Thursday, September 20, 2012

PPACA Penalty/Tax

The Congressional Budget Office predicts in 2016 up to 6 million largely middle income workers will pay the PPACA "tax" or "penalty" or whatever we decide to call it, averaging about $1200. This is about 50% higher than previous estimates of impacted taxpayers.

A weak economy plays into the increased estimate.

According to the CBO, most of the payers will be in the middle class. Does this constitute a middle class tax increase?

In this political season hot rhetoric is flying from both sides. Expect the charges and counter charges to continue.

Tuesday, May 15, 2012

PPACA and Employers

One of the more suspenseful issues of PPACA (aka  Obamacare) is the question of employer conduct in 2014 and after.

Question is, will employers drop health insurance and punt workers into the state exchange system? Some new perspectives have been added to the debate. (Both assume PPACA will not be repealed or materially altered before 2014, an issue to be settled by the 2012 election.)

The Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT)  have weighed in on the question ( . (Warning, very long)

This report tries to cover multiple options and scenarios, but I think it comes to a Goldilocks conclusion, not to hot and not too cold, but something in the middle of the range of possibilities.

A McKinsey and Company (MC) study ( reaches much different conclusions.

McKinsey sees up to 30% of employers dropping employer–sponsored insurance (ESI), and perhaps more as awareness spreads and 2014 approaches.  MC also suggests exploration of any number of employer options, some good for employees, some not.

My spin? If the labor market remains weak, and underemployment and limited employee options continue, more employers will drop ESI and employees will have little so say or do about it.

There is a lot to digest here. More analysis required.

Thursday, April 5, 2012

Physicians "Rationing" Care

Nine physician panels have recommended less testing of patients presenting with various conditions and diseases and less treatment for some diagnosis.

For Details: New York Times

Much of this is low hanging fruit, such as using less antibiotics for sinusitis.

Other recommendations may be more controversial. In 2009 evidenced based recommendations to do less breast cancer screening were met with a firestorm of criticism. Current recommendations to do less cancer screening may meet a similar fate.

There will be another controversy, whether or not these guidelines would protect a physician using conservative treatment protocols from malpractice suits. In my experience, probably not.

Eventually payment bundling and new payment schemes may accomplish the "rationing" via a different route.

Stay tuned.

Friday, March 16, 2012

Regulatory Train Wreck

In early 2009 (following up work by the Bush administration) DHHS decreed that all providers would convert from ICD-9* coding to ICD-10* coding by October 1, 2013,

Most medical billing requires both an ICD code (disease or condition) and a CPT code (treatments given).

This conversion was to take place at the same time as PPACA (Obamacare), a multitude of quality reporting initiatives, audit programs and a major push for electronic health records. This avalanche was especially difficult for physician practices

Vast resources were expended for technology, planning and process management, extensive training programs were being developed, and then....

DHHS came to its senses and has indefinitely deferred the conversion. Ghastly poor judgment by the technocrats. Poor judgment has costs and consequences.

* International Statistical Classification of Diseases and Related Health Problems, Editions 9 and 10, usually known as ICD-9 and ICD-10. The conversion would have increased the number of reportable codes by about 500%, required reprogramming of an immense number of IT systems, and massive training initiatives.

Irony Alert

The Obama administration has issued administrative regulations requiring health insurance companies to provide "plain English" explanations of health insurance coverages.

The regs, issued by the IRS and the DOL, are 150 pages of barely readable bureaucratic gibberish.

This continues a trend of the administration writing long and complex administrative regulations. Lawyers are celebrating.