Author Topic: What are the promises and realities of an EHR  (Read 5059 times)

shanbull

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Re: What are the promises and realities of an EHR
« Reply #15 on: July 11, 2014, 09:43:08 AM »
I think maybe we're an oddity in MN because our state economy is very focused on the health sector. I haven't heard anywhere near as much grumbling about this as all the other changes going on! We have more hospitals and doctors per capita than any other state, and most are affiliated with these huge systems that already have EHR in order to communicate among all the facilities. Even small practices see the benefit of being able to share data within EHR systems. It will be interesting to see how things go when the law is officially in effect. At least we've known about this for going on 6 years now, and with the claims submission law already in full effect I think there are very few doctors who haven't yet made the switch.

The other thing to note is that several years prior to the ACA, we expanded our own Medicaid program with state funds. The people who didn't qualify for Medical Assistance (our Medicaid program) due to income limits were set up with MinnesotaCare insurance, which does have premiums and deductibles but they are scaled to income so anyone making 100%-200% of the poverty level income gets some form of subsidy. With the ACA the subsidy limit was upped to 400% of the federal poverty income level. Because of this program, Minnesota had an insured rate of 90% before the ACA went into effect and now we're up to 95%. It's not that huge a jump. But anyway, because we already had this system in place almost all doctors here accept MA/MinnesotaCare insurance in the first place. The state offers additional incentive opportunities for doctors that deliver superior care to patients on MA/MinnesotaCare, so the reimbursement is a little more competitive compared to private insurance plans than Medicaid is in other states. This is paid for with a combination of premiums from MinnesotaCare, a state hospital tax, and federal Medicaid funds. So the distinction between accepts Medicaid/does not accept Medicaid matters much less here. But if a doctor were to sue over it, the doctor would probably win because the law is supposed to be congruent with federal law.

The other thing that happened with the ACA, which probably impacted more than 5% of people here, is that the state exchange plans here are the cheapest in the country. They're so inexpensive that a lot of people don't even get the tax credit even though they qualify, because the tax credit accounts for the difference between the "average" cost of a health insurance plan (however they calculate that) and the exchange plans. The plans here cost much less than the average plan so very few people get a tax credit. But that isn't stopping lots of people from dropping their pre-ACA plans and getting state exchange plans. This is driving down costs even more, so far. That is another trend that will be interesting to watch over time. We may end up self-selecting into single payer because that is what the market wants.

Trust Minnesotans to make a complicate issue even more complicated :P Our saying is "If it ain't broke fix it over the winter when we have nothing else to do."
« Last Edit: July 11, 2014, 09:47:18 AM by shanbull »