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A Few Thanksgiving Healthcare Morsels

Given the short week, MedHOK’s Strategic Insights will offer up some Thanksgiving-themed morsels on recent healthcare happenings. Happy Thanksgiving!

Super Committee A TURKEY: Congress Eats Crow – As expected, the committee deadlocked in its effort to cut more than $1 trillion from the federal deficit over the next decade, triggering automatic cuts beginning FFY 2013 that some say will devastate the defense budget. While Medicaid is not on the automatic sequestration list, all providers in Medicare FFS and managed care plans face a 2 percent across-the-board cut beginning January 1, 2013. Look for each party to attempt to remedy the situation in the coming year through offsetting legislative measures. In terms of reversing the mandated cuts without other savings, President Obama has already promised to bring out his veto pen.

Medicare Doc AGITA Over Looming Rate Cuts – The lack of a deal was bad news for doctors in Medicare FFS who had hoped the committee would roll in a temporary or permanent reversal of the impending 27 percent cut to their rates on January 1, 2012. Without a deficit deal, it will be that much tougher to reverse the so-called SGR reductions that have been the subject of temporary patches for the past several years. One possible plan calls for preserving PCP rates by reducing specialist ones.

Healthcare Costs Taking BITE Out of Family Income – A Commonwealth Fund study has concluded that premiums for employer-based family health insurance increased by 50 percent between 2003 and 2010. The Fund says that such increases are compromising family incomes.

Many Employers To Be STANDoff-ISH on Healthcare – At the same time, a Mercer Consulting survey indicates that 9 percent of employers with 500 or more employees will likely cancel health benefits altogether in 2014 due to the creation of the state health insurance exchanges. One of the unintended consequences of health reform appears to be coming true.

Healthcare MEAL Ticket At Risk – Healthcare advocates are challenging the proposed regulation that would define affordable employer-sponsored health coverage under PPACA. The advocates worry that basing affordability only on the cost the employee pays for employee-only coverage will mean millions won’t have access to the subsidies intended in the law. It is easy to see how this could occur. An employer could offer generous employee-only coverage, but only minimally subsidize dependent coverage — if at all.

Some Physicians May See ACOs as GRAVY Train – More evidence that the most experienced physician and hospital groups will likely choose to enter the smaller Pioneer ACO demonstration rather than the larger mainstream program set up by CMS. At least two Physician Group Practice (PGP) demonstration sites are looking at moving from the current demonstration to the Pioneer ACO program sponsored by CMS’ Innovation Center. PGP sites largely dismissed the idea of being an ACO in the past, but are taking a second look now that the regulations for the main and Pioneer programs are less rigorous and because of the capitation element in the Pioneer program.

Marc Ryan

Marc S. Ryan serves as MedHOK’s Chief Strategy and Compliance Officer. During his career, Marc has served a number of health plans in executive-level regulatory, compliance, business development, and operations roles. He has launched and operated plans with Medicare, Medicaid, Commercial and Exchange lines of business. Marc was the Secretary of Policy and Management and State Budget Director of Connecticut, where he oversaw all aspects of state budgeting and management. In this role, Marc created the state’s Medicaid and SCHIP managed care programs and oversaw its state employee and retiree health plans. He also created the state’s long-term care continuum program. Marc was nominated by then HHS Secretary Tommy Thompson to serve on a panel of state program experts to advise CMS on aspects of Medicare Part D implementation. He also was nominated by Florida’s Medicaid Secretary to serve on the state’s Medicaid Reform advisory panel.

Marc graduated cum laude from the Edmund A. Walsh School of Foreign Service at Georgetown University with a Bachelor of Science in Foreign Service. He received a Master of Public Administration, specializing in local government management and managed healthcare, from the University of New Haven. He was inducted into Sigma Beta Delta, a national honor society for business, management, and administration.

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