>>the affordable care act is officially underway, and we will hear how that is affecting florida insurance carriers
>>it is a first step towards reducing the number of un insurers in the state of florida
>>then, we'll speak with a central florida economist about the impact of this legislation on the economy >>what does it mean to the average family? and i don't think we know that answer yet.
>>but first, we'll examine the affect of the affordable care act on the medical community and patient care.. >>what we are really trying to do is focus on proactive, preventative care
>>three central floridians talk about the affordable care act and what it means to you. next, on metro center outlook. [music] >>hello, i'm diane trees.
i apologize for the raspy voice. i'm feeling a bit under the weather today. we have an appropriate topic to discuss. the affordable care act has certainly created a lot of conversation lately
about what affect it might have on medical care. joining us now is dr. anjali vyas, who is ceo of fpg healthcare, an accountable care organization. dr. vyas, welcome to the show.
>>thank you for having me. >>do you think in a general sense most physicians are supportive of affordable care act? >>umm..i think you'll find there are physicians on both sides of the bench on this.
i think that a lot of them, if they're smaller, independent groups, do feel overwhelmed by the volume of change that's happening in one time period. and they are definitely
happy across the board about the increased access to coverage for patients. but on the other hand, a lot of the new rules for them to be compliant for security rules and the new quality reporting has a lot of burden for them to
learn a lot in a short amount of time. >>with florida's refusal to participate in the expanded medicaid, the money there, how does that impact physicians? >>we're refusing funds that would have been very
helpful to be able to take care of these patients. from the perspective of a primary care physician, a lot of them don't get paid the same amount that they would a commercial patient. those medicaid patients
don't get the same access sometimes or sometimes don't have the same network that other patients may have. and so adding more funds to medicaid would not only expand who would have been covered with medicaid but
hopefully expand also with more wider network of physicians. >>so you think the affordable care act will help build more of a base for primary care physicians? >>i hope so.
i really think that should be one of the primary mantras of what we do here. umm and there's a lot of things that are faced that are not gonna move out of our realm of worries just because the a-c-a has been
implemented. we do have a primary care shortage coming up in front of us. so we have to find a way to get more physicians that are coming to the workforce to want to go into primary care and tell
them this is a good place to go into besides specialty care, which is what has had a lot of volume and where a lot of physicians go. >>now with the affordable care act, there's been a lot of criticism that it
steers physicians away from a private practice towards more of a larger medical network. are you seeing that as a trend? >>i am. i think that is a true statement.
because the needs for efficiency and population health is very difficult if you're independent. so there's a natural progression of physicians, especially the ones coming out of the workforce now, coming out of residency to
go into an employed model and have large consolidated networks. i think there's going to be pros to this and i think there's gonna be cons to this. that we will have to see as time progresses.
the a-c-a is a platform that will need adjustments and changes if there are some bad unintended consequences of consolidation; we need to address those. >>well the a-c-a does move toward a parent system
that awards better efficient care. how does that differ from the model that we currently have in place? >>so it differs in a big way. right now if you are a physician and you've
been practicing for ten years, you usually would be billing fee for service. so your focus is volume and to see a certain amount of patients per day and that's how you would calculate your profit
margins and you would be focused on episodic care because that's how you are traditionally financially aligned. the new system will be giving you care based on, well as for the a-c-o it's based on more, how
much the cost of care has been historically per member, per beneficiary, and how much you can save by reducing unnecessary costs. and the coviat to that is not to not provide care. it's to be able to have
an incentive to look at where we are being very inefficient with the care we're providing or providing care that's not necessary. for example, if someone has already gotten an echocardiogram within the
last six months but they've gone to a hospital. and that hospital doesn't have the records of that last echocardiogram, which is an ultrasound of your heart, they may repeat it
if they don't have that information. that is something that is unnecessary. >>so it's a duplicate of services. so are you looking at less in patient hospital stays and services as a result
of the a-c-a? >>i think naturally that will happen because what we are really trying to do is focus on proactive, preventative care. so if we're doing the right thing for patients, which is taking care of
them before major problems start, naturally you're going to have less in patient care. because that is where you go for acute episodes of problems that have occurred over time. there is definitely still
a value to hospitals and in patient care, but if we are preventing more complications of chronic diseases, you will naturally see a decrease in in patient care. >>do you think that with the new rules in place
that people will be more prone to pursue preventative kind of care for themselves through primary care physicians? >>i think they will. and the reason why and i'll focus on sectors because it will adjust
with different age sectors or different sectors of degree of disease burden, but i think looking at the law, the patients that have a large amount of, or a few chronic diseases, such as diabetes, coronary artery disease, and
they're elderly, they are gonna really benefit from the fact that we're gonna focus on population health, so that they're gonna have a team that they're gonna be able to access that will help them be engaged with their
care. and what i mean by that is that, currently under the fee for service model, if you have two chronic diseases, you're seeing your primary care doctor and a specialist or two, the time you ask questions
is in the visit, but so many times you don't ask those questions at that time because it's overwhelming. so they need to know that they have a team behind them that they can contact for education to know when
it's appropriate to go to the hospital, to know about interactions with their medications, and that is really when we're gonna see the benefit of this newer model care because that will again reduce the
amount of unnecessary procedures or in patient admissions that were happening because of lack of education or medication interactions. >>so what do you see as the biggest impact for the medical community that the
affordable care act is really making? >>i think the biggest change for them in the short term is that we're gonna have to change quite quickly about our clinical work flow and we're gonna have to change with
the burden with new regulations that have passed. some of the regulations make sense. there are some about security and patient privacy, but to operationally get a clinic
to adjust to that, requires a lot of investment of money and it requires a change of how you operate on a day to day business. everyone knows change is hard. so for the short term, i
think the medical community is gonna feel the brunt of that because it's confusing. there's not one way to slice and dice it. long term, i think the medical community will improve because the focus
on population health is where we should be. we need to focus on how to make a population more healthy. and that is in the benefit of the patient and the benefit of our community. >>that's very
optimistic. thank you dr. vyas for being here. >>no problem. thank you for having me. >>when we come back, we'll focus on what affects the affordable care act is having on the
insurance industry. >>javier mendoza is the vice president of strategic marketing and product development for av-med. welcome javier. >>thank you diane. it's a pleasure to be
>>we're here to talk about the affordable care act and there is still so much confusion. as an american citizen, am i required now to have medical coverage? >>under the affordable care act, all u.s.
citizens and legal residents are required to purchase and or have health insurance. and if you don't have it then you will be subject to a penalty. under the affordable care act, u.s.
carry insurance. >>so if i have coverage through my employer, do i need to do anything? >>if you have coverage through your employer, you don't need to do anything because you already comply.
and as a result of that, when you file your tax returns, you would be able to indicate that you do have the coverage and therefore would not be subject to the penalty. >>if i don't have coverage, am i required to
go through an exchange or do i have the option to go through private carriers for coverage? >>you have the option to go either to the health insurance exchange, which can be found at w-w-w health care dot gov or you
can purchase insurance directly from carriers. the advantage of going through the exchange is that for individuals who have household income, the low full hundred percent of the federal poverty level, those individuals
would be eligible and may qualify for subsidies in the form of advanced premium tax credits to be used to purchase health insurance. that's where you can get the subsidies, is on the exchange.
if you purchase insurance off the exchange, then you would not be eligible to receive those subsidies. >>so can my application be denied now ? >>under the new rules, those individuals that are eligible for coverage and
apply for coverage during the annual enrollment period, which ends now march 31, their applications can not be denied for coverage. so it's a little different than what it used to be, especially in
the individual space. >>now the goal of the, i say a-c-a to abbreviate, but the goal of the a-c-a was to reduce the number of uninsured. with florida, we chose not medicaid expansion, how's that affecting
numbers here for our state? >>i mean obviously, with florida not expanding on the medicaid, there will be a portion of the population that will still either have some coverage or may not eligible for
the subsidies. but for the overwhelming majority of individuals who are not eligible for medicaid, and there are many, the affordable care act will give them access to affordable care and part of that will be
through the availability of the subsidies, the advance premium tax credits, that they can attain on the exchange. so it is a first step the state of florida and hopefully over the course of the next several months
and upcoming years, we will address the rest of it as it relates to medicaid eligible individuals. >>one of the biggest, i think fears that i hear when people talk about the a-c-a is they're afraid
that premiums are going to rise. are we too early to tell that or is that a misconception? >>well under the affordable care act, carriers are still allowed to make adjustments to
premiums. now what we're seeing is that there are certain things, for example like, additional coverage under essential health benefits. that is expanded coverage. there are new rules that come in with regards to
how the health plans are rating. how we calculate premiums for individuals. in addition to that, under the affordable care act, all health plans are supposed to spend 80 percent of their premium
on medical costs, so for individual and small group coverage. and for large group coverage, 85 percent of the premium should be spent on medical costs. when you take all of these things together, in some
cases there will be individuals who may see decreases in their premiums, in other cases you may see individuals who will see increases in their premiums. i think overall what we'll see as premiums is
reflection of medical costs that while it has been tempered in the last several years, medical inflation continues to creep up and that's also represented and reflected in the premiums. but overall, i think what
we'll see, are individuals in some cases with reductions and others with some increases as well. >>how has the affordable care act impacted private carriers like you? >>well the affordable care
act has about 22 hundred pages of legislation, which is the law. and with every piece of legislation then that produces numerous pages of regulations which is how we can implement the law. so it's really been a
significant amount of additional work. at the same time, it's been some good work because we've been able to implement portions of that are highly beneficial. so for example,
preventative care and coverage for that basically at no cost is a good thing for the community because it helps to emphasize well being and wellness and really allow individuals to start taking better care of
themselves. >>so a lot of the work is just understanding what's actually in place for the a-c-a i would think. >>that's correct. and the affordable care act went into effect in
march of 2010. so we have, since 2010, been implementing pieces of it as the timelines came up. the significance, the bulk of it, really came to fruition now in 2014. so i think what we'll
continue to see is refinement as the regulations are interpreted and at times they're not working the way it should be, so like every good piece of legislation and regulation, doesn't
necessarily always produce what it's intended reults are. >>at least right away. what if you could look out three years down the road from now? do you think we'll have the kinks worked out or is
this going to take a little bit more time? >>i think we're seeing progress already and i think we will continue to see a progress and the kinks being worked out. the good thing about the that it does provide for
greater access to affordable care. what is not known at this point and has yet to be seen is the results of that can go in to materialize. the admit health plans, we are very pleased with and
support, the legislation as it relates to expanding coverage for individuals. so i think that we'll see more work and we'll see that the tweaks taking place and improving it as we go along because it is a major piece of
legislation in and it's taken four years to get here, so it will take a little bit more time. >>well thank you for clarifying some of the aspects of it. thank you. >>my pleasure.
thank you for being here. >>after the break we'll talk about the economic impact of the affordable care act. >>dr. sean snaith is the director of the ucf institute for economic
competitiveness. welcome seaã„6 >>thanks for having me. >>let's talk a little bit about the affordable what's the impact for the average american citizen? a financial basis,
what's it going to be out of my pocket? >>good question. and i think the answer is indeterminate right now. there are a lot of moving parts with this law. pieces of which have been delayed as far as their
implementation itself. there's just a tremendous amount of uncertainty as to what, when it's all said and done and the law is fully being implemented and markets and the economy have had time to adjust,
what that bottom line is going to be. i mean a lot of what we heard in the debate leading up to the passage of the law has not come to pass. it doesn't appear that we're gonna see a 2500
dollar savings in premiums for each american family. what will we see? we don't know. and really that is one of the biggest problems i think with the law is that the way that the roll out has gone before and sort
of the ad hoc delays in various components of the law, we're just left with a lot of questions. and that's one as well. what does this mean for my bottom line? there are a lot of taxes involved and so there's
so many pieces here that are moving that when it's all distilled down, what does it mean to the >>well when you say the delays and the changes in that, how has that impacted the business community?
>>well i think uncertainty and particularly policy related uncertainty has been a defining characteristic of this recovery which is historically weak one, the weakest recovery since the great depression.
and i believe not knowing answers to a plethora of questions, whether they're related to the health care reform law or whether they're related to financially regulatory reform laws. without answers to these
questions, i think businesses are sort of frozen in place and for example, when it comes to hiring decisions, it's a basic measurement that a business has to do. will this person bring in more revenue to my company
than it's going to cost to hire him or her? well you look at that scale and if they're going to bring in more revenue than it costs to hire them, then they'll add to your profits and you'll go ahead and
you'll make that hire, but when there's uncertainty about what those costs are, you know what's going to be on the side of the scale and we just don't know. you know, our premiums going to go up, well they
ultimately go down. i mean, you've heard, i've heard, we've seen numerous studies and reports that are all over the place. and the bottom line is, we don't have an answer to that question.
and i think that has made businesses hesitant to hire. if we knew all those answers, whatever those answers were, good, bad or ugly. businesses could then go ahead and navigate
forward. it's the not knowing i think is the most- >>the uncertain continues with that. the latest congressional budget office report predicts there will be 2 million less full time
workers by i think 2017. do you think that that's an accurate prediction and what does that mean if so? >>the c-b-o report, and i mean c-b-o is generally held up as sort of a umm neutral party in accessing policy.
they don't come out and say this a good policy, this is a bad policy. they're presented with a policy, they look at it, and they go ahead and assess what the impact is on the economy. that study was talking
about really purely the labor supply side of the impact of this law, that is people who would just, because of the affordable care act, would leave the workforce. so that's a supply side- >>now when you say that,
do you mean employer or employee driven? >>in a labor market supply side is the employer. so those are workers who say hey i don't need to work to get health care. i'm not gonna work. i can get it through the
exchanges. so that doesn't address the demand side, businesses making decisions about hiring or making these judgements between full time versus part time labor and how they're going to manage
their labor force. that's not part of the c-b-o. so the c-b-o is just sort of on top of whatever the business side impacts are going to be on the labor market. so i think this is pretty
significant impact particularly on the labor market that's been struggling to recover, particularly with the labor force that has been shrinking nationally to see yep here's another 2 million people taken out
of the labor force. i mean, labor's a key resource. it's a key part of the output of the economy and to see sort of that resource dwindling away i think has rasied some concern.
>>in a short period of time as well i think. what do you see as the biggest impediment for success for the affordable care act? >>i think the size and the complexity. i really think that could
ultimately be the source of it's undoing or the source of its undoing or its source of ongoing problems. i mean this is a large portion of our economy and it's very complex and to try to centralize all that
we have with this law with the sector of our economy. history is not in its favor as far as having the government sort of consolidate that much control over a portion over an economy. it doesn't end well
historically. >>a lot of people have been tied into their employment because of health care coverage. with other options now, might that spur some entrepreneurial activity? >>i guess there is the
possibility of that. the you know poets among us who have been repressed having to earn a paycheck as a i have. i could just you know sit out in the field and write my poems, no not to be facetious.
i think this may free up the ability because i mean being without health care insurance is a bit of a risk. now of course, if you're an entrepreneur, you should be a risk taker, so if you're afraid to
leave your health care to be an entrepreneur, maybe you're not going to be much of an entrepreneur, i don't know, but there may be some freedom in there, but i'm not sure that that positive aspect of it is going to make up
for sort of the negative impact for a shrinking labor force. at a time when our population's getting older. we're seeing more and more people move into retirement, so draining
the labor force of people that are of working age might not be the best thing. sean thank you so much for being on the show. >>that's all the time we have for our show today. please visit
wucftv.org/metro,
Fpg Diabetes,for interactive features, special content and much more. thanks for joining us.
Since you now understand how to handle your problem, you are far better ready to make your right alternatives and adjustments in your own life. Understand that these tips will only be appropriate if you are using as a lot of them as you can, and so you must start off now to see quick outcomes.
No comments:
Post a Comment