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Patient Protection and Affordable Act (Pub.Law.No.111-148): Challenges and Opportunities for AMCs. Sibu P. Saha, MD, MBA Professor of Surgery University of KY. Educational Goals. Review the rationale and historical background of healthcare reform “Obama Care”: What is in it?
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Sibu P. Saha, MD, MBA
Professor of Surgery
University of KY
We are Broke $$!!
Note: Figures from 1990 through 2005 represent historical data; data from 2006-2016 are projected.
Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (Historical data from NHE summary including share of GDP, CY 1960-2005, file nhegdp05.zip; Projected data from NHE Projections 2006-2016, Forecast summary and selected tables, file proj2006.pdf).
2.6%Increases in Health Insurance Premiums Compared to Other Indicators, 1988-2007
*Estimate is statistically different from estimate for the previous year shown (p<0.05). No statistical tests are conducted for years prior to 1999.
Note: Data on premium increases reflect the cost of health insurance premiums for a family of four. The average premium increase is weighted by covered workers.
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2007; KPMG Survey of Employer-Sponsored Health Benefits, 1993, 1996; The Health Insurance Association of America (HIAA), 1988, 1989, 1990; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April), 1988-2007; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey, 1988-2007 (April to April).
”our single largest domestic policy challenge is healthcare.”
The truth is, our nation’s healthcare system is in critical condition. It’s plagued by growing gaps in coverage, soaring costs, and below average outcomes for an industrialized nation on basic measures like error rates, infant mortality, and life expectancy.”
The Honorable David M. Walker
Comptroller General of the USA
Can you tell me what he was saying?
Healthcare was not one of his priorities!
Bill Clinton made health care reform one of the highest priorities of his administration. He asked the First Lady to chair the Task Force on National Health Care Reform.
1996 - Health Insurance Portability and Accountability Act Becomes LawHIPAA sets national nondiscrimination and portability standards for individual health insurance coverage, HMOs, and group health plans. The image shows President Bill Clinton signing the bill. Senators Nancy Kassebaum and Edward Kennedy, who co-sponsored the bill, are among the observers.
1997 - CHIP and Medicare +Choice EstablishedThe Balanced Budget Act funds the Children's Health Insurance Program (CHIP), a state-run program designed to make sure all children have health coverage. The BBA also gives Medicare beneficiaries the freedom to enroll in private health programs, including HMOs and PPOs. The image shows the logo for Utah's CHIP program.
Patient Protection and Affordable Act(Pub.Law.No.111-148):
Regulation ----- Competition ------ Collaboration
2010 – 2011
Lifetime coverage limits eliminated and annual limits restricted
“Fee for Service promotes overutilization.”
Supply creates demand
-Drugs and Alcohol
-Obesity and Type II Diabetes
“Politics and Power”
MR # 017679697 had an MSDRG of 166 and a principal diagnosis of 162.3 Malignant
Neoplasm Upper/Lobe Lung and a principal procedure 33.27 Closed Endo Lung Biopsy.
The FY 2010 and FY 2011 cases had the same MSDRG, principal diagnosis and principal
procedure as the case analyzed.
-Inpatient beds - $1M in capital and $250K-800K annual operating expense
-Operating rooms - $2 – 7Million, $250K+ annual operating expense
-Major imaging (CT,MRI,PET/CT, etc.) – approx. $1M+
-Cardiac Catheterization Lab – approx.$2M
-Commercialization of Healthcare
-Shift from Non-profit to profit
-Drive for globalization by multi-nationals
Remember 3 P’s