CMS Releases Information About Bundled Payments

The Centers for Medicare and Medicaid Services recently issued more information about the Bundled Payment for Care Improvement initiative, including a preliminary list of 48 episodes of care that would pay a targeted rate that is less than actual fee for service payments. If applied to all providers, these episodes would cover around 70 percent of all Medicare expenditures. Three bundled payment models will be tested as part of the initiative: payment for an inpatient stay for one of the 48 inpatient conditions plus targeted payments for services provided 30 or 90 days post-discharge, payment for post-discharge services associated with one of the 48 inpatient conditions, and payment for inpatient stays only. Hospitals will have to make several changes to meet the discounted targets in these bundles, including contracting, forging joint ventures, or vertically integrating with post-acute care provider practices to manage and coordinate post-discharge services.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

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Obamacare’s Effect on Businesses in 2013

Most of the provisions that directly affect businesses go into effect in 2014. The provision that most directly affects businesses is that they will pay a “tax” if they employ more than 50 full-time employees and don’t provide health insurance to all of their employees. This provision will encourage businesses to employ less than 50 people if they do not want to provide “acceptable” health insurance to their employees. Since health insurance premium support is a fixed cost per employee, this provision will tend to affect low-wage employers like retail stores and restaurants more than other types of employers.

This provision will probably provide great work for lawyers and accountants in 2013 as they legally divide bigger companies into multiple smaller companies.

Since the provision will only affect direct employees of the business, it will also encourage employers, especially large employers, to rely more on “temporary” employment agency employees and other contingent workers. Lower-wage employees, who previously may have been uninsured employees of businesses, may soon find themselves as uninsured employees working through temporary help agencies without any employment benefits at all.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.

ObamaCare Resistance: Citizens

ObamaCare’s individual mandate will take effect in 2014. The Congressional Budget Office (CBO) expects at least 6 million people to pay the initial $95 fine rather than purchase expensive, government-prescribed health insurance. The CBO expects the number to rise as the resistance movement against the healthcare law grows.

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Contact ABISA, a consultancy specializing in solo and small group practice management. Visit us at ABISALLC.com.