Random Health Care Notions

As most of you have noticed, I've tried to take an even-handed approach to the landmark health care reform law. I worry that the bill is designed to lead to care rationing and price controls, but I also think it could help small businesses grow and would-be entrepreneurs take the plunge, so I've taken a wait-and-see approach.

Barbara Schlaefer, owner of JC Rose Associates, an employee benefits insurance agency, advises businesses to first determine whether they qualify for the tax credit that applies to companies that have less than 25 (full-time equivalence) employees, that have an average wage of less than $50,000, and is retroactive to Jan. 1 of this year. (The IRS has released information about how to calculate FTEs for part-timers.) "This is going to impact quite a few companies because you have to contribute at least 50% of premium cost to do that," Schlaefer said, "and the majority of insurance companies I work with in Dane County require that you pay that for at least a single plan."

While more guidance is expected, small employers should also keep an eye out for federal grant money for wellness plans. Dane County has a pretty good handle on wellness — most local insurance companies already offer wellness plans — but the grants might mitigate cost.

Now, some downsides. Mandated additions to health plan design, however popular, will drive up premium costs, and companies will incur administrative costs with various requirements, including the tracking and documentation of which employees are insured and which are not. Starting in 2011, employers also are required to show the cost of employer-sponsored benefits on their W-2s, Schlaefer noted.

CPA Gordon Meicher of Meicher & Associates worries that very small businesses won't deal with paper work required to join the state-run health exchanges established under the bill, leaving them uninsured. These businesses typically lack the in-house expertise to handle heavy paperwork, and some treat their employees as independent contractors. "These same people are not going to join the exchanges," he predicted.

Another point for health care purchasers to consider: One criticism of the law is that likely lower Medicare reimbursements, combined with the lack of tort reform, will drive doctors out of the profession. Yet attorney Michael Skindrud, who chairs the Health Care Practice Group for Godfrey Kahn, noted the law funds grants to states for the development of alternatives to the current tort litigation for resolving patient malpractice claims. For a period of years, it also provides 10% bonus payments to primary care physicians beyond the amounts due them under Medicare, and provides incentives for general surgeons to practice in areas where there are care shortages.

In addition to demonstration projects designed to control costs, the law provides bonus payments to doctors whose nurse practitioners see patients and follow up with patients, another way to spread the physicians' skills over a broader set of patients. "People will find that sometimes they initially will be met not by a primary care physician, but by a nurse practitioner, and get good service," Skindrud said.

In other section of law, the federal government require states to pay doctors serving Medicaid patients at levels equal to what they would receive under the Medicare program, which is designed to address the disparity in pay between the two programs.

Finally, I offer praise for a Wisconsin Congressman. While his colleagues made backroom deals in exchange for their health care votes, U.S. Rep. Ron Kind led a coalition of 30 House members who used their leverage to actually improve the bill! Taking up the mantle of the Health Care Quality Coalition, a group of reform-minded Wisconsin health care organizations, the coalition convinced President Obama to endorse Medicare reform proposals that would reward quality care, which is the best way to control costs. Kudos all around!

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