Reimbursement

A report released last month by the California HealthCare Foundation found that total and operating margins in the state's hospitals were higher than they have been in the past nine years -- 5.1 percent and 3.1 percent respectively. But looking beyond those two basic numbers, hospitals are working on razor-thin margins.

A new study is adding fuel to the debate over the value of copay offset cards, used to defer a patient's copayment for prescription medications.

After President Obama suggested reducing "taxpayer subsidies to prescription drug companies" as an avenue for Medicare savings in his State of the Union speech, the Pharmaceutical Research and Manufacturers of America trade group went on the offensive, saying it would "upend the successful Medicare Part D prescription drug program by imposing government price controls on it" and "harm Part D's competitive dynamics, yielding higher premiums."

At President Obama's State of the Union address, Oregon Governor John Kitzhaber, a guest of Michelle Obama, might have been hoping for a mention of Oregon's ambitious Medicaid reform program, an ACO-like financing and delivery redesign that may eventually extend to Medicare members, public-sector employees and even privately-insured residents.

As a result of the Affordable Care Act and the additional 30 million new customers who will be shopping for and buying insurance products starting in October, health insurance companies are trying to find ways to change their business model. Whereas insurers' focus for decade has been on B-to-B relationships, this new world of healthcare consumerism will make it necessary to become focused on a retail consumer market.

Despite improvements, Medicare has once again been placed on the Government Accountability Office's high-risk list -- a designation the program has held since 1990.

When Senator Marco Rubio (R) of Florida said in the Republican response to President Obama's State of the Union address that "the biggest obstacles to balancing the budget are programs where spending is already locked in," the first example he then turned toward is Medicare.

For many physician practices -- especially those working with health maintenance organizations (HMOs) -- obtaining pre-authorization to perform certain treatments or procedures is a necessary evil: Physicians must request pre-authorizations accurately and in a timely fashion or they won't get paid.

The Internal Revenue Service (IRS) declared employer-sponsored health insurance tax exempt in 1943, and ever since health benefits have been an integral part of the American workplace and the greater economy. Today, it is at a crossroads, amid health reform, economic and demographic trends.

States that continue to resist the Affordable Care Act (ACA) are finding themselves in a tougher and tougher spot. It's hard to retain ideological purity while dealing with the nuts and bolts of implementation. Exhibit A is the health insurance exchanges. States can run their own exchanges, but those that decide not to act will find the federal government running their exchanges for them. So you will have the weird phenomenon of blue states running their own exchanges and red states ceding authority to the feds.