Health reform implementation

The successful implementation of the new healthcare reform law will hinge on physicians and hospitals working out trust issues with one another, according to a new survey.

The reform law requires increased collaboration and information sharing between physicians and hospitals, including through new accountable care organization (ACO) arrangements, to reduce costs and increase quality.

However, one in five physicians don’t trust hospitals, and 60 percent of hospitals believe it will be difficult to obtain information from community physicians to improve patient care, according to a new PricewaterhouseCoopers (PwC) survey. Physicians said they were less inclined to trust hospitals because of competing goals, not enough physician leadership on hospital boards and lack of transparency, communication and similar incentives.

The relationship between physicians and hospitals soured during the 1990s, as hospitals bought and sold physician practices and physicians opened outpatient surgery centers and special hospitals to compete, the report said. However, the trend is reverting back toward consolidation, the PwC survey said. Almost three-fourths of physicians surveyed said they have financially aligned with hospitals through employment, joint ventures or directorships, and 58 percent said they want a closer financial relationship.

More than half (54 percent) believe hospitals and physicians will become more aligned over the next five years through ACOs, which were incentivized in the reform law. The Department of Health and Human Services is expected to release regulations on ACOs by early next year.

The Susan B. Anthony List, responding to Rep. Steve Driehaus’s defamation lawsuit against the anti-abortion group, said his vote for healthcare reform — and not the group’s messaging — cost him a seat in Congress.

Driehaus (D-Ohio), who lost his reelection bid last month, announced Friday that he was suing the group for knowingly misleading voters about his position on public funding for abortion. The SBA List asserted that the reform law provided for taxpayer funding of abortion.

“Counter to his claims, the voters of Ohio's First District are the ones that cost Steve Driehaus his livelihood,” SBA List President Marjorie Dannenfelser said in a statement Monday afternoon. “Congressman Steve Driehaus' problem is not that the Susan B. Anthony List allegedly lied about his vote for taxpayer-funded abortion in the health care bill. It’s that he caved when it counted, took the wrong vote, and paid the price on Election Day.”

During the campaign, Driehaus had issued a complaint with Ohio’s election board against the SBA List to prevent the group from posting billboards that claimed the one-term congressman voted in favor of public abortion funding by supporting the reform law. However, the billboards never went up, and Driehaus dropped the complaint.

The Medicare payment advisory panel is warning that accountable care organizations (ACOs), boosted by the new healthcare reform law, might face public backlash similar to what managed care organizations experienced in the 1990s.

The reform law provides incentives to ACOs — groups of providers and hospitals that coordinate efficient and quality care to a certain set of Medicare patients.

However, prior history shows that patients felt forced into managed care by their employers without seeing any benefits from the change, and some doctors who opposed the organizations helped stoke patients’ fears, the Medicare Payment Advisory Commission (MedPAC) wrote in a letter to the Medicare chief last week.

Legislative changes may be necessary to provide incentives, such as reduced beneficiary cost sharing or providing a share of the savings, to help beneficiaries accept ACOs, MedPAC wrote. Further, Medicare should allow beneficiaries the choice to switch from an assigned primary care provider to another provider who is not in an ACO, it said.

Meanwhile, physician and hospital groups said the government needs to create explicit safe harbors from antitrust enforcement and anti-kickback laws. The American Medical Association asserted that current laws and guidelines favor hospital-based systems with employed physicians, as opposed to small, independent physician practices.

The Department of Justice told a House judiciary subcommittee last week that it intends to offer expedited guidance to ensure that providers can form ACOs compliant with antitrust laws.

Wisconsin’s top lawyer may bring a new lawsuit challenging the constitutionality of the federal healthcare reform law, according to The Associated Press.

Attorney General J.B. Van Hollen told the AP he hasn’t decided whether Wisconsin will file a new lawsuit or join the Florida challenge filed by 20 states. He has about a month to decide, because he must wait until the new governor takes office on Jan. 3.

Last week, a federal judge rejected another challenge to the healthcare reform law, marking the second time the law’s mandate that people buy insurance has been ruled constitutional. Liberty University had challenged that the law violates the First Amendment by requiring people to buy insurance that cover abortions.

Oral arguments in the Florida case are scheduled for Dec. 16.

Sen. Roger Wicker's (R-Miss.) bill would allow state officials to challenge federal regulations before they go into effect.

A liberal group is hitting back against an incoming Republican congressman's promise to forego congressional health benefits, pointing out that he already receives government health insurance as a retired military officer.

Rep.-elect Bill Johnson (R-Ohio), who campaigned on repealing the new healthcare reform law, announced on his blog Friday morning that he will decline insurance available to members of Congress. “This is one substantial way I can show that my commitment to the people of eastern and southern Ohio is to help them, not to gain exclusive benefits for myself," he wrote.

However, Health Care for America Now (HCAN) said Johnson's campaign against government-run healthcare falls flat, pointing to a local news report that said Johnson already receives government insurance as a retired Air Force officer.

"Bill Johnson has piously announced that he will forgo the government-health care he can receive as a newly elected congressman — but that's because he can take the government-sponsored health care for retired military people," HCAN Executive Director Ethan Rome said in a statement Friday afternoon. "Apparently, he misses the point about the hypocrisy."

Scott Walker, Wisconsin's Republican governor-elect, wrote to President Obama this week requesting maximum state flexibility in meeting the healthcare reform law's coverage requirements.

"As you might know, I raised major concerns about the (healthcare reform law) especially with respect to the individual federal mandate provision," the letter states. "However, it is my hope that your administration will allow Wisconsin to take a free-market, consumer driven system approach under the health care exchange provisions of the federal act."

The letter comes as Sens. Ron Wyden (D-Ore.) and Scott Brown (R-Mass.) are pushing legislation that would allow states to ignore the individual mandate and other provisions of the law as long as they cover at least as many people, at least as well and as cheaply as required by the law.

Rep.-elect Bill Johnson (R-Ohio) said he will turn down Congressional health insurance when his new job starts, according to an announcement Friday morning on his website.

Johnson, who said Republicans must focus on repealing the healthcare law, said members of Congress “shouldn’t have access to premium health care benefits when millions of Americans are struggling just to make ends meet.”

“I oppose ObamaCare because government-controlled healthcare will create more debt and huge bureaucracy,” Johnson said. “We need to reverse the government takeover of our healthcare, and we should adopt common sense, patient-centered, private sector solutions like making healthcare portable from job to job and state to state, tort reform, and promoting health savings accounts.”

Johnson's announcement comes as Democrats said Friday they will target newly elected Republicans opting for government-backed healthcare plans after campaigning against the healthcare reform.

A survey released two weeks ago found the majority of voters want congressional opponents of healthcare reform to decline government-provided healthcare coverage when they take office. Two other incoming GOP congressmen, Bobby Schilling (Ill.) and Mike Kelly (Pa.), have already vowed to refuse congressional health insurance.

Vigilance of unreasonable premium hikes might be lax in some states despite their robust authority to review and approve rates, according to a new Kaiser Family Foundation study.

The study found many states might only disapprove rates in select situations, such as for certain insurers or products. Further, many states not have enough staff to review all filed rates, and some automatically approve rates if they are not reviewed within a month or two.

Most states interviewed by the foundation also made little effort to make rate filings transparent. Some described the rates as trade secrets and therefore not available to the public.

The healthcare reform law gives the federal government new power to examine “unreasonable increases” in premiums charged for some individual and small group health plans.

The Obama administration on Thursday released new guidance to help small businesses claim the tax credits they're eligible for under the healthcare reform law.

According to the administration, the new guidance "addresses small business questions about which firms qualify by clarifying that a broad range of employers meet the eligibility requirements," including:

• Employers that pay for a portion of their employees' healthcare costs through a broad range of contribution arrangements. This includes firms that pay more to help older workers cover the higher premiums and firms that allow employees a choice of coverage;
• Religious institutions that provide coverage through denominational organizations. While the credit is for employers that fully insure in most cases, denominational organizations that self-insure their coverage can qualify for the credit; and
• Certain small employers that cover their workers through multi-employer healthcare and welfare plans. This is true as so long as 100 percent of the cost of coverage for all employees covered by the multi-employer plan is paid from employer contributions and not by employees.

In addition, the guidance includes a one-page form (Form 8941) and instructions to help small businesses claim the credit when they file their 2010 taxes.

The Democrats' law created a tax credit that could save small businesses as much as $40 billion by 2019, according to the Congressional Budget Office. Both for-profit and nonprofit organizations may qualify for the tax credit, but not the self-employed.

Eligible firms will get a 35 percent tax credit for their healthcare costs. To qualify for the full credit, businesses must have fewer than 25 employees, pay average annual wages below $50,000, and pay for most of their employees' health coverage.