New York and New Jersey Hospitals making the Grade

In March of 2010 HealthGrades released the 7^th Annual Report on Patient Safety in American Hospitals Study. Four out of the five New York Hospitals honored are Long Island Hospitals.  These hospitals are Southampton Hospital, Saint Francis Hospital-Roslyn, John T. Mather Memorial Hospital and North Shore LIJ Huntington Hospital.  

The New Jersey Hospitals honored are Jersey Shore University Medical Center, Morristown Memorial Hospital, Ocean Medical Center and Our lady of Lourdes Medical Center. 

Hackensack University Medcial Center has received the honor of being named one of America’s 50 Best Hospitals in 2010. No other hospital in the tri-state has received this honor in 2010. Jersey Shore University Medical Center and Hackensack University have also received the Womens Health Excellence Award” for 2010.

Congratulations to all of our Long Island and New Jersey Hospitals!

About HealthGrades: Health Grades, Inc. (Nasdaq: HGRD) is the leading independent healthcare ratings organization, providing quality ratings, profiles and cost information on the nation’s hospitals, physicians, nursing homes and prescription drugs.

Health Care Reform Law Update

I have attached several documents that allow for you to understand in greater detail the major provisions of the law President Obama has signed as well as an overview of the changes that will occur when the Senate and House agree on provisions of the Reconciliation bill.

NEW HEALTH CARE LAW BASICS

SENATE BILL AND RECONCILIATION SUMMARY

Health Care Reform Passes Congress

On Sunday, March 21, 2010, the House of Representatives approved H.R. 3590, the Patient Protection and Affordable Care Act by a vote of 219 to 212. Following that vote, the House adopted H.R. 4782, the reconciliation package, which makes a number of changes to H.R. 3590, by a vote of 220 to 211. H.R. 3590 will now go to President Obama for his signature and enactment into law. H.R. 4782 will be sent to the Senate.

The rules of reconciliation require there to be twenty hours of Senate debate as well as consideration of amendments. Although the Senate Democratic Leadership and President Obama would like the Senate to complete action on the reconciliation package by the end of the week. Senate Majority Whip Richard Durbin (IL) has suggested that, although they have the 51 votes necessary to approve the bill, the Senate may not meet the weeks-end objective.

Senate Minority Leader Mitch McConnell (KY) has stated that Republicans plan to offer amendments on substance, with expected topics including medical liability, the individual mandate and the Medicare payment reductions. Republicans also will raise points of order against various provisions in the bill that may violate reconciliation rules. If the Senate adopts any changes to the reconciliation package, the measure will go back to the House for consideration, as such the Democratic Leadership is hoping to keep the bill “clean.”

Although the Senate expects to adopt the Reconciliation Bill, President Obama will first sign into law H.R. 3950, which includes the following provisions;

• FSA Cap of $2,500 effective January 2011 and indexed to CPI
• OTC limitation of medicines and drugs (i.e., to require a physician recommendation) effective January 2011
• High-Cost Plan Excise Tax with thresholds set at $8,500 for individuals and $23,000 for families effective January 2013 and indexed to CPI+1 percentage point

Upon adoption of the Reconciliation Bill, the effective date of the required changes above will be extended.

Other provisions of the legislation include:

• it bars health insurance companies from denying coverage to individuals with pre-existing conditions — the ban takes effect for children six months after enactment, and for all others starting in 2014
• within six months after enactment, it will prohibit health insurance companies from dropping people from coverage when they get sick;
• it bans health insurance companies, within six months after enactment, from placing lifetime caps on coverage
• it begins to close the Medicare Part D coverage gap for Medicare beneficiaries who have surpassed their prescription drug coverage limit
• it requires individuals to carry insurance or pay a penalty that would be the greater of $750 or 2 percent of income by 2016
• companies with 50 or more employees will be required to help offset the cost of insurance for their employees if taxpayers are footing the bill for those workers’ insurance;
• it establishes 50 state-administered insurance marketplaces to allow small businesses and people without employer sponsored coverage to buy insurance that meets new federal standards; and
• it expands Medicaid to cover everyone earning less than 133 percent of the federal poverty level, or $29,327 for a family of four

Stay tuned for changes as they happen over the next 4 years………….

Governor Patterson’s Budget Proposal Threatens NYS Hospitals

The Governor’s proposal would significantly increase the tax burden on hospitals, nursing homes, and home care providers at a time when they are already struggling to remain afloat. It would also cut an additional 20% from the indigent care pool, further weakening the already fragile health care safety net for New York’s most vulnerable populations. 

New York City’s Health and Hospitals Corporation—a public provider of an extraordinary volume of uncompensated care to low income, uninsured populations—stands to lose hundreds of millions of dollars under the Governor’s plan, and, as a result, forecasts a deficit of $1 billion for its upcoming fiscal year.

To get specific information on how your local hospital will be impacted by these proposed changes go to http://helpyourhospital.org .  Please spread the word and share with your family, friends, neighbors, and colleagues.  If you share this message with just ten people, together we can convince state legislators to reject Governor Paterson’s proposed health care provider taxes and cuts.

Thank you for taking the time to protect your community and support New York’s hospitals, nursing homes, and home health care providers.

US News & World Report Releases List of Americas Best Health Plans

Below please find links to:

Americas Top Health Plans

America Best Medicare Plans 

Flexible Spending Account Substantiation Mandate

Beginning July 1, 2009, IRS Notice 2008-104 mandated the auto-substantiation of Medical FSA and Health Reimbursements Accounts debit card transactions at pharmacies. 

Auto substantiation refers to the use of an Inventory Information Approval System (IIAS) to isolate eligible healthcare expenses. Eligible healthcare items purchased at a pharmacy that have implemented an IIAS will be substantiated at the point-of-service expenses. The IRS did give merchants a grace period thru December 31, 2009 to comply with the Inventory Information Approval System (IIAS).

This requirement may feel burdensome for employees using the debit cards at pharmacies that haven’t implemented the IIAS system, but will in the long run reduced the dreaded “pay and chase” events for third party administrators, will decrease participant fraud in your programs and reduce financial risk.

Two Levels of IIAS Auto-Substantiation

Healthcare Eligible Total (HET) Each card terminal at an IIAS merchant will “break down” the items purchased and categorize the expense as either healthcare eligible or non-healthcare.  The Healthcare Total is defined as all IRS Section 213(d) expenses (all Medical FSA eligible items).  All non-healthcare products will be declined at the point of sale and will require the customer to use a different form of payment other than the Flex debit card.

Prescription Subtotal (Rx-Only) many pharmacies will implement a higher level of IIAS that will separate the HET into two categories: Medical Over-the-Counter (OTC) and Prescription Rx. Even though this higher-level IIAS system is not mandated, it will facilitate administration for many prescription-only HRA plans.

If your pharmacy is hasn’t implemented the IIAS system your debit card will not be accepted.  A special interest group has been formed for IIAS Standard.  I have attached a list of Compliant IIAS Merchants click here.

Taking Control of the Healthcare Experience

I’m often surprised by the number of C-suite executives I meet who buy only “best in class” services and products, yet accept far less than this standard from the organizations that are responsible to manage their family’s healthcare experience.  While it often seems that we have little real control over the quality of our family’s healthcare experience, several new organizations are helping their members to receive far greater control than most would have imagined possible. 

PinnacleCare is one of a new breed of “private patient advocacy” service providers that empower their members to take back control of the entire healthcare experience.  PinnacleCare members receive efficient access to the finest healthcare experiences, expert guidance through the complex healthcare system and the assurance of leading the healthiest lives possible, whether at home or while traveling or living abroad. 

I’ve had the opportunity to meet with representatives of this fine organization, and urge all C-Suite executives to learn how this firm can help you and your family.  Click this link to access a video about PinnacleCare’s services, or this link to be directed to the section on their website that details the many membership options available.

Please feel welcome to contact me for a personal introduction to this firm and or additional information on Pinnacles services.

2010 HSA Indexed Contribution Limits

For High Deducible Health Plans & Health Savings Accounts

The Treasury Department and Internal Revenue Service released IRS 2009-29 which lists the new indexed amounts, adjusted for inflation, for High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs) under Internal Revenue Code section 223(g).

To whom do These New Inflated Amounts Apply?

These rates will apply to any employer offering an HSA and/or a qualified HDHP. Merely because a plan has high deductibles, will not in and of itself, make the plan an HDHP. In order for a plan to be considered a qualified HDHP, in addition to other requirements, the plan must satisfy minimum deductible and maximum out-of-pocket requirements. 

What are the New Inflated Amounts?

For  HSAs: The annual HSA contribution amount for individual coverage is $3,050 and $6,150 for family coverage. Catch-up contributions continue to be allowed for HSA eligible individuals age 55 and over. The annual catch-up contribution amount is $1,000.

For an HDHP: In order for a plan to be considered a qualified HDHP, for 2010, the minimum deductible cannot be less than $1,200 for an individual or $2,400 for a family. The maximum out-of-pocket cannot exceed $5,950 for an individual or $11,900 for a family. 

When do These New Inflated Amounts Go Into Effect?

The new inflated amounts will apply to calendar years starting January 1, 2010.

How do These New Inflated Amounts Impact Employers?

For any employer who currently offers an HSA and/or a qualified HDHP, employers must amend their plan documents and other marketing materials to reflect these new inflated amounts. Any employers who are considering adding an HSA and/or HDHP, should remember to build those plans keeping the above limits in mind.

New Jersey Prepares to Launch Accountable Care Organization

New Jersey is one of the first states to experiment with accountable care organizations, or ACOs, a relatively new health care model that is similar to the patient-centered medical home, or PCMH, and that links primary care and subspecialist practices with area hospitals to create an integrated delivery system. Providers are accountable for costs and the quality of care delivered, and bonuses and penalties are tied to overall spending and quality measures. Learn more

Money Saving Tips on Brand Name Medications

The next time your doctor prescribes a name brand medication it may be worth checking online or with your local pharmacy to see if there is any special money saving offers available.  Many of these brand name drugs have their own dedicated websites that will provide  specific information to obtain savings.  

Provided below is a SAMPLE of medications that have special money saving offers.  This is not an all inclusive listing, so if you do not see a particular medication listed you may want to research the medication online.

Check here to see the sample Brand Name money savings list.