The federal government will be allowed to tax people for failure to have health insurance. The U.S. Supreme Court ruled that the Patient Protection and Affordable Care Act is mandate requiring Americans to buy health insurance or pay a penalty is unconstitutional under the commerce clause but allowable under a taxing clause.
The landmark decisions end two years of legal uncertainty and vigorous barbecue and cocktail party debates. The decision has wide-ranging implications that are yet to be fully understood.
”The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax. Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness” Chief Justice John Roberts wrote in the ruling.
The 26 states that opposed it said that while Congress has the authority to regulate interstate commerce, it doesn’t have the power to require people to buy a product.
One area of the law that did see a significant restrict ion was the portion of the law relative to the expansion of Medicaid, the government health-insurance program for low-income and sick people. The ruling gives states some flexibility not to expand their Medicaid programs, without paying the same financial penalties that the law called for.
According to the Congressional Budget Office, the law will cost the government about $938 billion over 10 years. The CBO has also estimated that it will reduce the federal deficit by $138 billion over a decade.
It is unlikely this will be the last we have heard of it. Our politicians will still have more to say. And barbecues and cocktail parties will not be left bereft of conversation this summer.
If you missed BIO 2012, you missed a lot. The public and private sector came together this week on Boston to examine innovation opportunities to promote economic growth through collaborative research and development projects. The event drew 16,505 industry leaders from 49 states and 65 countries. Boston was host to universities, researchers, state, local and federal government economic development representatives, clinicians and private industries. This was science at its best at a truly global event. Discussions around where the biotech industry is going and how pharma is changing took center stage most of the week.
A positive trend was noted in a special state of bioscience development report that analyzes state and national biotech employment patterns. Despite job losses in the U.S. private sector, it showed that US biotech industry actually added jobs between 2001 and 2010. Throughout the week multiple conversations and meetings took place discussing how the ability to collaborate was a key element to attracting biotech projects. Many countries visited the Cisco booth to discover what they needed to do to create an infrastructure to welcome biotech development. How can governments work together with biotech companies to produce and atmosphere that welcomes and fosters innovation?
Last year Ernst & Young coined the term ‘Pharma 3.0’ describing an ecosystem where healthcare innovation shifts from being product centric to an outcomes focus. This market transition has come as a result of the generally recognized lack of a sustainable model in global healthcare concurrent with rapid advancements in healthcare technology. This paradigm shift has created multiple transitions in the healthcare market, including how products come to market and how corporate enterprises mobilize their resources. It has also has opened the door for traditional biotech and pharm companies to invest in non-drug innovations like Smartphone Apps and offering services aimed at improving overall health outcomes through disease management and coordinated care. This is happening at a time when patients are becoming more informed and more engaged with managing their healthcare decisions.
Speaking on a panel at BIO 2012 in Boston this week, Robert Prachar, senior vice president at Endo Pharmaceuticals Holdings Inc., stated that there is an abundance of information out there, but “The question becomes how we build decision-support systems that are patient- and physician-friendly rather than just whatever flows to the top in a Google search? Anyway you cut it, we are still in an employment-based health care system…If we start to deliver coordinated care that works, people will pay for that.”
A few years ago I surveyed around 500 hospital employees in all job categories and departments and asked what the biggest challenge to their workday was. Three of the top six responses contained “communication”. So today when I was reading an AHA report on patient flow I was not at all surprised to see communication winning the top prize as the most pervasive and the hardest problem to fix -- taking 60% of the votes. It outpaced the second runner up -- visibility to data – which came in with only 30% of the votes.
“There is strong agreement that communications is the most difficult obstacle to overcome”
-AHA Report of the 2012 Patient Flow Challenges
Dr. Daniel Z Sands
Communication concerns were seen to impact discharge, inefficient patient handoffs and insufficient post-discharge contact with patients. This is consistent with another study done by the University of Maryland on the impact of inefficient and poor communication, finding that U.S. hospitals conservatively waste over $12 billion annually as a result of communication inefficiency among care providers. Interestingly, the study linked communication issues with increases in the length of hospital stays which has a direct impact on profitability – accounting for nearly 53 percent of that $12 billion annual economic burden.
Another study by Thompson Reuters demonstrated an indirect relationship between average length of stay (ALOS) and operating income -- the shorter the ALOS, the better the operating income.
99% of patients said they would use telehealth services again. You can’t get much better than that. St. Joseph Health System successfully launched a telehealth pilot earlier this year using CiscoHealthPresence™ that allows patients, physicians and other health and wellness specialists in disparate locations to meet and consult virtually via immersive video and audio technologies. The telehealth pilot is part of St. Joseph Health’s Healthiest Communities initiative, which focuses on improving access to health care services and quality of care to the communities it serves. The results are impressive.
The pilot has now been live for four months supporting Urgent Care, Specialty Care, Chronic Disease Management, and Wellness and Health Improvement. Care has been provided to about 250 patients. In addition 99% of patients said they would use telehealth services again. 95% of patients seen were “completely satisfied” with their telehealth experience. The telehealth program is providing access to healthcare in areas where it previously was not accessible.