Audits and investigations into the effects of ObamaCare from congressional committees, government auditors, advocacy groups, and others.

“[T]he only sure way that we’re going to
bend the cost curve is by coming up with fundamentally new ways to deliver
healthcare services that improve efficiencies and enable us to get more medical care
for each dollar we spend. These ideas are going to come forward the same way
better ideas have always arisen – from start-ups backed by entrepreneurs,
supported by investment capital, coming together in search of profits. Yet PPACA
contains provisions that I fear tilt against these kinds of innovations. The legislation
relies instead on arrangements that could serve to entrench existing players.”

“At issue is a new payment scheme that pays renal doctors a lump sum, or ‘bundled payment,’ for taking care of dialysis patients. Under the program, the doctors mostly get one fixed payment regardless of how much time they spend with patients, or how many drugs and procedures they use in caring for these folks. These ‘bundled payments’ are a key feature of the Obama health plan. That legislation uses various forms of capitation to shift financial risk onto providers in a bid to cut down on the use of costly, and some argue wasteful, medical services.”

“The health reform law changes that: It raises Medicaid rates for primary care to match those of Medicare for 2013 and 2014. That, the Obama administration hopes, will lure doctors to accept Medicaid patients — and also prevent some costly emergency room visits down the line. But there’s a problem: The payment boost runs out at the end of 2014. While the federal government estimates that it will spend $11 billion raising provider rates for 2013 and 2014, no additional federal funds are appropriated beyond that. There’s already some thinking, among the health-care provider community, that a fierce lobbying battle could play out as doctors look to turn a short-term pay boost into a permanent one.”

“CMS’ goal here is to cut down on the number of procedures. The same device has been approved in Europe for almost 5 years and has gained widespread use by patients who want to forgo very invasive open-heart surgeries—for good reason. The minimally invasive approach poses a lot less hardship on patients. This ruling will force people to get open-heart surgeries that might have been avoidable. These decisions used to be left to patients and doctors. Now it’s clear that for costly procedures, Washington will be making more of these choices for us.”

“The Patient Protection and Affordable Care Act of 2010 (PPACA) – regardless of the view one has of the legislation – has created enormous disruption. And with disruption comes enormous opportunity, as well as risk. Many provider organizations (e.g. hospitals and physician groups) have responded to the changing healthcare delivery environment by safety in size through merger and acquisition. Payers are also buying or creating partnerships with hospitals, and hospitals are acquiring other hospitals and physician practices to become gigantic systems.”

“In February, the U.S. Department of Health and Human Services issued a ‘guidance bulletin’ regarding the compatibility of health savings accounts with Obamacare’s insurance regulations. According to HSA expert Roy Ramthun, the news isn’t good. ‘HSA plans will not be as affordable as they are today,’ says Ramthun.”

“If you like your doctor, you can keep her — unless you’re poor or disabled.
The latest installment of ObamaCare is a scheme that’s uprooting the elderly poor and disabled who get care under Medicare and herding many into state-run Medicaid plans.”

“As part of the Affordable Care Act (ACA), Congress directed the Centers for Medicare and Medicaid Services (CMS) to penalize hospitals with ‘worse than expected’ 30-day readmission rates. This part of the law has stimulated hospitals, professional societies, and independent organizations to invest substantial resources in finding and implementing solutions for the ‘readmissions problem.’ Although a focus on readmissions may have good face validity, we believe that policymakers’ emphasis on 30-day readmissions is misguided, for three reasons.”

“A majority of young doctors feel pessimistic about the future of the U.S. healthcare system, with the new healthcare law cited as the main reason, according to a survey released to Reuters on Wednesday.
Nearly half of the 500 doctors surveyed think the Affordable Care Act, President Barack Obama’s signature domestic policy achievement, will have a negative effect on their practices, compared with 23 percent who think it will be positive.”

“The biggest flaw in the Obama approach to bundling is that the administration is lumping the doctors’ services along with the cost of the technology that physicians use to treat patients and paying for both in the same ‘bundled’ payment. That means that if a physician chooses to use newer but pricier drugs to treat a cancer, for example, then the cost of the medicines will come out of the doctors’ bottom line.”