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The Next Challenges in the Affordable Care Act Print E-mail
Written by Marcum Healthcare   
Saturday, 14 July 2012 15:58

How health care providers should begin planning for the impact of the Affordable Care Act now that the Supreme Court has upheld the mandate

The Supreme Court’s 5-4 decision to uphold the individual mandate of the Affordable Care Act, ACA is generally viewed as a positive outcome for hospitals, physicians and other health care providers.  However, the Supreme Court’s ruling and many original provisions of the ACA raise significant concerns for health care providers.   

Both the American Hospital Association and the American Medical Association issued formal press releases praising the decision to uphold the individual mandate. The AHA said “Today’s historic decision lifts a heavy burden from millions of Americans who need access to health coverage. The promise of coverage can now become a reality.”   

The AMA said “We are pleased that this decision means millions of American can look forward to the coverage they need to get healthy and stay healthy.” 

However, the AHA also signaled that it sees deficiencies in the ACA. It said “Now that the Supreme Court has made its decision, hospitals will continue their efforts to improve the law for patients, families, and communities.”  

Increased Revenue and Payment Cuts

On one hand, the ACA’s insurance coverage for 32 million uninsured means additional revenue for providers. Additionally, the CMS chief actuary projected $575 billion in Medicare payment cuts for hospitals, skilled nursing facilities, long term care hospitals, inpatient rehabilitation facilities, hospices and home care agencies. 

A 2010 Rand study estimated that net income for US hospitals would decrease by $11.3 billion despite a $75.2 billion increase in revenue from the newly insured. The decrease in net income resulted from the additional cost of services for the individuals who gained coverage.  

The Rand study also projected that physician revenue and net income would increase but those increases would be seen largely by physicians who deliver primary care services to Medicare patients.

Changing Payer Mix. Lower Margins        

According to Matt Bavolack, Director of Marcum’s Health Care Group, “One area of great uncertainty and concern for providers is a changing payer mix.”  He noted that 16 million of the 32 million people who are expected to gain coverage will be covered by Medicaid.  Medicaid payment rates are usually lower than Medicare rates and certainly lower than commercial rates. 

“Providers may see rapidly eroding operating margins,” says Bavolack  “The unit cost of services could go up because of increased demand from additional patients while lower Medicaid payment rates may mean less revenue per unit of service.”   

Mark Fromberg, another partner in Marcum’s Health Care Group adds that “The mix of commercial insurance plans could also change.  Large employers have said they will continue to sponsor coverage for their employees which is comforting to providers, but millions of people are likely to obtain commercial coverage through the health insurance exchanges.”  Fromberg continued “The companies that offer coverage through the exchanges and the benefit levels in those plans could cause an undesirable shift in a provider’s payer mix.”

A Pathway for Health Care Providers

The Affordable Care Act has started to reform the country’s health care system and unless it is repealed or modified, the Supreme Court’s decision means the pace of new regulations and other changes will increase going forward.  The most significant changes are now less than 18 months away.  Health care providers need to fully understand how the ACA will affect their services and the patients they see, and they need to begin planning for the changes that will occur.  

For more about Marcum's Healthcare Industry Service Group, visit

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About Marcum LLP
Ranked among the top 15 firms in the nation, Marcum offers the resources of more than 1,100 professionals, including more than 150 partners, in 23 offices throughout New York, New Jersey, Massachusetts, Connecticut, Pennsylvania, California, Florida, Grand Cayman, China, Hong Kong and Shanghai. The Firm's presence runs deep with full service offices strategically located in major business markets. Marcum is a member of the Marcum Group, the gateway to a group of organizations that provide a variety of professional services including accounting and advisory, technology solutions, recruiting, and wealth management. These organizations include Marcum LLP; Marcum Technology LLC; MarcumBuchanan Associates LLC; Marcum Search LLC; Marcum Financial Services LLC; and Marcum Cronus Partners LLC.

Michael Curto
Phone: 954.320.8030
Email Michael

Mark Fromberg
Phone: 954.320.8050
Email Mark
Last Updated on Sunday, 15 July 2012 08:57
"Automated hovering" in health care Print E-mail
Written by Harold Pollack   
Friday, 13 July 2012 10:42

If you are interested in novel approaches to improve health behaviors within and outside the formal healthcare system, there's no better group to watch than the University of Pennsylvania's Center for Health Incentives and Behavioral Economics.  If you are not familiar with their work, the July 5 New England Journal of Medicine perspectives piece, Automated Hovering in Health Care - Watching Over the 5000 Hours is worth a look.

Authors David Asch, Ralph Muller, and Kevin Volpp start out with a simple but powerful observation about how medical care (and systems outside medical care) must change to better promote health:

The dominant form of health care financing in the United States supports a reactive, visit-based model in which patients are seen when they become ill, typically during hospitalizations and at outpatient visits. That care model falls short not just because it is expensive and often fails to proactively improve health, but also because so much of health is explained by individual behaviors, most of which occur outside health care encounters. Indeed, even patients with chronic illness might spend only a few hours a year with a doctor or nurse, but they spend 5000 waking hours each year engaged in everything else - including deciding whether to take prescribed medications or follow other medical advice, deciding what to eat and drink and whether to smoke, and making other choices about activities that can profoundly affect their health.
The authors also note three developments which offer promise that our health system can do better:
  • Payment mechanisms that reward providers based on patient health outcomes
  • The proliferation of new computer and communication technologies
  • Deepening understanding of behavioral economics
Click HERE to read the entire blog post.

Excerpt from: The Incidental Economist

Contemplating health care with a focus on research, an eye on reform.
Last Updated on Monday, 16 July 2012 07:49
Quality Healthcare: The Future of Medicine Print E-mail
Written by Heather Miller   
Monday, 09 July 2012 07:21

The government has taken an active role in shaping the way that healthcare will be provided in the future. The historic first step taken by Congress was to pass the controversial Patient Protection and Affordable Care Act ("ACA"), signed into law by President Obama in 2010. Congress will continue to pass legislation that will force physicians to practice medicine in a manner that will focus on better quality of care while reducing costs.

After Congress passed the ACA legislation, private insurers reacted, as expected. Within the past few weeks alone, Aetna launched a new program in Connecticut and New Jersey that will offer incentives to primary care doctors to oversee a patient's overall health; Anthem Blue Cross and Blue Shield in Connecticut announced an innovative, primary care program that will allegedly dump an extra $1 billion or more into primary care; and UnitedHealth Group announced that it intends to replace its current fee-for-service payment model. UnitedHealth Group, the nation's largest health insurer, intends to compensate hospitals and physicians for reaching certain quality goals. Currently, only 1%-2% of UnitedHealth Group's 26 million commercially insured members are covered by its value-based payment contracts. UnitedHealth Group plans to change this statistic at a staggering rate.

By the year 2015, UnitedHealth Group intends to apply value-based payment contracts to up to 50%-70% of its commercially insured members. It plans to use several approaches for these types of contracts, including compensating providers in part through a bonus mechanism. If physicians meet certain quality metrics, they are compensated. If they don't meet those metrics, pay increases could be withheld, according to the proposed plans. Eventually, this contract model will include most high-volume hospitals and medical groups. Hospitals will be measured by their readmission rates, mortality rates for certain conditions, hospital-acquired infection rates, and patient satisfaction; physician measures may include inpatient admissions, emergency department visits, and preventive screenings.

By making these changes in payment methodologies, the private health insurers are fundamentally changing their relationship with healthcare providers. Essentially, they will be increasing their financial support for those providers who help manage their patients' overall health, eliminate duplicative services, and boost preventative efforts. The insurers' ultimate goal in adopting these incentive programs is to advance the quality of healthcare, lower costs, improve coordination of care, and promote a more accessible and efficient experience for patients. The only way these goals can be achieved is if people are kept out of hospitals and physicians get more involved in patient care.

While these changes sound great in theory, meaningful improvement in the quality of care provided continues to remain on the shoulders of patients, who need to be active agents in their own healthcare. Patients will need to be rewarded for healthy behavior (or penalized for unhealthy behavior). The truth remains that quality healthcare is limited by the choices patients make when they walk out of a physician's office.

About the author: Heather Siegel Miller is Senior Counsel in the Miami and Boca Raton offices of Broad and Cassel. She is a member of the Firm's Health Law Practice Groups. Click HERE to read the rest of the bio.

What the ACA Decision Really Means for Private Health Insurance Print E-mail
Written by Paul Gionfriddo   
Friday, 06 July 2012 07:56

Did the Supreme Court save private health insurance, or just drive another nail in its coffin?

Ironically, it might well turn out to be the latter.

Keep in mind that from a consumer perspective, much of the Affordable Care Act was about trying to keep private insurance affordable in America. But "affordable" is a relative term. When your employer pays most of the cost, insurance is a lot more affordable than if you're paying the bill yourself.

At over $20,000 per year for a typical plan providing family coverage, health insurance now costs around 40% of the median household income of $49,445!

Being mandated to take on that expense - even with the generous subsidies ACA provides - understandably rankles people. It's no wonder that millions of healthy people may still choose to roll the dice and go without.

But even though we have spent so much time arguing about the cost of insurance and the private insurance market, the fact is that it pays only a small part of the nation's health care bill.

An August 2011 article in the New England Journal of Medicine reported that private insurance paid only a little over a third of all health care costs, and even less - one quarter - of mental health care costs.

Even those small numbers are high. When you take into account (1) the share of private insurance that is subsidized by the government through tax benefits and (2) the share of private insurance that is paid by all levels of government on behalf of public employees, the percentage of care paid for by privately-funded private insurance is only in the teens.

Click HERE to read entire blog post.  Click HERE to view author's bio.  

Last Updated on Friday, 13 July 2012 10:45
Dade Docs Celebrated in Alternative Weekly Print E-mail
Written by Jeffrey Herschler   
Monday, 02 July 2012 10:13

Michael Salzhauer, MD won Best Plastic Surgeon while Gary Curson, DPM won Best Podiatrist in Miami New Time's annual BEST OF edition. Dr. Curson is located in Surfside, walking distance to Dr. Salzhauer's office in Bay Harbor Islands.  

Dr. Salzhauer is no stranger to the media spotlight.  He made a big splash earlier this year with his Jewcan Sam video and was featured on the cover of the June 21st issue of New Times.

Last Updated on Monday, 02 July 2012 10:23
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