Journal of Urgent Care Medicine

Oops! ACA Architect Says Small Practices Make ‘Better’ Improvements Than ACOs

Industry insiders have watched accountable care organizations (ACOs) thrive at the expense of smaller practices—including more than a few urgent care centers. Now one of the architects of the Affordable Care Act (ACA, also known as “Obamacare”), which laid the foundation for the ACOs, is having second thoughts. Bob Kocher, MD, who as a special assistant to President Obama helped shape the ACA, writes in a Wall Street Journal op-ed piece that in spite of …

On the Heels of Medicare Fraud Sweep, Advice on Creating a Compliance Program

Recently we told you more than 300 people were charged with healthcare fraud involving some $900 million in false billings. Surely some were out to juke the system, but others were probably guilty of nothing more than poor compliance practices. Either way, the government is likely to continue cracking down on this multibillion dollar waste, making it a prudent time to shore up your own compliance program (as required under the Affordable Care Act [ACA, …

CDC: One Out of Five Visit a U.S. Emergency Room Every Year

New data from the Centers for Disease Control and Prevention reveal that one out of every five Americans visits a hospital emergency room at least once a year, with California, Florida, Illinois, New York, and Texas accounting for more than a third of all ED visits nationally. The report also reconfirms that most of these patients are adults who are not admitted to the hospital. Of interest to urgent care operators, the national rate for …

New Data: Hospital Bills Don’t Discriminate Between Insured and Uninsured

New data from the National Bureau of Economic Research (NBER) indicate that while the Affordable Care Act (ACA, or “Obamacare”) has made sure more Americans have health insurance, it has done little to make care more affordable across the board. While nearly 90% of the country has coverage, NBER statistics show that more people than ever find basic healthcare unaffordable. A recent study of over 1 million patients from 2003 to 2007 illustrates just how …

Urgent Care Surges in Southeast Michigan

Southeast Michigan is seeing a surge of urgent care growth this spring—and industry watchers are saying operators can thank President Obama, in a roundabout way. Regional growth started to pick up speed after the Affordable Care Act (ACA, or “Obamacare”) was passed in 2010, fueled by an influx of newly insured patients who need care immediately, but who may have been steered into urgent care by employers hoping to stem rising emergency room bills. With …

Advantage, Urgent Care? Plans Are Already Passing ACA Losses Off on Members

Urgent care operators may have new leverage when negotiating reimbursements or appealing to cash-paying patients in North Carolina. Blue Cross and Blue Shield of North Carolina (BCBSNC) says it has lost $280 million by covering residents under the Affordable Care Act (ACA, or “Obamacare”)—and in response, it’s filing for a 2017 rate increase of 18.8%. BCBSNC says higher-than-expected ED visits and orthopedic treatments (the cost of which could be greatly diminished if appropriate patients visited …

With Less Competition, ACA Insurers Plan Major Price Increases

With many health insurers already scaling back—or vacating—state exchanges under the Affordable Care Act (ACA, or “Obamacare”), companies that plan on continuing to offer coverage may start charging members more for the “privilege” of being insured soon. Insurance industry projections show that many states could see jumps of 20% or so, while plan members in Pennsylvania and Georgia could see premiums go up by more than a third next year. Initially, 23 health insurance co-ops …

Fewer Americans Are Uninsured—But Is ACA a Success?

The percentage of uninsured Americans dropped below 10% by the end of 2015, compared with 16% when the Affordable Care Act (ACA, or “Obamacare”) was enacted in 2010. While the Obama administration chalks that up as a “win,” ACA critics question whether patients covered under ACA-supported plans have adequate coverage. Further, insurers have complained that offering coverage through ACA’s state exchanges is not cost-effective, with UnitedHealth and Humana deciding to stop participating in many states. …

CMS Chief: Healthcare.gov ‘Failed Millions’

Acting Centers for Medicare and Medicaid Services administrator Andy Slavitt has acknowledged that Healthcare.gov, the platform through which previously uninsured Americans have accessed coverage under the Affordable Care Act (ACA, or “Obamacare”), has “failed millions” since its launch more than 2 years ago. While he claims inherent problems in the system have been fixed, he says he recognizes the consequences of clunky EHR systems, low reimbursements, burnout, and various compliance requirements for primary care providers—consequences …

ACA: A Bust for Insurers, a Boon for Big Hospital Systems

Where the Affordable Care Act (ACA, or “Obamacare”) is proving to be a major financial challenge for insurers, some large hospital systems are experiencing a windfall since it launched. Tenet and HCA Holdings each say that ACA member admissions were up significantly over the previous fiscal year’s results. Tenet reports a 28% increase in inpatient admissions for that segment, with overall patient revenue going up 6%; HCA’s ACA inpatient hospitalizations were up 27%. The companies have …