much everyone in the health-care world—other than the patient—has an interest in keeping prices opaque."

Read more posts like: Why Is Healthcare Price Transparency So Hard?

9. Save On Medical Blog

"This is why 32% of patients are price shopping for their care.  Patients are learning that by being well-educated about their care opportunities, they can acquire quality care at affordable prices. Since radiology services are the procedures most frequently searched for, be sure to investigate before spending or deciding to go without care.”

Read More Posts like: Patients Find Affordable Health Care

10. TRENDSparency

"Consumers themselves must be aware that you can shop for care as you would any other consumer product. In short, people think they have little responsibility for the cost of their healthcare, when the reality is quite the opposite.Forbes writer Zina Moukheiber echoed those sentiments about our HCTI, calling it “More Proof to Shop Around for Care.””

Read more posts like: Preventative Care Under the ACA: Transparency Offers Opportunities for Healthcare Consumer Empowerment

11. Zina Moukheiber’s Healthworks: Forbes Contributor

"As consumers start bearing the brunt of costs, they are going to shop around and push for greater price transparency."

Read More Posts Like: Start-Ups Can Help You Reduce Health Care Costs

12. Taegan Goddard’s WonkWire

“Most doctors and hospitals would rather not post their prices, because then patients would shop around, placing pressure on their incomes. Insurers don’t like price transparency, because they view the rates they negotiate with hospitals and doctors as proprietary trade secrets that give them an advantage over their competitors. Suppliers of medical products, of course, also benefit from high prices… Transparency is the sort of thing that Republicans and Democrats should be able to agree on. But instead, they’ve agreed to let industry lobbyists preserve the status quo.”

Read more posts like: Who Opposes Health Care Price Transparency?

13. FierceHealth

"As healthcare costs continue to rise and fluctuate based on hospitals’ location, price transparency efforts will continue to be important."

Read more posts like: Online Healthcare Price Transparency Tools