A Simple Guide to Today's Healthcare Reform Changes

Today the next stage of healthcare reform arrived on the scene, meaning a change in landscape for providers, insurance companies, and patients.

Several changes will begin taking shape this week. Here’s a look at what we will see as the autumn open enrollment period approaches (some changes won’t be felt until January 1st, when many new healthcare plans kick in):

  • Free preventive services.  Preventive care such as immunizations, breast cancer screenings, prostate and cervical exams, blood pressure checks, and cholesterol tests will not be subject to deductibles or co-pays.  This will lead to an increase in the amount of patients seeking these services.
  • Easier OB/GYN and pediatric visits. Prior authorizations for visits to obstetricians and pediatricians will no longer be required.
  • No “Out of Network” charges for some emergency services.
  • No lifetime limits on coverage.  If you sign up for a new plan after Sept. 23, you can keep it for life.
  • Rescission ban. Insurers will no longer be able to cancel individual coverage if a customer gets sick.
  • Adult child coverage extended. Parents can keep their children on family plans until the kids hit 26.
  • Pre-existing condition changes for children and adults. Insurers will no longer be able to bar children with pre-existing conditions as of this fall; the same rule goes into effect for adults in 2014.
  • Small business tax credits. Companies with 25 of fewer employees, who make $50,000 on average, will get a 35 percent tax break on the cost of premiums. The credit is slated to rise to 50 percent in 2014.
  • Subsidized care for low-income families. Families and individuals with income levels of 400 percent of the poverty line will qualify for subsidized coverage.
  • Significant changes trigger new plan status. If employers make significant changes to healthcare plans, i.e. raise employee premiums or cut benefits, the plan is deemed new and falls under the new guidelines.
  • New insurance company decision appeal process.  The law requires insurance companies to set up an outside appeals process for claims that are denied.
  • Medicare wins, Medicare Advantage loses. Basic Medicare benefits are set to grow, but Medicare Advantage plans — privately administered Medicare plans — could see benefits shrink.

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A Caring Attitude

The economy has eased our worker shortage temporarily, but I have no doubt it will be back very soon.  With healthcare reform to add 32,000,000 new patients to a system already facing a retiring baby boomer generation, this is going to get very interesting…and stressful.

In an industry with unlimited choices, where will all the talent go? 

I believe they will seek to work with servant leaders who are knowledgeable, engaged, and caring.  With burnout reaching epidemic proportions, and many medical professionals re-evaluating their career paths, caring will not only lead to your success as a leader, but to an increased quality of life for your people. 

If you want to compete and make a difference, you will need to have an attitude of caring…and mean it.

That’s why it made my top 4.

Does it make yours?

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About the Author:  Aaron lives in Milwaukee, WI with his wife and two children and is the President & CEO of Clear Medical Solutions.  When he’s not leading new initiatives, he periodically takes on interim leadership or consulting projects.  He also enjoys teaching, speaking, writing, and sharing his passion for people and their healthcare.

Learning on the Fly

(This post is part 2 of a short series on 4 Skills for Healthcare Leaders)

Question:  What do 32,000,000 new patients, FourSquare.com, ICD-10, and Audit MICs (Medicare Integrity Contractors) have in common? 

Answer:  They will all be important to our industry.  They are new.  And they’re knocking at your door.

Increasing shortages of doctors and nurses, social media usage, new regulations, EMR’s, reforms, technology upgrades, and on, and on…and on.  It never seems to stop, and it never will. 

Many people now say that we live in a world of continuous change, and when I see what our partners, suppliers, and government contractors are inventing every year, it seems quite obvious.  Change is no longer something to prepare for; it’s a way of life. 

Our new way of life 

Some people might say that I’m being dramatic.  However, if you look back just a couple years, it is interesting to think that there were no RAC’s, no Healthcare Reform, few EMR’s, no HITECH Act, no Twitter, no iPhones.  Change is now constant, and as developing countries only add innovation and  new technology, times and tools will change even more. 

In the world of continuous change, the only way to ride the wave will be to lead by learning, and learning quickly. 

That’s why it made my Top 4. 

See you tomorrow for the topic of Social Media Savvy.  Have a great day! 

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About the Author:  Aaron lives in Milwaukee, WI with his wife and two children and is the President & CEO of Clear Medical Solutions.  When he’s not leading new initiatives, he periodically takes on interim leadership or consulting projects.  He also enjoys teaching, speaking, writing, and sharing his passion for people and their healthcare.