Obamacare and the Future of Healthcare

As everyone knows by now, the Supreme Court upheld the constitutionality of state healthcare insurance exchanges subsidized by the federal government.  If this decision had gone the other way, it could have had a significant impact on the percentage of insured patients currently, and in the coming years.  With this decision, this key component of Obamacare seems to be a permanent part of the future financial core of healthcare reimbursement.

I was traveling when I heard the announcement.  A few hours later, on CNN, I saw the news about large jumps in the value of stock for major healthcare insurance companies like Aetna, Cigna and United Healthcare.  Many of these organizations were seeing increases of 15% to 40% in a single day toward the value of their shares.  I began thinking about how this will impact my own company and healthcare delivery in general in the coming years.

obamacare
The future of healthcare.

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Opposition to ICD10 – A Perspective of Self Interest

Last week I read several articles about the current efforts to delay the implementation of ICD10 by the AMA and some of our congressmen, possibly influenced by this organization.  Their extremely weak arguments against implementation focus on their own lack of preparedness for the implementation.  Anyone with any knowledge of what has already been done to prepare for this new code set would realize that the negative impact of another delay would far outweigh any benefits of allowing these procrastinators additional time to prepare.

ICD10 Coding
Opposition to ICD10

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Medicare Public Use Files

CMS has provided access to data collected through the administration of claims to researchers since 2003 through the PUF (Public Use Files).  These files contain useful information on patients going back to 1999.  These files are offered for free as CSV (spreadsheet) files and offer valuable information on specific healthcare services.

These files are designed for researchers, but for you number crunchers out there, they can provide valuable insight into industry trends and how your own organization compares to your competitors.

For example, the current PUF file on hospice beneficiaries contains data for 2010 for a total of 56,943 beneficiaries.  The file contains eight pieces of information for each one.  These totals come from the data dictionary and code book describing this file.  The totals themselves are very interesting:

Public Use Files
Medicare Public Use Files

 

 

http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/BSAPUFS/Downloads/2010_BSA_Hospice_Bene_PUF_DataDic_CB.pdf

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ICD10 and Medi-Cal Processing – Preparing for Chaos

As the ICD10 deadline approaches, providers and health plans (and their vendors) prepare for the transition with varying levels of effort, efficiency and success.  Although it is true that the organizations that plan, train and test for this event will be more prepared for the transition from ICD9 to ICD10 than their competitors, no organization will avoid the consequences of an industry that seems to struggle with change.

What will happen when Medicare requires the ICD10 codes and other health plans are unable to accept them?  From the provider perspective, the bottom line is receiving reimbursement for your services.  Regardless of the “rules”, providers have always had to comply with reality to get their money.

prepare for chaos
ICD10 Chaos on the horizon.

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