Thursday, June 19, 2014

PPACA - bad news, good news

Pulled from some seminar materials I am developing, and based on recent interactions with hundreds of executives, financial officers and providers:

Problems with Obamacare (and related)

#1 by a huge margin in non-scientific poll of hundreds of providers: deferral of care due to larger co-payments (premium share, co-pay, deductible)

       a weak labor market combined with ACA impacts on insurers = massive risk shift to employees

       insurers reacting to ACA, employers reacting to ACA, shifting costs to working middle class

      immense shift in bargaining power in insurer vs. provider balance


mid sized employers confused and beleaguered

chaos in the hospital sector (due to ratchet down of revenues and scramble for business models)

mad scramble to integrate and build new business models, often fueled by massive uncertainty

ACOs not delivering yet at any large scale

failure to properly implement the back end of

           hundreds of thousands of families may have to repay due to flawed
                    subsidy calcs

providers cannot get easily or timely get coverage information, but on the hook

major problems with EMR/EHR implementation, “meaningful use” a mess

DHHS-CMS late with regulations (compliance), or writing incoherent regulations (meaningful use)

family practice not better off and often worse off

nothing significant to boost supply of family docs or nurses

               (will we see a boomer provider retirement surge? Stay tuned)

Medicaid fees with small contribution margins (variable costing) and negative contribution margins (full costing)

C.L.A.S.S. was stillborn and long-term care funding is being ignored at our peril

readmission penalties – first stage of formal rationing?

future of rural health care in doubt (small hospitals are probably toast within 5 years), small improvement in urban health care access (the hospital shake out will impact the outcome)

ACA based innovations

access improved somewhat and screening procedures in place (although someone has to pay)

surge of integration and construction of new business models (for better and worse).

ACO trials are in progress, could yield scaled results in the future

surge of innovation in business models

bundling could provide major benefits

surge of innovation in analytics (the government is not much help)

surge of innovation in clinical care

more careful use of ordering (imaging, Rx, therapies) but could have a clinical downside

FINALLY, providers have significant negotiating leverage in dealing with some suppliers