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Health Care Reform Memo: January 30, 2012

Deloitte Center for Health Solutions publication


The health care reform memos are issued on a weekly basis, highlighting news from the previous week's activities in the administration and implications for the C-suite and various stakeholder groups.

My take: health reform: use your words wisely

From Paul Keckley, Executive Director, Deloitte Center for Health Solutions

The cover story of the current issue of the Harvard Business Review is titled “The Value of Happiness”, affirming “the pursuit of contentment has shaped the West’s culture and economy”.

Delving into the theme, one author concludes that the U.S. bent toward happiness is in our genotype, as it is included as an “unalienable right” in the Declaration of Independence. Another suggests happiness is escalating as cultural bedrock in U.S. commerce and pop culture, noting 14,000 titles on bookshelves offering happiness recipes, “happy meals”, and increased academic analytics correlating workforce happiness to productivity and earnings.

This week, the bipartisan Joint Conference Committee of 20 Senate and House conferees began the vexing process of determining whether and how to extend the payroll tax cut after February 29. Embedded in the same deliberation is a decision about physician pay: the sustainable growth rate (SGR) formula used as the basis for payments to physicians calls for a 27.4 percent pay cut if the committee fails to come up with a plan to pay for a permanent increase at a cost of $300 billion or temporary fix (one year at $21 billion).

The most recent gambit by health industry stakeholders is a proposal to offset costs of the fix by allocating some defense department savings from troop withdrawals to the fix. U.S. Department of Defense Secretary Panetta and Defense Department officials argue the proposed cuts—almost a trillion dollars over ten years—would debilitate the military while noting its budgets are already being cut and health benefits costs ($50 billion in 2010) are its fastest growing expense.

Caught in the debate crossfire are physicians. They value happiness. They’re not happy, especially primary care physicians (PCPs)—internists, family physicians, OB-GYNs, and pediatricians. Their reasons are clear: in the national discussion about health reform, they like the troops are the front line. And in their view, the war is being lost. Data showing growing disparity in population health and the epidemics of obesity and systemic poor health are widely accessible and support their case.

The Affordable Care Act (ACA) is premised on expansion of insurance coverage for at least 32 million people and improved performance of the delivery system to facilitate coordinated, evidence-based care compensated on the basis of results, not volume. But for primary care troopers, there’s little happiness in the possibilities.

In my view, transformation of primary care into an effective, efficient, and accessible high performing sector is key to long-term cost reduction and quality improvement in the U.S. health system. But the headwinds are strong and the ranks of primary care providers are restless. There are five reasons:

  1. Consumers are demanding more value from PCPs. Most U.S. consumers (82 percent) have a primary care relationship and most (73 percent) are satisfied with their PCP’s performance. Both are slipping as a result of cost and perceived inadequacy of service. The majority of consumers expect their PCP to offer online tools for visit scheduling and results reporting, shorter waiting times, and better personalized service. And dissatisfied consumers vote with their feet: use of retail clinics, over-the-counter medications, and non-conventional providers is increasing—fastest among consumers with health insurance. (Source: Deloitte Center for Health Solutions “2011 Survey of U.S. Health Consumers”)
  2. Most PCPs work hard and get paid less than their peers. The average primary care physician’s income for 2010 was $202,392—less than half for most specialties but well above the median family income of a soldier ($36,000) or American household ($50,300). PCPs compare their incomes to other physicians, not troops or teachers. And they reason they are paid less due to the politics of the profession—specialists dominate hospital boards and have disproportionate clout. They have five employees to manage versus four for a specialty practice, and see 35 patients daily to generate income. It’s a tough business. (Source: MGMA 2011 Physician Compensation and Production Survey Report, AMA)
  3. The pressure to change is frustrating. Demand for primacy care services is increasing and strong; the supply cannot be met by traditional methods. The supply of PCPs is inadequate to accommodate the demand, but for most PCPs, these new methods compromise their ideals. Performance-based payments, public report cards about outcomes, prices and patient satisfaction, legislative efforts to expand scope of practice for nurses, meaningful use requirements to adopt electronic health records by 2015, promotion of accountable care organizations (ACOs) and employment by health plans and hospitals are to many a slippery slope to the profession’s demise.
  4. PCPs think they are not valued adequately or accurately. The performance of PCPs is highly variable and unrelated to population health outcomes. Medicare beneficiary access to PCPs and their outcomes do not correlate (Source: Chang et al “Primary Care Physician Workforce and Medicare Beneficiaries Health Outcomes” JAMA 305, 10 May 25, 2011). But they are respected by patients and most health plans are experimenting with a medical homes model as a way to accurately monetize their value in reducing costs and improving health. What seems logical to PCPs—that they are the front line in the war against unhealthy lifestyles that lead to high costs—is seemingly discounted or marginalized by forces threatened by the potential for a primary care gatekeeper model as the centerpiece of the U.S. system.
  5. PCPs think ACA does not solve these problems adequately. 91 percent of PCPs accept new Medicaid or Children’s Health patients, but 84 percent report difficulty getting specialists to see patients they refer. And PCPs think ACA might not be enough to fix health care: 55 percent are not optimistic about ACA vs. 72 percent of surgeons (Source: GAO survey of 932 PCPs July 2011, Deloitte Center for Health Solutions Physician Perspectives about Health Care Reform and the Future of the Medical Profession). They understand their role is central to ACOs, episode based payments, avoidable readmissions to hospitals, and chronic care management; they doubt the law will recognize their importance or compensate appropriately.

Affordable Care Act and Primary Care: Key Sections

Section Provision Importance for primary care
1202 Payments to primary care physicians Increases Medicaid payments to primary care physicians to at least 100% of Medicare payments in 2013 and 2014; additional costs to states will be fully funded by the federal government.
5501 Expanding access to primary care services and general surgery services Institutes 10% Medicare payment bonus from 2011-2016 to primary care providers and general surgeons in primary care shortage areas.
5201 Federally supported student loan funds Funds ease qualifications and decrease non-compliance provisions to improve primary care student loans.
5203 Health care workforce loan repayment programs Establishes a loan repayment program for pediatric subspecialists and providers of mental/behavioral health services working in a health professional shortage area, medically underserved area, or medically underserved population.
5402 Health professions training for diversity Funds scholarships for disadvantaged students who commit to serving as PCPs in underserved areas and expands loan repayment for faculty in eligible institutions.
5502 Medicare payment system for Federally Qualified Health Centers (FQHCs) Establishes a Medicare payment system to reimburse FQHCs for health services; additional Medicare-covered preventive services will be eligible for payment when provided by an FQHCs.
5503 Distribution of additional residency positions Residency positions that go unfilled for three consecutive cost reports will be redistributed by U.S. Department of Health and Human Services (HHS) Secretary for training PCPs.
Community Health Centers and National Health Service Corps Fund Establishes a Community Health Centers and National Health Service Corps Fund and increases mandatory funding for community health centers to $11 billion over five years (fiscal year [FY] 2011 – FY 2015).
5601 Spending for FQHCs Authorizes additional funding for FQHCs as follows: FY2010 - $2.98B; FY2011 - $3.86B; FY2012 - $4.99B; FY 2013 - $6.44B; FY2014 - $7.33B; FY2015 - $8.33B.

Happiness for many primary care physicians may not be attainable. Perhaps the combination of ACA, meaningful use, consumerism, pay cuts, and increased accountability are overbearing pressures that might prompt some to quit.

Or perhaps happiness will be redefined by a new generation of primary care givers—physicians, nurses, health coaches, nutritionists, social workers, psychologists, dentists—that practice as teams, manage populations, accept risk for outcomes and costs, leverage technologies to reduce redundancy and error, engage consumers, embrace alternative models of health, and affirm their value proposition to a system sorely in need of transformational change.

The realities are that primary care in the new normal will be defined less by the degrees after a person’s name and more by the value of services provided. It will be marked by measurable changes in consumer engagement and self-care, full implementation of information technologies that facilitate timely, appropriate and cost effective means of interaction, shared decision-making with consumers, medical management that include prophylactic dentistry, psychological counseling, and end-of-life care as active elements, and acceptance of clinical and financial risk in contracts with employers, plans, health exchanges, government payers, and consumers.

The professions of primary care are in many ways their own worst enemies: while complaining they “get no respect”, they harbor distrust for peers in primary care, reinforcing sectarian biases with archaic rules and disjointed efforts supportive of their proprietary view of a solution.

We all want to be happy. Its pursuit can be healthy only when realities and circumstances are understood, and leaders recognize its value and pursue it passionately and purposely. For primary care, that time is now.

Paul Keckely

Paul Keckley, Ph.D., Executive Director, Deloitte Center for Health Solutions

Implementation update

PCORI releases draft research agenda with five main priorities

Monday, the Patient-Centered Outcomes Research Institute (PCORI) released its comparative effectiveness research (CER) agenda highlighting the five research priorities it will fund starting late spring 2012 per ACA Section 6301:

Priorities Funding allocation Background and goals
Comparative assessments of prevention, diagnosis, and treatment options 40% The research goal is to determine which option(s) work best for distinct populations with specific health problems.
Improving health care systems 20% Focuses on ways to improve health care services, such as through the coordination of care for patients with multiple chronic conditions.
Communication and dissemination research 20% Examines ways to provide information to patients so that they can make informed health care decisions with clinicians.
Addressing disparities 10% Addresses the health care needs of all patient populations as some treatments may not work equally well for everyone.
Accelerating patient-centered and methodological research 10% Includes patients and care givers in the design of research that is quick, safe, and efficient.

For background about PCORI and CER: see attached summary and Deloitte Center for Health Solutions’ study, “Comparative Effectiveness Research in the United States: Update and implications,” June 27, 2011.

OMB reviewing final rules related to exchanges, Medicaid expansion, and state innovation waivers

The Office of Management and Budget (OMB) is doing final reviews for rules that impact health insurance coverage expansions under ACA:

  • Final rule on state requirements for health insurance exchanges (HIX) related to reinsurance, risk corridors, and risk adjustments to minimize negative impacts of adverse selection in HIXs per ACA Sections 1321, 1341-1343
  • Final rule on the ACA's Medicaid eligibility expansion per Section 2001
  • Final rule for uniform disclosure to consumers on benefit design, cost sharing, and standards for definitions per Section 1001
  • Proposed rule on state innovation waivers per Section 1332

Note: “final rules” are reviewed by OMB after “proposed rules” are submitted by agencies after a comment period to assess budgetary impact and administrative consistency before being released for implementation.

Constitutional challenge update: actuaries argue mandate exclusion would invalidate rest of ACA

In its brief filed last week, the American Academy of Actuaries told the Supreme Court that invalidation of the individual mandate would also require invalidation of the community rating and guaranteed issue provisions of ACA, concluding the rest of the law would not be actuarially sound without the mandate.

HHS provides essential health benefits guidance

Wednesday, the HHS Center for Consumer Information & Insurance Oversight (CCIIO) released an “illustrative” list of three small group products to “facilitate a better understanding of the intended approach to essential health benefits (EHBs).” Non-grandfathered plans in the individual and small group markets inside and outside of the HIXs must cover EHBs starting in 2014. ACA Section 1302 requires EHBs to include services in ten defined benefit categories and requires coverage equivalent to a typical employer plan in a state. December 16, 2011, HHS released a bulletin describing its intended approach to defining the EHBs, allowing states to select an existing health plan to set the “benchmark” for the items and services included in the EHBs package. States may choose a benchmark from the following health insurance plans:

  • The largest plan by enrollment in any of the three largest small group insurance products in the state’s small group market
  • Any of the largest three state employee health benefit plans by enrollment
  • Any of the largest three national Federal Employees Health Benefits (FEHB) plan options by enrollment
  • The largest insured commercial non-Medicaid health maintenance organization (HMO) operating in the state

HHS releases proposed rule to increase rebates from drug manufacturers

Friday, HHS released a proposed rule increasing rebates drug manufacturers are required to pay for drugs covered by Medicaid, saving the program $17.7 billion.

CLASS repeal vote expected

The House will vote Wednesday on a bill to repeal the Community Living Assistance Services and Support (CLASS) Act per Section 8002. The bill previously passed the House Ways and Means and the Energy and Commerce Committees. This bill is not expected to pass the Senate.

Note: the removal of the CLASS Act provisions of ACA would be the second major change to the law since its passage; repeal of 1099 reporting requirements” was the first.

Legislative update

Joint Conference Committee begins talks; physician pay cuts, payroll tax continuation on agenda

Tuesday, the 20-member Congressional bipartisan joint conference committee tasked with determining the advisability and funding for extension of the payroll tax, physician pay, and unemployment benefits extension after February 29 began deliberations. For physicians, a 27.4 percent physician pay cut based on the SGR formula is required if the committee does not arrive at a way to pay for extension, but rules require the costs to be offset by spending cuts.

Note: a one-year SGR fix will cost $21 billion. A permanent fix would cost in excess of $300 billion that would be added to the national deficit—not likely in an election year. Last week, the Federation of American Hospitals, the American Medical Association (AMA), along with 108 state and specialty medical trade groups, urged the committee to consider a permanent fix offset by savings from troop withdrawals (reduced military spending) over ten years.

OMB reviewing proposed rule related to stage 2 meaningful use

The OMB is reviewing a proposed rule on stage 2 meaningful use of electronic health records (EHR) under the Centers for Medicare & Medicaid Services (CMS) Medicare and Medicaid EHR Incentive Program, prior to release anticipated in February. The proposed rule will establish requirements for stage 2 meaningful use criteria, and expand the stage 1 criteria to (1) encourage the use of health IT for continuous quality improvement, and (2) enhance the exchange of information in more rigorous data structures (e.g., electronic transmission of orders entered using computerized provider order entry, electronic transmission of diagnostic test results).

ICD-10 final rule unclear on penalties for noncompliance

January 16, 2009, CMS published a final rule on ICD-10. Notably, the rule does not address penalties for providers who are noncompliant with ICD-10. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires the ICD-9 code sets used to report medical diagnoses and inpatient procedures to be replaced by a more granular and specific coding system known as ICD-10 by October 1, 2013. In the final rule, it is unclear if and how entities noncompliant with ICD-10 will be penalized. One thought is that providers potentially could be fined under current violations for HIPAA transaction and code sets. CMS could issue further guidance and regulations clarifying such penalties for ICD-10 noncompliance closer to ICD-10’s effective date.

Tuesday, the AMA sent House Speaker John Boehner (R-OH) a letter asking to halt the required implementation of ICD-10. Depending on practice size, the switch to ICD-10 could cost medical practices between $83,290 and over $2.7 million. In the letter, James Madara, AMA CEO, stated that the switch will “create significant burdens on the practice of medicine with no direct benefit to individual patient care.”

GAO: Medicare overpayments for Medicare Advantage plans

Thursday, the Government Accountability Office (GAO) released a report showing the differences between how Medicare Advantage (MA) plans and the traditional fee-for-service (FFS) program calculate risk scores. GAO found that before CMS’s adjustment, 2010 MA beneficiary risk scores were 4.8 percent to 7.1 percent higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. Higher risk scores amounted to $3.9 billion to $5.8 billion in payments to MA plans. Both GAO and CMS found that the impact of coding differences increased over time, suggesting that the cumulative impact of coding differences in 2011 and 2012 could be larger than in 2010. GAO recommends that CMS improve the accuracy of its MA risk score adjustments by incorporating adjustments for additional beneficiary characteristics, using the most currently available data, accounting for all relevant years of coding differences, and incorporating the effect of coding difference trends. (Source: GAO, “CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding Practices,” January 2012)

Note: in contrast to GAO, CMS estimated that 3.4 percent of 2010 MA beneficiary risk scores were attributable to coding differences between MA plans and Medicare FFS. CMS’s adjustment for this difference avoided $2.7 billion in excess payments to MA plans. CMS’s 2010 estimate differs from GAO’s in that CMS’s methodology did not include more current data, did not incorporate the trend of the impact of coding differences over time, and did not account for beneficiary characteristics other than age and mortality, such as sex, health status, Medicaid enrollment status, beneficiary residential location, and whether the original reason for Medicare entitlement was disability.

ONC launches new health IT challenges

Last week, the Office of the National Coordinator for Health Information Technology (ONC) announced three IT challenges for which funding will be awarded successful applicants:

  • EHR Accessibility challenge: seeks multidisciplinary teams to create and test modules and applications to make it easier for disabled consumers to access and interact with health data stored in their EHRs. Applications are due July 23, 2012.
  • Health Innovations in Commuting challenge: seeks applicants to develop models for improving the health of American commuters through better collection, exchange, and analysis of health data. Applications are due March 5, 2012.
  • Discharge Follow-Up Appointment care transitions challenge: seeks applicants to develop simple, information technology-enabled processes and tools to make transitions easier and safer for patients, caregivers and providers, particularly when a patient is discharged from a hospital. This is the second part of the ONC’s Investing in Innovation (i2) Initiative. Applications are due April 30, 2012.

State update

State round-up

Friday, CCIIO rejected Texas’s request to adjust their medical loss ratio (MLR) for the individual market from 80 percent to 71 percent, 74 percent, and 77 percent in 2011, 2012, and 2013, respectively. The rejection was based on data showing almost all current issuers in Texas met the 80 percent MLR standard already and could remain profitable within the law. Texas is the tenth state to have its request for an MLR adjustment denied.

North Carolina’s Medicaid managed care medical home program, Community Care of North Carolina, covering 1,000,000 people, announced savings of $1 billion between 2007 and 2010 resulting from decreased hospitalizations and emergency department visits. Savings were inconsistent for elderly and disabled enrollees.

Georgia released a study finding it advisable to transition its Medicaid program and Children’s Health Insurance Program (CHIP) covering 1.7 million people to managed care. (Source: Navigant, “State of Georgia Department of Community Health Medicaid and PeachCare for Kids Design Strategy Report,” January 24, 2012)

Mississippi legislators proposed health budget cuts to $20.7 million, the lowest level since 1990.

The Massachusetts Division of Insurance approved increased premiums in the small group market by 2.3 percent effective April 1, following a 9 percent increase last year. A Health Affairs study found that over 94 percent of the state’s population had health insurance as of 2010, up from 86.6 percent in 2006; however, in 2010, about one in four reported unmet need for care due to health care costs. (Source: Sharon K. Long et al, “Massachusetts Health Reforms: Uninsurance Remains Low, Self-Reported Health Status Improves as State Prepares to Tackle Costs, January 25, 2011)

Kansas Governor Sam Brownback (R) proposed shifting all its 330,000 Medicaid enrollees into a private, managed-care system in order to save millions of dollars over the next few years.

Vermont’s Green Mountain Care Board released its plan to implement a single-payer system in the next five years. As proposed, the system would be publically financed, run by the state government, and responsible for raising funds. As proposed, the board will encourage three strategies: bundled payments, hospital/physician budget to population-based payment, and population-based global payments. (Source: Green Mountain Care Board, “Annual Report of the Green Mountain Care Board to the Vermont General Assembly,” January 17, 2012)

Idaho Governor Butch Otter (R) told reporters last week that he thinks the state may not meet the January 1, 2013 certification date to set up a state HIX. Note: HHS signaled through guidance that it would be flexible on the January 2013 deadline if a state can show progress toward establishing a state-based exchange.

Industry news

Hospitals challenge Medicare funding cuts, impact on jobs

Medicare funding cuts under consideration by Congress (H.R. 3630 plus sequester) will cost the nation's hospitals $61.4 billion over the next decade and result in 278,000 fewer jobs per the American Hospital Association (AHA).

Note: the AHA analysis did not include operating losses that might result from physician employment: currently, 23 percent of physicians are employed in hospitals—it is expected to double in the next 2-3 years (Deloitte Center for Health Solutions analysis).

Preventive health in primary care settings incomplete

A study of primary care practice patterns by Virginia Commonwealth University researchers found patients get 46 percent of recommended preventive health services at an annual check-up by their doctors. Data was extracted from audio recordings of 484 periodic health examination visits to 64 general internal medicine and family physicians in southeast Michigan. Guideline-recommended preventive services most likely to be delivered were screenings for colorectal cancer, hypertension, and breast cancer; services not discussed were counseling about aspirin use, vision screening, and an influenza immunization. (Source: Shires et al, Prioritization of Evidence-Based Preventive Health Services During Periodic Health Examinations, American Journal of Preventive Medicine, Volume 42, Issue 2 , Pages 164-173, February 2012)

MLR requirement for student health plans challenged

Tuesday, representatives of America’s Health Insurance Plans (AHIP) met with officials at OMB to encourage relaxation of MLR requirements in ACA for student health plans (covering three million people). Citing the unique administrative features of these plans, related issues raised by the trade group were bans on lifetime limits, rescission, and discrimination based on a pre-existing condition in the student health plans.

Note: in December, representatives of Young Invincibles met with OMB officials to encourage maintenance of the 80 percent MLR requirement for college plans on the premise that insurers earn profits on student health plans and provide minimal coverage. A final rule on student health plans is expected soon.


“As Congress looks to trim budgets and deficits, a task made harder by the inability of the Supercommittee to find common budgetary ground, this is important to remember: there are wise ways and foolish ways to save money in healthcare. Wisdom calls for everyone to pitch in. Hospitals must learn to be more efficient, to pull costs out of service while maintaining superb quality. Care must be coordinated across multiple settings to avoid redundant tests and procedures. Insurance companies and government payers must standardize their claims to save administrative costs by allowing doctors and hospitals to fill out a single form. Courts need to rein in frivolous malpractice lawsuits that drain billions of dollars from the health system. Wise savings are achievable.”

 —Steve Corwin, MD, CEO NY-Presbyterian Hospital, “Watch what you cut”, Modern Healthcare, December 19/26, 2011

“Health care spending in the U.S. increased at the slowest rate in half a century in 2009 (3.9 percent) and 2010 (3.8 percent), essentially keeping pace with the growth of the economy… It’s too early to know whether the trend of slower growth will persist after the economy improves. What is certain is that as the population ages, controlling spending will require reforms that coordinate delivery of services, reduce unnecessary care, and spur innovations that improve quality and curb medical costs.”

 —The New York Times, editorial “Slower Growth in Health Spending”, January 12, 2012

“According to the most recent long run projections from the CBO, the federal deficit as a share of the GDP [gross domestic product] will shrink from its current bloated level for several years even without further action. The real deficit problem comes in the 2020’s, 2030’s and beyond, and it is huge. The CBO projections show the deficit bottoming out at 5.6 percent of GDP in 2014, rising to an astonishing 12.7 percent of GDP by 2030, to an unthinkable 18.4 percent of GDP by 2040 and continuing to rise further after that….Myth: America has a generalized problem about runaway spending. The truth is that we have a huge problem of exploding health care costs, part of which shows up in Medicare and Medicaid spending.”

 —Alan S. Blinder “Four Deficit Myths and a Frightening Fact”, The Wall Street Journal, January 19, 2012

“I will not go back to the days when health insurance companies had unchecked power to cancel your policy, deny you coverage or charge women differently from men. I’m a Democrat. But I believe what Republican Abraham Lincoln believed: that government should do for people only what they cannot do better by themselves, and no more. That’s why our health care law relies on a reformed private market, not a government program.”

 —President Obama, State of the Union address, January 24, 2012

Fact file

  • Screening rates for breast and cervical cancer remained relatively stable over the ten years: 3 out of 4 eligible women receiving mammograms vs. 81 percent targeted, 4 out of 5 having Pap tests to screen for cervical cancer vs. 93 percent targeted, 59 percent of eligible men and women had colonoscopies vs. 70 percent targeted. (Source: Centers for Disease Control and Prevention [CDC])
  • Consumer spending on health care in 2012 percent change vs. 2011:
    • Asia & Australia: +11.7 percent
    • Eastern Europe and Russia: +11.6 percent
    • Middle East and North Africa: +10.7 percent
    • Latin America: +8.3 percent
    • North America: +4.7 percent,
    • Sub Saharan Africa: +3.4 percent
    • Western Europe:-1.3 percent (Source: The Economist “The World in 2012” p 121)
  • Range of avoidable readmissions in U.S. hospitals: 11-32 percent for heart failure, 8-27 percent for pneumonia. (Source: Epstein et al “The Relationship between Hospital Admission Rates and Rehospitalizations” New England Journal of Medicine 365:24 December 15, 2011)
  • 116 million American adults have chronic pain—20 percent higher for women for 21 of 22 pains analyzed in medical chart reviews like fibromyalgia, migraines, irritable bowel syndrome. (Sources: Journal of Pain Management January 23, 2012, Institute of Medicine)
  • 1.2 million people in the U.S. are infected by HIV: 80 percent are aware, 20 percent not. 77 percent are linked to medical care, 51 percent diagnosed stay in medical care. (Source: CDC)
  • Fluoridation of water is one of the ten most important public health measures—tooth decay dropped 60 percent in communities where water is treated, costing 95 cents to $10 per capita to implement. (Source: CDC)
  • Americans under 65 who were uninsured for the full year: 12 percent (1996), 13 percent (2001), 14.5 percent (2006) 16.2 percent (2009). (Source: Agency for Healthcare Research and Quality [AHRQ])
  • Public support for elements of ACA: health insurance exchanges (79 percent), subsidies for individuals (75 percent), Medicaid expansion (69 percent), employer mandate (61 percent), individual mandate (33 percent). (Source: Kaiser Health Tracking Poll)
  • 39 percent of physicians communicate with patients via instant messaging/text/video vs. 22 percent in 2005. (Source: Manhattan Research)
  • 85 percent of adults have cellphones; 9 percent of these have downloaded apps for health management. (Source: Pew Internet)
  • Estimated Presidential campaign costs: $2.5B in 2012 vs. $1.6B in 2008 McCain-Obama. (Source: Politico)
  • U.S. Small Business Administration loans to physician offices increased ten-fold from $60 million to $675 million from 2000 to 2011 as insurance reimbursements decreased, regulations changed, and business, medical liability, and drug costs increased. (Source: Parija Kavilanz, “Doctors living on loans,” CNN Money, January 20, 2012)
  • 50,000 jobs to be added to the health care industry as it converts to digital medical records. (Source: Ken Alltucker, “Health-care I.T. demand heats up,” The Republic,, January 21, 2012)
  • The overall U.S. uninsured rate increased from 14.8 percent in 2008 to 17.1 percent in 2011 but declined for young adults (ages 18-25) from 28.2 percent to 24.5 percent in the same period. (Source: Gallup, “More Americans uninsured in 2011,” Gallup Wellbeing, January 24, 2012)
  • In 2011, $227.4 billion was spent for health care merger/acquisition/takeover activity—up 11 percent from 2010. In 2011, there were 980 transactions in 13 sectors of health care—3 percent decrease from the 1,007 deals in 2010. (Source: Irving Levin Associates, Inc., “Health Care M&A Report,” January 25, 2012)
National health reform: What now?




National health reform: What now?

National health reform is here. The health reform bills (HR3590 and HR4872) are now law and will trigger sweeping changes and disruptions – some rather quickly and some over many years. The industry is asking, “What now?” At Deloitte, we continue to explore and debate the key questions facing the industry, and we look forward to helping our clients find and implement the right answers for their organizations. To learn more, visit today.

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