U.S. Supreme Court Rules on Healthcare Reform Laws

Today, the United States Supreme Court addressed the constitutionality of two provisions in the Patient Protection and Affordable Care Act (ACA): (1) the “individual mandate”, and (2) the expansion of Medicaid and corresponding federal funding.

The Court held that the individual mandate is constitutional, but the Medicaid expansion provision is in part unconstitutional and, therefore, the Government may withhold new, additional funds, but not existing funds, from a state that fails to comply with the ACA’s Medicaid expansion requirements. Beyond the Medicaid expansion provision, the Court’s decision leaves the ACA, including all provisions applicable to insurers and health plans, fully intact.

Below are the issues the Court heard followed by the majority decision on each issue.

Issue 1: Is the individual mandate constitutional?
Decision 1: Yes. The individual mandate may be upheld within Congress’s power under the Taxing Clause, not the Commerce Clause, of the Constitution.

Issue 2: Can Congress require states to expand Medicaid eligibility as a condition of receiving any federal funding for their existing Medicaid program?
Decision 2: No, the Government may not withdraw existing Medicaid funds for failure to comply with the requirements set out in the Medicaid expansion provision of the ACA, but may withhold additional funding designated solely for the expansion.

Issue 3: Does the holding affect other provisions of the Affordable Care Act (a.k.a. the “severability” issue)?
Decision 3: No. The rest of the Act remains intact.

Issue 4: Is suit barred at this time by the Tax Anti-Injunction Act?
Decision 4: No. The Affordable Care Act does not require that the penalty for failing to comply with the individual mandate be treated as a tax for purposes of the Anti-Injunction Act. The Anti-Injunction Act therefore does not apply to this suit.

CoreSource will continue to support its clients’ compliance implementation efforts, given the ACA provisions will remain in force.

In addition, CoreSource remains very active in the Benefits Administration industry and serves on the Board of the Self Insurance Institute of America. This association actively engages state and federal legislators to ensure its member clients’ interests regarding self-insured health plans are well represented.

CoreSource along with SIIA have strongly supported the positions of our self-insured clients and will continue those efforts to strive for the best regulatory and market environment for our clients and their members.

Please contact your CoreSource representative if you would like to further discuss your questions or how we can support you through the HealthCare reform requirements.

Shortage of Primary Care Doctors Increase Emergency Room Visits

 Emergency room visits are on the rise. According to a recent press release, the Centers for Disease Control and Prevention (CDC) gauged that emergency room visits have increased 1.8 percent for the overall population, and 2.9 percent for those older age 65. The stats cover the span of 1997 to 2009.

During a similar timeframe, there’s been a steady decrease in the number of practicing primary care physicians. Some healthcare providers see a correlation between the lack of primary care physicians and a greater use of costly emergency rooms when individuals become ill. Why fewer primary care doctors today? Experts point to the fact that more medical school students are turning to specialist fields rather than primary care or preventive care. By 2025, there will be an estimated shortage of up to 44,000 primary care generalists in the U.S.

Such a shortage, however, offers an opportunity for employers to provide onsite wellness, screening and fitness services for their employees. While complete physical examinations and some other procedures might only happen in doctors’ offices or outpatient clinics, many of the top cost-effective preventive medicine services that can be offered in the workplace can help fill this healthcare gap. According to studies, employers that implement such preventive services can help curtail costly emergency room visits, improve the health of their employees and reduce absenteeism.

A list of the most cost-effective preventive medicine services was published by the National Commission on Preventive Priorities, in conjunction with Partnership for Prevention, an organization working to make evidence-based disease prevention a national priority.

Additional information for employee benefits brokers:

These findings create the perfect opportunity for brokers to market such onsite wellness services and wellness programs, such as CoreSource’s YourCare, to employers.

Which of the following top cost-effective preventive medicine services for workplace-age adults are your employer clients either providing onsite or encouraging their members to discuss with their doctor?

• Daily aspirin use for men older than 40 and women older than 50
• Smoking cessation advice and help to quit
• Alcohol screening and brief counseling
• Colorectal cancer screening for adults older 50
• Hypertension screening for adults 18 and older
• Cervical cancer screening for women
• Cholesterol screening for men 35 and older and women 45 and older
• Diabetes screening
• Diet counseling

In order to help brokers outline the depth of need for wellness onsite services to their employer clients, more information is revised and provided each year by the U.S. Preventive Services Task Force and entitled “The Guide to Clinical Preventive Services.” This guide offers schedules and recommendations for screenings, tests and exams, according to age and gender.

New claims data points to higher healthcare costs in spite of lower utilization

Questions behind healthcare use, costs and spending have vexed Americans for decades. Now a non-profit, non-partisan group called the Health Care Cost Institute has gathered a huge data trove from three of the largest health insurers, Aetna, Humana and UnitedHealthcare, to more closely determine actual cost drivers.

A Politico article cited that healthcare costs rose 3.3 percent in 2010 even though people were using fewer services than before. This indicates, according to Politico, that spending did not focus on unnecessary procedures and treatments but rather on healthcare services themselves becoming more expensive.

This first-year study reviewed 3 billion claims for 33 million individuals with employer-sponsored insurance, filed in a single year. Previous to the availability of the Health Care Cost Institute data trove, researchers relied mainly on far smaller surveys and Medicare data. Until now, researchers found it difficult to determine how people younger than 65 used healthcare services or how the private market drives costs.

As for lower utilization of services, an article in the Washington Post surmises that the dip could be connected to the recent recession and sluggish recovery. Many analysts also argue that lower utilization stems from the rising prices patients pay for care, as well as the decision by many employers to push more cost of care onto workers via higher deductibles and other out-of-pocket costs.

Doctors Discuss Pros and Cons of EHR Systems

With any new or evolving technology, some features will impress users while others will fall short. The same holds true for doctors who use electronic health records (EHRs).

The ability to more thoroughly document patient exams, which can lead to more charge captures, is one capability that doctors who use EHRs enjoy, but some physicians have been disappointed to discover that there are no guarantees for increased office productivity, according to amednews.com.

The Centers for Disease Control and Prevention reports that preliminary 2009 data showed 43.9% of physicians reported using all or partial EHRs in their offices, but the issue of whether the systems lead to improved patient care is still open for debate.

In a study published last year, Stanford University researchers found that EHRs did little to improve the quality of healthcare from 2005 to 2007. The research findings were published online in the Archives of Internal Medicine on Jan. 24, 2011.

Doctors Cite Overuse of Commonly Ordered Tests

 Nine U.S. medical specialty groups and more than 374,000 physicians joined together to pinpoint overuse of commonly ordered medical tests and procedures.  Unnecessary testing can both endanger patient health and drive up the cost of healthcare.

According to WebMD, examples from the groups’ compiled list of 45 things doctors and patients should question include:

• Exercise stress tests during routine physicals if you are at low risk for heart disease
• Antibiotics to treat an uncomplicated sinus infection; sinus infections are mostly caused by viruses, which do not respond to antibiotics
• Chest x-ray, cardiac stress test, or imaging before non-heart surgery
• A DEXA screening if you are a woman younger than 65 or a man younger than 70 with no risk factors for osteoporosis

CNN News blog “The Chart” also cited these tests from the list:

• A CT or MRI scan after fainting, if your behavior is normal and you have no seizures or neurological problems.
• A back scan within the first six weeks of lower back pain
• A repeat colorectal cancer screening more often than every 10 years if your results are normal

 This landmark campaign, called “Choosing Wisely,” is led by Consumer Reports and American Board of Internal Medicine (ABIM) Foundation. The aim is to get doctors to think twice about certain tests in certain situations, and to educate patients about unnecessary tests or to question ones that their doctor may suggest.

Obesity rate may be worse than expected

The U.S. obesity rate, a leading driver of rising healthcare costs, may be higher in than previously thought, particularly among women, according to the Los Angeles Times.

A recent study shows that the use of body mass index (BMI) in determining whether a person is underweight, normal, overweight or obese doesn’t take into account body fat percentage, causing the obesity epidemic to be underestimated, according to  CNN.com. Doctors involved in the study suggest that the current BMI obese threshold of 30 be lowered to 24 for women and 28 for men.

When people aren’t being diagnosed as obese, they’re not being told about their risk of disease or being given instruction on how to improve their health, according to U.S. News & World Report,   

The study was published in the journal PLoS One and conducted by Eric Braverman, M.D., president of the Path Foundation, a nonprofit organization in New York City dedicated to brain research, and Nirav Shah, M.D., who is now New York State Commissioner of Health.

 

Improving the Prognosis: Mammograms Mean Earlier Breast Cancer Detection

Mammograms detect cancer far earlier than any type of patient or physician examination. A recent study from the Swedish Cancer Institute in Seattle found that when mammograms detect breast cancer in women between the ages of 40 and 49, there is a trend toward earlier detection requiring less treatment, including lower likelihood of needing chemotherapy or reconstructive surgery.

 Other good news: When mammograms provide early detection of breast cancer, there is less chance of the disease recurring after treatment and lower mortality rates, than when detected by self-detection or a routine physician’s examination.

 Breast cancer affected more than 48,000 people in 2008, with over 11,000 individuals dying from the disease the following year. Many institutions are involved in the research and testing of new cancer treatments, such as the use of the mineral zinc.