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January 5, 2011

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January 5, 2011

Making Sense of Healthcare Reform Changes (part II)

Passage of HR3590, the Patient Protection and Affordable Care Act, has created fear, confusion and uncertainty among doctors and consumers. Far from being a panacea for “fixing” America’s healthcare system, the bill contains many pluses and minuses. And if you’re like most physicians, you want to know how these will affect you and your practice.

In this second of a two-part series, we’ll look at three remaining major provisions of HR3590 and how they affect you and your patients from a plus-minus standpoint. These provisions took effect on September 23, 2010. Our primary sources for this article were WebMD’s September 21, 2010 edition of Medscape Today and the AMA’s booklet entitled WHAT HEALTH SYSTEM REFORM MEANS TO PHYSICIANS AND PATIENTS.

Provision 3: No Coverage Denial for Children With Pre-Existing Conditions

Once a real heartbreaker for parents with sick children, this provision prevents denial of coverage to children under age 19 due to “pre-existing conditions.”

PLUS: More Care for More Children
This will bring many newly covered children into our healthcare system. Pediatricians and family physicians may see an increase in the number of young patients in their practices. Young children with chronic pre-existing conditions will likely need to see specialists such as ENTs and allergists. There will be more reimbursable preventive visits that require less work. Physicians will gain opportunities for increased revenue by offering ancillary services such as weightloss, wellness and anti-aging and hiring PAs or NPs to provide these services.

MINUS: Higher Price Tag
This coverage will cost insurers and American society. Patients may be confused about co-pays and cost-sharing for preventive visits. More patients may lead to scheduling and access problems for health practices. And preventive visits will have to remain strictly focused on preventive care in order to receive full reimbursement. This provision will have a major cost to society and may worsen the physician shortage.

Provision 4: Extending Dependent Coverage for Unmarried Adult Children to Age 26

PLUS: More Healthy Patients
People under 26 who don’t have health problems typically don’t think about doctors and screening tests. But given the opportunity to get a physical or preventive exam at no cost to themselves, many will likely have regular preventive exams. Even those with minor problems are more likely to utilize preventive care to prevent major problems. The healthcare system should benefit from seeing patients who are healthier. This extension of coverage to young adults allows physicians to continue to care for children of families they’ve been treating. It also gives physicians a new business opportunity – marketing to young adults who are health-oriented.

MINUS: Exacerbates the Primar-Care Physician Shortage
A large influx of new young adult patients will stretch the scheduling limits of primary-care doctors who are already in short supply. Methods of healthcare delivery will be forced to change to handle these new patients. The new methods may negatively impact physicians.

Provision 5: Insurers Cannot Drop Policyholders for Becoming Ill Except in Case of Fraud

Dropping coverage for sick policyholders is a hot-button issue that infuriates consumers. It’s hard to defend any insurer that does this. Now, thankfully, no one will have to.

PLUS: Continuity of Care
Doctors can continue to treat their sick patients unimpeded by moral or ethical questions about stopping care for patients who have lost their coverage.

MINUS: Huge Cost
The benefit, while indeed a lifesaver, has a huge price tag for society. This affects doctors by way of potentially lower revenue payments to cover healthcare costs as well as increased taxes that could be levied on higher-earning citizens in general. Private insurance rates may start to climb.

“I have received reports from patients that the rate at which premium increases are increasing is escalating,” says Hood. “It may be that insurance companies are strategizing that they won’t ‘rescind coverage,’ but they will price it so that the patient elects to change to a government plan.”

What Is Regenerative Medicine and Why Should You Consider It ?

Every day, more and more doctors look for ways to attract more revenue to their practices. They add cash-based services such as fitness, weightloss, wellness, anti-aging and cosmetic services such as microdermabrasion and BOTOX® – services their patients are willing to pay for – to improve cash flow and reduce reliance on insurance reimbursements.

Quick. Can you name the fastest-growing, hottest medical specialty in America and the world? The answer may surprise you. It’s anti-aging or regenerative medicine. It’s the proverbial ‘Fountain of Youth’ and patients are flocking to it like hungry seagulls. The biggest growth factors are the aging ‘boomer’ population and the general public’s heightened interest in quality-of-life issues and longevity.

The American Academy of Anti-Aging and Regenerative Medicine (A4RM) was established in 1997. It’s a professional physician certification and review board that offers fellowship training and board certification. There is also a new master’s degree in medical sciences, metabolic and nutritional medicine at the University of South Florida School of Medicine. It’s the first curriculum of its kind in the US. What’s more, according to a February 2009 report by Global Industry Analysts, the worldwide anti-aging products market is expected to reach nearly $292 billion with the United States’ portion of that market exceeding $5 billion by the year 2015.

This exciting new specialty focuses on early detection, treatment and reversal of age-related conditions that cause human decline. Ongoing research into anti-aging is well-documented by peer-reviewed medical and scientific journals. It uses evidence-based methodologies for patient assessments. Regenerative medicine optimizes the body’s built-in self-repair capabilities and adds proven and near-future regenerative treatments and technologies.

Now is a great time to consider incorporating regenerative medicine into your practice, especially if you are a cosmetic surgeon or dermatologist. These specialties include fee-for-service practices with similar demographics and office settings. Expect other specialists and generalists to jump on this bandwagon as the movement gains strength and advocates.