By Marni Usheroff September 16, 2015
Doctor visit ©Laura Smith
The headlines are hard to miss. “Experts See Big Price Hikes for Obamacare” and “Is Obamacare Destroying Wealth?” In any given week, local and national newspapers and magazines are packed with stories about healthcare service providers, hospitals, medical device makers and other companies whose businesses have been transformed by the Affordable Care Act.
The new law has flooded the marketplace with millions of newly insured people, created new costs and hurdles to doing business for some industries and outfits and opened giant windows of opportunity for others. It has even bred new rivalries and led to some unlikely alliances—for instance between big employers and labor unions who are fighting a tax on expensive insurance plans they say will force companies to cut benefits.
Last month, CoveringBusiness provided a primer on the new act for healthcare reporters who are just getting their feet wet on the subject. In the second part of this two-part series, we examine what aspects of the law in particular business reporters can mine to find great stories as they unfold.
New Payment Models
One way to hunt for good stories is to examine some of the new financial incentives the law created. For example, as required under Obamacare, Medicare is testing payment models that don’t pay medical providers a fee-for-service but rather reimbursements tied to the quality and outcome of those services, an attempt to encourage providers to offer higher quality care at a lower cost.
One of these payment models is the accountable care organization (ACO), a group of providers that work together to coordinate patients’ care, and in doing so, limit unnecessary services and slow the rise of health care costs. In return, ACOs can take a slice of the cost savings they provide to the government. Another model being tested is the bundled payment, a lump sum reimbursement for an overall episode of care such as hospitalization. In some cases, providers receive bonuses if they keep costs below established thresholds.
Both of these programs and other new models are being tested by the Centers for Medicare and Medicaid Services Innovation Center, a division tasked with evaluating new service and payment delivery models. The center’s website provides detailed information about the various programs it is exploring and which providers are involved.
Business reporters could sift through the participants to find out who has taken advantage of the new models and how they’re faring. Have the models actually lowered costs and how have provider revenues been affected?
Transparency Trackers
Obamacare is reshaping U.S. businesses in a number of significant ways.
In addition to experimenting with more economical ways to pay health care providers, the Affordable Care Act created a tool to track money paid to doctors by the pharmaceutical industry. Open Payments, as it’s called, hosts huge datasets on the CMS website revealing cash and gifts doctors and teaching hospitals have received from drug and device manufacturers.
The data, meant to expose and reduce financial conflicts of interest, goes back to 2013 while the most recent set was released in June. ProPublica has built its own more user-friendly application that also includes information on some companies from as far back as 2009, data that was made available as a result of legal settlements with the federal government often related to lawsuits alleging improper marketing or kickbacks.
As ProPublica points out, reporters can parse the data for stories in a variety of ways. For example, a business journalist covering a regional or local beat could find out if the top prescriber of brand-name drugs in that area also got substantial money from the drugmaker. It might also be interesting to see if pharmaceutical firms have reined in physician compensation now that this data is public, and if so, are they finding other ways to influence doctors?
But reporters should make certain they put any data used into proper context. Just because money has changed hands doesn’t necessarily imply malfeasance. Contacting the parties involved and an outside expert or two is key to clarifying these numbers.
Digital Dollars
Another more oblique approach a reporter can take to following the money is to track the startups cashing in on health care reform and the investors willing to bankroll them.
The Affordable Care Act has ushered millions more customers into the health care market while promoting transparency and greater efficiency in the industry, which presents a tempting opportunity for tech companies. In fact, since the passage of Obamacare in 2010, more than 90 new health care startups have launched themselves into the world. And venture funding for digital health firms more than doubled last year to $4.1 billion.
By reading digital health funding reports issued by industry watchers such as analytics firm CB Insights and venture capital fund Rock Health, business reporters can see what kinds of innovations are being encouraged by the newly expanded market. Journalists can also explore whether these innovators are indeed disrupting the traditional marketplace and how that’s affecting providers, insurers and consumers.
Controversial Taxes
Taxes © Images Money
Implementing the most massive health care industry overhaul since Medicare and Medicaid were created in the 1960s has been predictably challenging and fraught with battles pitched around issues that range from passing the law itself to rolling it out. Keeping tabs on potential areas of conflict the law has created can be another way for business reporters to mine it for stories.
One such point of conflict are the new taxes the Affordable Care Act created to finance health care reform, close loopholes or incentivize providers and consumers to uphold the law. These included everything from taxes on medical device makers to tanning salons to generous employer health plans.
The affected industries have been fighting these new taxes, and it might be worth looking at what those taxes have done to their businesses. Explore the law’s taxes and fees as laid out by the Kaiser Family Foundation and check out how the involved parties are faring.
Rocky Rollouts
Another tip for finding tension points: talk to knowledgeable health insurance brokers and consultants that specialize in helping companies with Affordable Care Act compliance. Ask them about finer points of the law yet to be rolled out for employers, and whether they present any issues.
For example, medium-size employers have until 2016 to start providing health insurance coverage to their workers. But come tax time next year, those companies still must file a return with the Internal Revenue Service showing whether they offered coverage to their workers this year and what kind. Employers also must give employees an additional form in January along with their W2 stating that information.
But it’s no simple task culling the data for these reports. Employers must match up human resources and benefits stats on a monthly basis for every worker. Many companies may be caught off guard, especially if they wait until year’s end to start the process. And if they don’t file this information with the IRS, businesses might be fined $100 a worker with totals of up to $1.5 million.
Brokers and consultants can offer insights into issues like these and others that insurers, employers and consumers might face with new Obamacare-era insurance plans or during enrollment periods.
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The Kaiser Family Foundation offers great resources for understanding the ACA. Also check out the original source at the U.S. Department of Health & Human Services’ website.
