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Hidden Gems of the ACA

If you had the time to read through the 2,300 page health care reform bill you might be surprised that it is not all bad, or good for that matter. However we have been reading not only the bill but also the plethora of articles, both in print and on the internet, that have been published about it. It is truly an information overload! We selected three of the lesser known rules, laws or regulations from the bill that seem to be a benefit to everyone, regardless of your economic, political or social situation.

Physician Payment Sunshine Act

Different pharmaceuticals companies often manufacture prescription drugs that have similar uses. Obviously each company wants more of the drug they make prescribed than their competitor’s but how can they accomplish this? Magazine advertisements, television commercials and direct mailers are some of the methods used. However there is another, lesser known, marketing tactic… soliciting physicians. Through direct payments, meals, gifts, travel, etc. doctors and other medical providers can be incented to prescribe drugs manufactured by certain pharmaceutical companies. The Physician Payment Sunshine Act “shines” some light on this situation. It requires drug, device or medical supply companies to report annually certain payments or items of value that they’ve given physicians and hospitals. This information is then published on a public website for all to see. Check it out by clicking here.

Incentives for Employees to get (and stay) Healthy

Many of the conditions that our healthcare dollars are used to treat are preventable, sometimes self-inflicted diseases such as obesity, lung disease, hypertension and diabetes just to name a few. They could be the result of a poor diet, tobacco use or even a desk bound job. The health care reform law took aim at this issue on two fronts. First, it made most preventive care treatments free to policyholders. Hopefully this will encourage people, or at least give them one less excuse, to go for their annual check-ups and routine diagnostic tests. This should help prevent chronic diseases or at least catch them in their early stages. Second, a stronger emphasis is being placed on wellness in the workplace. The new laws allow for a reduction in employee contributions by up to 30%, and possibly 50% in the future, for employees that meet certain “Healthy Lifestyle” goals. Some examples of these goals may be quitting smoking, losing weight or keeping blood pressure levels low.

Accountable Care Organizations (ACO)

Our current fee-for-service health care system provides little incentive for physicians, labs, hospitals or other medical providers to cure or prevent illness. Instead they make a “fee” for every “service” they provide. So in a sense a sick patient is more valuable than a healthy one. The Accountable Care Organization model is very much the opposite. An ACO is a group of physicians, labs and sometimes hospitals that contract with an insurance company,or the government, and agree to treat a group of policyholders for a pre-determined budget. The budget is based on the prior claims experience for the selected group. If the medical care for the policyholders provided by the ACO costs less than the budgeted amount the physicians and other medical providers share a portion of the savings. This provides a great incentive for the ACO to be more efficient in providing care to their patients. ACOs use a variety of techniques to keep cost down such as: assisting patients in managing chronic illnesses, making sure patients receive recommended preventive services, expanded weekend hours to avoid ER trips, better communication between physicians and patients and additional support and guidance from nurses and other trained medical professionals for those with highest risk of hospitalization.

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