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 Seattle Children's Hospital Sues Washington State Insurance Commissioner over Exchanges
During the initiation of open enrollment on October 1, 2013 for the Health Exchange Marketplace ("Exchanges") under the Affordable Care Act (ACA), the potential consequences of the limits Exchanges would impose on providers and hospitals were virtually ignored. Pending the outcome of the Seattle Children's lawsuit, and any subsequent legal action by providers, these side effects of the Exchanges may have a greater negative impact on the future of healthcare reform than ever expected.
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Anti-Kickback Statute Not Applicable to Title I ACA Facilitated Healthcare Exchange Programs
While many "low cost" medical areas, e.g., primary care services, are encouraged by, and will hopefully flourish under, the healthcare reform, some specialty services with more expensive treatment plans have suffered under these cost containment initiatives, particularly cancer care. The increasing survival rates, in addition to growing trends in physician shortages and more complex and prolonged treatments of exorbitant cost, have led cancer care to a virtual precipice in a healthcare environment moving towards more stringent cost containment and efficiency goals.
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Does CEO Compensation at Non-Profit Hospitals Need to be Tied to Quality Metrics?
While hospital performance in various quality metrics has been laboring under increasing levels of scrutiny, the issue of whether executive-level compensation relates to quality performance has largely been ignored during healthcare reform implementation. A recent publication from the Journal of American Medical Association sheds more light on compensation for CEOs of non-profit hospitals noting a lack of association between higher CEO compensation rates and typical quality metric indicators.
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How Will Rising Costs of Cancer Care Fare Under the ACA?
With the initiation of open enrollment in the Affordable Care Act's Health Exchange Marketplace on October 1, 2013, several inquiries have arisen from stakeholders related to potential regulatory implications of the Health Exchanges on healthcare entities and providers. One such regulatory implication recently questioned was whether qualified health plans (QHP) established under the Affordable Care Act would be considered "federal health care programs" under the Anti-kickback Statute.
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