The scramble by local hospitals to form their physicians and facilities into “clinically integrated” networks
that can do business with employers and health insurers has another huge motivating factor: Beginning January 2012, they can
also do business with Medicare, the massive federal program for seniors.
Indiana and other states face a struggle as they grapple with putting the health care changes into place in a relatively short
span of time while they also contend with the economic downtown and strained state budgets.
Caregivers anticipates coping with declining Medicare reimbursements while having to offer insurance to its employees.
As doctors threaten to drop Medicare patients, Congress delays cuts for another six months.
Physician offices will begin receiving payments from the Medicare that are 21.3-percent below
what they’ve been getting so far this year. Doctors still expect Congress to reverse the payment cuts, but physicians
and the Medicare program will have to reprocess claims, costing both extra money.
The latest idea from Dr. James Spahn, an Indianapolis health care entrepreneur, should help hospitals and nursing homes do
a better job of preventing severe bedsores, or pressure ulcers. That’s good, because Medicare and private health insurers
increasingly won’t pay to treat them.
Don Stumpp, manager of payer contracting at Indianapolis-based physician group American Health Network and president of the Indiana Medical Group Management Association, discussed the impact of the health care reform law on primary care physicians as well as the near-constant threat of a sharp cut in Medicare reimbursement.
Ball Memorial Hospital in Muncie and Bloomington Hospital were among nine U.S. hospitals that had been charged with submitting
false claims to the Medicare program.
Dr. Rob Stone wants the giant health insurer to convert to not-for-profit status and put him, an advocate of national health
insurance, on the company’s board.
As physician mergers increase in Indianapolis, a new study has determined that quality at large, multispecialty practices is at
least 5 percent higher and costs are 3.6 percent lower than at small group practices.
The two largest U.S. health insurance companies, UnitedHealth, based in Minnetonka, Minn., and WellPoint Inc., based in Indianapolis,
sell Advantage plans.
The new federal health care bill will put 500,000 more Indiana residents on Medicaid and lead to higher state taxes, Gov.
Mitch Daniels said Monday, but a government insurance proponent said it will help families and businesses.
Sweeping changes phase in slowly for most, but insurers, hospitals, drug companies, employers, workers, medical device makers
and more will eventually feel impact.
Drugmakers and insurers could gain millions of customers under the legislation, but the industry also will pay new fees and
face stricter rules that may shrink profit and fuel mergers.
To pay for the changes, the legislation includes more than $400 billion in higher taxes over a decade, roughly half of it
from a new Medicare payroll tax on individuals with incomes over $200,000 and couples over $250,000.
Insurers WellPoint Inc. and others would get a delay in taxes on premiums and high-cost medical benefits, along with additional
funding for expanding Medicaid, under a White House proposal
Obama, seeking to break an impasse over health-care legislation, proposes a plan that includes the first Medicare tax on unearned
income such as capital gains and higher fees on drugmakers.
State lawmakers say a proposed bill would help people get quicker access to in-home care that most seniors
prefer to nursing homes.
House and Senate versions of health care reform could halt the trend toward physician-owned hospitals.
The Indiana Division of Aging wants to change Medicaid rates to nursing homes to reward quality care and penalize the lack
of it, leaving the industry divided over whether to support the groundbreaking rule or to seek revisions and a slower phase-in.
