For those that know me, they know that I am passionate about unveiling the true cost of healthcare and making change that will impact all Americans. There is no greater %^$#* (my daughter reads these and I couldn’t think of an appropriate word to use) than in the area of dialysis. If you or a family member have a dialysis story related to cost you would like to share with me please reach out! Chances are you might not even know what is happening behind the EOB. The inflated charges and cost shifting that occurs (in some instances) is unbelievable!! I have seen some charges in excess of 2000% of what Medicare would reimburse!! At what point does it become a crime?

On August 27th, 2013, the Treasury Department and IRS issued final regulations on the Individual Mandate, otherwise known as the individual shared responsibility provision of Obamacare. Starting in 2014 individuals are required (mandated) to have minimum essential coverage. Individuals that choose to go without coverage will be subject to a penalty. The penalty starts at $95 per person per year or 1% of their income in 2014, whichever is greater. By 2016 this penalty will increase to $695 or 2.5% of the applicable income. I have provided a link to the Treasury Fact Sheet and as always, please feel free to contact me with any questions you may have.

Consumers can sign up for Obamacare Health Insurance Exchanges beginning October 1, 2013! By January 1, 2014 the exchanges must be operational and offering coverage in every state. Who will ultimately enroll? Will they be ready? How easy will it be? Will premiums be more or less, and what is in the fine print? I will be blogging about this issue on a regular basis so stay tuned for updates and testimony on the process itself!

September 23, 2013 is the date physicians and other covered entities must be in compliance with privacy and security changes announced by HHS in January. The final omnibus rule was published in the Federal Register on January 25, 2013.

Prompted by the U.S. Supreme Court striking down the Defense of Marriage Act (DOMA) the Treasury and the IRS have announced that all legal same-sex marriages will be recognized for federal tax purposes.

We are seeing a movement across this country where doctors are refusing to do business with the government. As a ‘payer’ of healthcare.  Many of them will treat patients enrolled in Medicare but they will refuse to submit claims to the government. Cash only please…

Read the article from Kaiser Health News

There has been a huge shift to self-funding when it comes to small employers. Savvy employers do not want to leave their fate in the hands of an insurance company as they make their way through the PPACA maze. CMC Consulting is instrumental in assisting these small employers as a co-fiduciary and in bringing clarity and solutions their way!

Several times a year I find myself in our nation’s capital visiting with various organizations, constituents and members of congress about healthcare and employee benefit matters. Shortly after PPACA was enacted I met with several folks addressing its various provisions, ramifications and the unintended consequences that were beginning to surface as the long-awaited and debated legislation was unveiled, for many, for the first time. One day in particular, I, along with a few colleagues, met with Gerry Shea, Assistant to the President for External Affairs with the AFL-CIO, and Lynn Quincy, Senior Policy Analyst with the Consumers Union. Regardless of what side of the aisle you sit on or lean towards, the commonality amongst everyone in these meetings, and everyone in the United States, is that we can all agree that PPACA did not address the fundamental problem with health care in the United States. Cost!!

As I was getting ready to exit the Consumers Union office I walked by their display of what seemed like hundreds of Consumer Reports. It hit me!! Not for the first time, but again!! I could stand there and compare price and quality for nearly everything I could walk outside and purchase, with the exception of health care. Why is that, and why do we as Americans allow it?

Last fall I was fortunate enough to cross paths with Dr. Keith Smith and Dr. Steve Lantier. They are the founders of the Oklahoma Surgery Center in Oklahoma City. I was listening to Dr. Smith speak at a conference and I was in disbelief that he actually meant what he saying. “Free market medicine, we post our prices, price honesty, true price transparency, we don’t mark up implant costs,…”. I found it all too hard to believe. Then I quickly realized that he truly was genuine about his message. My immediate reaction was to race to a microphone and professed my love. Wouldn’t you? You can go log on to their website and for every procedure they perform the prices are posted. Novel idea!! As a consumer, you can actually identify the cost of a procedure before the bill arrives. Game changer!!

Last week I received a message from Dr. Smith informing me that he just performed surgery on an individual from MT. Someone that lives in our great state needed to have a procedure performed. S/he obtained quotes from MT facilities and somehow managed to find the Oklahoma Surgery Center website where the same procedure was listed for 75% less. Free market does work! Dr. Smith gets calls on a regular basis from patients that never walk through his door. They are simply calling to thank him for posting his charges on his website so they have a place to start when they are having conversations with their providers about COST, the fundamental problem with our health care system in the US that was not addressed in PPACA.

Many employers and local governments across the US have taken the cost issue into their own hands and have started opening on-site clinics, some of which are tied to their self-funded group health plans, in an attempt to impact the trend of their health care spend. In MT, miCare was the leading force in this initiative when EBMS opened its first miCare clinic at its corporate headquarters in Billings, MT in 2006. The miCare clinic for EBMS employees is accessed by their employees and dependents that are covered under their self-funded group health plan. For the patients, the visits are free and in many instances the maintenance medications are as well. A step beyond price transparency – Free Medicine!