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Expanded coverage requirements and potential increased demand on physicians
April 5, 2010
Expanded coverage is set to begin January 1, 2014, and
continue through 2019, eventually providing access to approximately
32 million individuals currently considered uncovered. All U.S.
citizens and legal residents will be required to obtain coverage or
incur a tax penalty. In response to the increasing numbers of
insured, the demand for additional healthcare providers is
initially expected in primary care specialties, and then expanding
to other specialties.
Expanded coverage is expected in the form of three options:
1.) newly formed health insurance exchanges
2.) subsidies available to assist low-income individuals
3.) Medicaid expansion
Employers will not be required to provide coverage. However, employers with more than 50 employees that do not offer coverage will be charged an assessment if one or more of their employees utilize federal subsidies. Furthermore, employers that offer coverage and have more than 50 employees will also be charged an assessment if one or more of their employees utilizes federal subsidies. States are required to establish the health insurance exchanges (Exchange) effective January 1, 2014. Employers providing coverage are required to offer a free choice voucher for enrollment in a plan in the Exchange to employees with income less than 400 percent of the Federal poverty level.
There remains a significant amount of groundwork to be defined and implemented before the expanded coverage begins. The outcome of lawsuits and threats of repeal will also impact implementation of expanded coverage rules. These next few months promise to be challenging and unpredictable, as this bill begins to take shape.
Future articles will address physician payments, physician-owned hospitals, Medicaid programs, health insurance exchanges, the new Independent Payment Advisory Board and more.
If you have any questions about this article or if you would like more information about HORNE's Health Care Services, please contact Jennifer Lott at jennifer.lott@horne-llp.com or by phone at 601.268.1040.
Links
- Medicare Fee Cut Slides Through Again
- Agreement to Postpone Medicare Cuts—Effects on Providers
- Expanded coverage requirements and potential increased demand on physicians
- Hold on payment of claims for providers paid under the Medicare Physician Fee Schedule
- Stark gets its own self-disclosure rules
- Accountable Care Organizations: Providing Care to a Defined Medicare Patient Population
- A Look at Tort Reform
- Health Care Reform Act Calls for Increased Transparency in Physician Relationships
- Prohibition on New Physician Hospital Ownership
- Medicaid Reimbursement to Increase for Primary Care Physicians
- Expanding Access to Primary Care Services and General Surgery Services
News
Establishing and Maintaining Fair Market Value Physician Compensation
May 2012: The use (or misuse) of compensation survey data,
descriptions commonly used physician employment compensation
models, and the use of the rebuttable presumption for establishing
and maintaining fair market value for all physician-hospital
compensation arrangements are all points that must be
addressed.
Improved Delivery Key to Success for Health Care Organizations
April 2012: According to HORNE's Tommy Prewitt, M.D., success
for health care organizations is going to be dependent upon
clinical process improvement, and success will depend primarily
upon leadership.
HORNE Partner Contributing Author to the The ACO Handbook Published by AHLA
RIDGELAND, Miss., January 24, 2012 - HORNE LLP, one of the
nation's top 50 accounting and business advisory firms, along with
the American Health Lawyers Association, recently announced the
publication of The ACO Handbook: A Guide to Accountable Care
Organizations, First Edition with CD-ROM. HORNE Partner Rud
Blumentritt, CPA/ABV, CVA, was a contributing author to the
resource published by AHLA.
Events
Hospital-Physician Integration
May 8, 2012: Lafayette, LA - Partner Rud Blumentritt
addresses hospital-physician integration strategies, suggestions
for success, potential issues, and current trends/future models at
the Louisiana HFMA Annual Institute.
Downloads
Assessing Intangible Value in a Physician Practice Acquisition
Capitalizing on Healthcare Reform--Providing Value to Your Clients in a Time of Change