The study explored the range of services community health centers currently need from supporting organizations in order to fulfill their mission as safety net providers. Our goal in this study was to examine the benefits and drawbacks of different organizational approaches to the issue, and found that Primary Care Associations (PCA), “sister” corporations, and other independent stakeholders each play a unique role in supporting community health centers. The study was commissioned by the California HealthCare Foundation (CHCF).
The presentation was delivered to the Northeast Home Health Leadership Summit in Boston on January 20, 2010. The presentation considers who the winners and losers might be in the post-acute care (PAC) industry under a bundled payment system, and examines the possibilities for adapting elements of existing prospective payment systems (PPS) to develop a PAC payment bundle. This speech also examines the financial implications of PAC bundling and ways PAC providers might evolve under a changing payment system.
The paper entitled, ‘"Must Have' Provisions under Health Care Reform," analyzed the potential impact of remedying three significant problems in the health insurance market and evaluated several publically available cost estimates for the proposed legislation. Our analysis focused on three solutions to insurance market failure: eliminating pre-existing conditions, waiting periods and cancellations; limiting out-of-pocket expenses; and eliminating annual and lifetime coverage limits. This white paper was delivered to every member of the Congress.
WASHINGTON, D.C. – Introducing a government-run health insurance plan could cause hospitals to shift a new financial burden onto patients with private insurance, raising premiums for those who already have coverage.
According to a new study by Dobson DaVanzo & Associates, LLC – published today on the Health Affairs Web site – implementing a public plan could place a variety of financial pressures on hospital management, resulting in sharply raised private insurance premiums if hospitals prove unable to curtail costs under a new system.
When public programs pay less than costs for the services their patients receive, hospitals attempt to shift costs to private payers in order to cover their expenses, modernize, and stay current with emerging technology. A health care system with a public plan could increase hospital pressures to shift costs.
"This paper supports the contention that a government-run plan that is aggressively implemented to include large proportions of the privately insured could test the U.S. health care financing system," write Allen Dobson and Joan DaVanzo, lead authors of the study. "Rising hospital private-payer payment-to-cost ratios could be followed by rising private insurance premiums. The result could be the antithesis of what advocates say is the advantage of a public plan: to curtail cost growth for the average citizen."
A large influx of individuals to a new public health care program could place tremendous strain on the nation's health care financing system, even if payments are set at Medicare rates plus 10 percent. While some hospitals may be able to absorb the initial costs imposed by a government-run plan, some degree of cost shifting could occur to pay for the new, and likely underfunded, public program.
Based on hospital financial data from the California Office of Statewide Health Planning and Development (OSHPD), the study was designed to show the effect of various reallocation scenarios on hospital patient revenue margins and private payer payment-to-cost ratios. The study indicates that a high level of enrollment of the uninsured would initially bolster hospital finances. However, when the privately insured begin to move from the private sector into the public plan, this positive effect is reversed and hospital patient revenue margins decrease. The mass reallocation of the privately insured to the government-run plan could lead to an increase in private insurance premiums to defray hospital costs, unintentionally forcing private plan enrollees to bear a portion of the costs of health insurance reform.
Article: "How A New 'Public Plan' Could Affect Hospitals' Finances And Private Insurance Premiums," Allen Dobson, Ph.D., Joan DaVanzo, Ph.D., M.S.W., Audrey El-Gamil, and Gregory Berger, Dobson DaVanzo & Associates, LLC, Vienna, Virginia; Health Affairs, September 15, 2009.
(Full text of the article is available at HealthAffairs.org.)
Dobson DaVanzo & Associates, LLC is a health care consulting firm based in the Washington, D.C. metropolitan area. The work of the firm's principals has influenced numerous public policy decisions, and appears in legislation and regulation.
The presentation was delivered to the National Investment Center for the Seniors Housing and Care Industry (NIC). The presentation was part of the Skilled Nursing Federal and State Reimbursement Update Session of the NIC Annual Conference on September 24, 2009. Dr. Dobson provided an overview of the Fiscal Year (FY) 2010 Skilled Nursing Facility (SNF) Prospective Payment System (PPS) final rule, and discussed how the future implications of Resource Utilization Group (RUG) IV, non-therapy ancillary payments, and post-acute care bundling may affect the SNF industry.
The presentation provides an overview of how post-acute care (PAC) payment bundling might be designed and implemented, and considered who the winners and losers in the PAC industry might be under a bundled payment system.
The presentation took place at the 2009 America's Health Insurance Plans (AHIP) Medicare and Medicaid Conferences on September 15, 2009. They presented findings from an earlier Dobson|DaVanzo report commissioned by MedSolutions, which examined the potential savings to Medicare of implementing a radiology benefits management (RBM) program.
Al Dobson delivered a presentation entitled "How Should Bundled Payments be Structured: Bundling from the Perspective of an Administrative Price Setter" at a one-day conference on bundling payment for post-acute care at Georgetown University's Leavey Center on June 24. The conference was hosted by the Center for Post-Acute and Long-Term Care Studies, and sponsored by the National Rehabilitation Hospital Center for Post-Acute Studies and Georgetown University School of Nursing and Health Studies. Materials from the conference can be accessed here: http://www.postacuteconference.org/