Saturday, January 29, 2011

Structuring Accountable Care Organizations (ACOs)

The success of PPACA (Obamacare) cost control depends heavily on innovative delivery systems such as ACOs.

With the health care industry there is lot of chatter and lots of thinking about how these innovations can be achieved.

One problem though. Over the past couple of decades the federal government (Congress, FTC, Justice) have been concerned about anti-competitive actions. The Stark legislation (I, II, III) and antikickback statutes add to the mix (being a health care transaction lawyer has been and will be very lucrative).

There is much concern about innovating organizations into trouble, and the possible considerable costs if all parties in a transactions have to buy legal assurance each step of the way.

Suggested solutions include "safe harbor" rules (a big help with Stark) or perhaps an omnibus pre-screening mechanism.

Innovation can be very complicated.

Future reading: Modern Healthcare and other health care sources

Health Care House of Horrors

This is almost too difficult to read.

(c) Philadelphia Inquirer

Additional details can be found via Google.


PPACA Phase-ins

Numerous PPACA changes became effective for insurance plan years starting after 9/23/10 (for most patients this would be a plan year beginning January 1). Many changes are related to insurance coverage, including:

  • coverage extends to dependents up to age 26
  • certain preventive and immunization services will be covered with no patient cost sharing
  • lifetime dollar limits will be removed from benefit plans
  • pre-existing condition exclusions and waiting periods are eliminated for patients under 19 (older patients phase in later)
  • retroactive cancellation will be only in cases of fraud or failure to pay

Other changes:

  • increases in penalties for misusing health savings account funds
  • changes in flexible savings accounts (FSAs)

Much of this will increase insurance premiums in the short run, and employers are passing much of the cost down the ladders to employees.

C.L.A.S.S. commentary

The C.L.A.S.S. long-term care financing program in the PPACA has been under the radar, but eventually we will need to look at the phase-in and the potential benefits.



Friday, January 7, 2011