PPACA Supreme Court Hearings Coverage in Social Media Need Holistic View

When the Supreme Court hears Florida v. HHS, which contests President Obama’s Patient Protection and Affordable Care Act (PPACA) known as health care reform, the U.S. Supreme Court is set to issue one of the most important decisions in its history.

If PPACA is repealed it will be interesting to see if it is repealed in whole or in part.  The Supreme Court of the United States (SCOTUS) may excise the individual mandate requiring health insurance coverage, or it could strike it down entirely.  There is an excellent discussion regarding a case that both sides are expected to use, known as Wickard v. Filburn on Forbes, and other cases, entitled The 10 Cases You Must Know To Understand The Obamacare Case.  Widely read conservative Hoover institution has a post today referring to ACA as An Unconstitutional Misadventure, however it only addresses the individual mandate component of PPACA.  Let’s look at some of the proposed benefits in terms of efficiencies.  The biggest danger may be that popular press only review the impact of the Affordable Care Act in its simplest form, without reviewing several efficiencies that are embedded.

Note: our intent is to provide a non-partisan view of the HIT impacts, which are separate from the highly politicized consumer impacts.

You have no doubt read that the biggest resistance to PPACA is in response to consumers being required to buy health insurance.  The Constitutionality of this provision regarding the Commerce Clause of the Constitution is being heard because some believe that it over-regulates consumers for the apparent national good.

Many don’t realize that other legislative measures such as The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 are separate from PPACA.

From a clinical data and efficiency perspective, the HITECH Act is focused on creating efficiencies:

  • Meaningful Use of Electronic Medical Records ($27 billion plus in stimulus funds to wire up the hospitals and physicians in this country so that health records are electronic enabling efficiencies, analytics, etc. as well as standards for health care data interoperability which are desperately needed in health care to modernize it and remove paper.  Estimates are $77 billion in cost savings over time for EMRs.)
  • Health Care (Payment) Reform (using comparative effectiveness research [fusion_builder_container hundred_percent=”yes” overflow=”visible”][fusion_builder_row][fusion_builder_column type=”1_1″ background_position=”left top” background_color=”” border_size=”” border_color=”” border_style=”solid” spacing=”yes” background_image=”” background_repeat=”no-repeat” padding=”” margin_top=”0px” margin_bottom=”0px” class=”” id=”” animation_type=”” animation_speed=”0.3″ animation_direction=”left” hide_on_mobile=”no” center_content=”no” min_height=”none”][“…compare the effectiveness of different treatments for the same illness…”] to apply what the industry calls ‘quality measures’ to change physician payments from per procedure [FFS or fee for service] to pay for performance).  In essence this means that if a physician or hospital meets certain benchmarks of quality and patient population health they can receive more reimbursements for Medicare patients, and health insurance companies who support these health care providers can receive incentives as well.
  • Health Information Exchanges (ability to share information across multiple physicians, hospitals, and geographies, realizing efficiencies and enabling some of the provisions of payment reform), although HIEs are impacted by PPACA because Health *INSURANCE* exchanges are viewed as the mechanism by which consumers will purchase insurance. HIEs that exchange information about population health may have actuarial impact and pricing impact on the policies offered by Health INSURANCE Exchanges.

There is less uncertainly about a mandate that is separate from PPACA.   We  provide services to clients who must transition to a new medical coding standard called ICD-10. ICD-10 is a HIPAA mandate. Although CMS has delayed ICD-10 it is appears certain that this mandate will go forward.

The World Health Organization (WHO) sets this standard, and it was mandated prior to Obama’s election by Health and Human Services (HHS) Centers for Medicare and Medicaid (CMS) that it had to be used in this country.  But CMS just announced a postponement in this mandate from October 1, 2013 to a future, yet to be specified date.

We’ve  taken on some ambitious speaking engagements this spring covering these areas. One where we’ll be presenting is the American Academy of Professional Coders (AAPC) in April is entitled, “How ICD-10 and Payment Reform impact Hospital Revenue Cycles.”

Follow the discussion on Twitter athttp://www.twitter.com/marrigo, using hash tags #PPACA and #SCOTUS, as well as here on our blog.  Discussions available for health plans, hospitals and other providers at http://www.linkedin.com/groups?gid=1777488&trk=hb_side_g

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Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.

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