Here is part two of our continued saga of long term planning.
Here is part two of our continued saga of long term planning.
Here is an article my dad sent me from the Wall Street Journal. I thought it was very insightful about our current working generation. Plan and save for yourself is basically the gist of the article but please read on and I think everyone will glean something from it. Here is part 1.
Here is the third and final part of an analysis of the ObamaCare decision. I saw this on SeniorHousingForum.net and thought it provided some good points of view. Only time will tell what the real pros and cons of the Supreme Court’s decision will be. Read on.
If you take a look at the comments under part two, you will see I took some shots, for my article listing the losers. It is clear this is an issue that generates a lot of heat and with good reason, it will in one way or another, impact each of us. Even when I get taken to task (and sometimes I even deserve it) I really appreciate the dialog and will continue to allow the comments to stand.
Healthcare Delivery System Under ObamaCare
In my mind, the biggest question we need to ask is, What will the healthcare payment and delivery system look like 10 years from now? It seems that we are headed toward one of two scenarios:
1. Health Plans for Everyone – I think this is the more likely of the two scenarios. Direct payment by the government to providers will cease to be. Rather the government will pay those dollars to health plans, who will then manage the care of the people they are responsible for. This will mean an end to Medicare as we know it today. Essentially what will happen is everyone will be forced into an HMO type plan, some will function like true HMO’s and others will look more like preferred provider networks. I also see the Medicaid system moving in the same direction.
2. Medicare For All – There are a significant number people who would like to see the Medicare system expanded to include everyone and this would be true universal care. There are many barriers to this, not the least of which, is a formidable insurance political lobby. Probably not in my lifetime, but it would likely lead to an even more uneven distribution of services, and delays in getting appointments, treatments and procedures as measures to control costs.
I see opportunities in these areas:
1. Skilled Nursing (SNF) Costs less than an Acute Hospital – Under the old system, hospitals caring for patients with Medicare, received a specified lump sum payment for a particularly diagnosis. The faster the hospital could get that patient discharged the more money they would make. As a result, patients got discharged to skilled nursing or or other levels of care earlier than what was optimal.
This is being changed so that if a patient is readmitted within 30 days of discharge, the hospital will be penalized financially. Hospitals will be looking to create tight relations with SNF’s that will take extraordinary steps to make sure those readmissions won’t happen.
2. Assisted Living Costs less and Skilled and Acute Care – Assisted living stands to be the biggest winner of all senior housing options. Assisted living communities need to build tight relationships with hospitals. In order to develop those relationships they will need to demonstrate they can accept these post acute patients and provide for their medical needs at a lower cost and in a much better environment. And most importantly, keep those residents from going back to acute care in that 30 period.
Along this same line, those assisted living communities that develop relationships with senior HMO’s will tap into another source of post acute care opportunities. The big win here is that in effect, these HMO’s are allowed to spend money that formerly could only be used for skilled nursing. The HMO’s have a single goal, getting their members better at the lowest cost. If your assisted living community can do that, you will win. While many of these residents will be relatively short stay, some will convert to longer term residents.
3. Independent Living costs less than Acute, Skilled and Assisted Living – The reason independent living needs to pay attention is that there will be residents who can successfully return to an independent living setting if appropriate resources are made available. This is why the management needs to have a good rolodex of these resources and be willing to work with the residents and the resident families to access these services.
What other opportunities do you see? What risks do you see?
I joke with my wife about my having Alheimer’s Disease every time I forget things. While it’s common for us to forget things as we age, how do we determine if we may be developing the early symptoms of Alzheimer’s? I saw these symptoms on the Alzheimer’s Association website and thought they were something everyone should see. Enjoy.
1) Memory loss that disrupts daily life: One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; increasingly needing to rely on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
This is the second part of three on Obama Care. I am using it from the Senior Housing Forum. While I believe in a free market system and I am dessappointed that the law was upheld, I know there should be some changes. Fraud is rampant and with the increased healthcare rolls, I see more targets for fraud. There should also be some way that medicines are kept at an affordable price. I am currently taking one pill that costs about $60 per pill. That is about $1,800 per month. Now the drug company can charge whatever it wants but it is easy to see how many people choose between medicine and food. I truley hope Obama Care isn’t as bad as I anticipate it will be. Read below for some more info.
On Friday I talked about the winners, in light of the Supreme Court ruling. Inevitably if there are winners, there are losers. Thursday will close out the series talking about the specific implications for senior housing.
1. Taxpayers – It has been said that, in effect, this is the single biggest tax increase ever implemented by the Federal government. Hardest hit will clearly be the middle class. Initially, it is clear the Affordable Care Act will add to the tax burden. What is less clear is what savings, if any, will be achieved, when they will be realized and if they will save money for the middle class as promised.
2. Drug Companies – In the short term, the drug companies have created an agreement with the government that, in effect, protects their bloated profits. The jury is still out on how long it will take for that agreement to crumble, but it will. For consumers, this is a mixed bag. Over time it will eliminate derivative drugs that are expensive but provide only marginal real benefits to patients. On the other hand, it will likely dampen the innovation of new drugs that could radically improve life.
3. Durable Medical Equipment Providers (DME’s) – Several times each year a story on Medicare fraud splashes into the news. Probably seven out of ten times, the fraud, involves DME providers. One government study indicates more than 10% of all DME dollars paid out are for fraudulent claims. We can look forward to ObamaCare coming down hard on DME. If all they do is reduce fraud that is great, but look for real claims to also be denied and delayed.
4. Physicians – There is ongoing pressure to reduce payments to physicians. They are an easy target as the general impression is that they are wealthy and by extension, overpaid. There is no doubt that some specialities can still make practitioners wealthy, but in truth, being a physician generally means a very nice living but it is no longer a guaranteed path to wealth.
5. Consumers – A few weeks ago I had a significant allergy attack. After a day of trying to push through it, I was nonfunctional. First thing in the morning I called my primary physician and had an appointment for later that same day. I got to my appointment on time and maybe 3 minutes after paying my co-pay I was ushered into the physician exam room and 3 minutes later the physician was there to see me. This happens because there is competition and significant reimbursement. I do not expect it to stay this good. There are already so many stories coming out of Canada and England of individuals having to wait weeks for a physician appointment for even serious (but not immediately life threatening) problems and long waits when the appointment day finally arrives.
Too Early to Tell
1. Skilled Nursing – There is no doubt that skilled nursing communities must continue to fight to protect their funding. Both Medicaid and Medicare dollars are at risk. I predict that within 10 years every single recipient of government healthcare dollars will receive their benefits through an HMO like entity. This will likely benefit top notch facilities and make life more difficult for the rest.
It is my view that, in reality, Skilled Nursing faces essentially the same problems with or without ObamaCare.
2. Home Health – This one is really difficult to predict. It seems clear that Home Health actually provides the most bang for the buck and it feeds the instinctual desire people have to age in place. The flip side is that, home is a pretty easy target. Recipients do not speak as a single voice and providers are almost as equally fragmented.
3. Hospice – Ditto Home Health.
I saw a blog in Senior Housing Forum that I thought was interesting and on target. While I personally think we do not have a healthcare crisis I do believe we have a health insurance crisis. We need to put our heads together to find a way for those with no insurance and/or pre-existing conditions can purchase affordable, quality insurance. If anyone figures this out, please let me know. Enjoy.
This is part one of a three part series, that will be published today (Friday), then on Monday and Tuesday of next week.
First Things First: No matter what the other side says, life will go on!
– If you are a fan and see this as a victory, you will end up thinking it was not good enough and did not go far enough.
– If you are depressed, believing that, in one fell swoop, the Supreme Court eviscerated the constitution (an opinion I am somewhat sympathetic to); This is a great country and a few bad decisions will not crush the nation. Even the Supreme Court has reversed itself over time. Life will go on and America will continue to be a great country and a great place to live.
It will, ultimately, take years to fully understand the impact on senior housing but here is my initial analysis for whatever it’s worth.
1. Hospitals – At least in the short-term, hospitals are the first or second biggest winners. They will go from having many non paying patients to having very few indigents overnight. No one seems to be suggesting that payment rates to hospitals should be modified to reflect this new standard.
That being said, over the long term, their prospects may not be so bright. They consume lots of dollars and so will become a natural target for cuts.
2. Many Uninsured – In truth this is the one bright spot in the whole sorry mess. There are a bunch of people who did not have insurance who will have coverage. No matter how you slice it, this is a good thing for them and for society. Clearly people with no access to basic health-care can end up becoming very ill and requiring hugely expensive indigent care.
3. Government Workers – The plan will require more government workers; those who administer and regulate the system and the IRS who will enforce the plan.
4. Fraudsters – Today the government healthcare plans are a favorite playground for fraudsters. This plan will increase the size of that playground. It will increase the opportunities to steal the people’s money.
5. Some Employers – It appears the health plan will in effect provide incentives for employers to eliminate private health plans in favor the government “healthcare exchanges”.
6. Health Plans – At least in the short term they will be big winners. The current thinking seems to be that it is more efficient to hand big buckets of money to private health plans and make them responsible for the healthcare of corresponding groups of people.
Recapping the Winners
While there are, in my view, at least six groups that will see huge benefits from the health plan, this does not mean it is good for society as a whole. Still to come, the losers and how it will impact senior housing.