Trump's New Insurance Options for Small Businesses

January 5, 2018

The proposed new rules would make it easier for small businesses to create insurance plans that exempt them from certain consumer protections under the ACA.

Welcome to Practice Rounds, our weekly column exploring what's being covered in the larger world of healthcare.

New Insurance Options for Small Businesses

On Thursday, the Trump administration proposed new rules that could make it easier for small businesses to create health insurance plans that would make them exempt from the consumer protections of the Affordable Care Act (ACA).

The rules would allow small business owners, employees, sole proprietors, and others to form a single group to purchase insurance, called associated health plans. These plans would be exempt from requirements of the ACA, according to The New York Times. For example, they may not have to provide "essential health benefits" like mental health care, emergency services, maternity, and newborn care and prescription drugs.

According to a Labor Department press release, as many as 11 million Americans could find coverage under the proposal. "By joining together, employers may reduce administrative costs through economies of scale, strengthen their bargaining position to obtain more favorable deals, enhance their ability to self-insure, and offer a wider array of insurance options," says the release.

HHS Takes Next Steps toward Interoperability

On Friday, HHS' Office of the National Coordinator for Health Information Technology (ONC) released the draft Trusted Exchange Network.

The release, required by the 21st Century Cures Act of 2016, enforces Congress' goal of building and maintaining trust to ensure that health information is available where and when it is needed to manage patient health.

The proposed Trusted Exchange Framework aims to support ONC's goal of achieving nationwide interoperability using three key methods, including patient access, population-level data exchange, and open and accessible APIs. 

According to the press release, the proposal would not prevent existing or new organizations from creating point-to-point or individual agreements between organizations that have a particular business need to exchange information.

"The draft Trusted Exchange Framework we issued today reflects the successes and challenges already existing in the exchange of health information and is designed to help guide the nation on its path to interoperability for all," stated Don Rucker, MD, national coordinator for health information technology.

Study: More Time Under Risk-based Payment Programs Does Not Improve Outcomes

According to a new study done by British Medical Journal, allowing hospitals more time to adapt to risk-based payment programs failed to improve patient outcomes.

For the study, researchers looked at Medicare claims from 214 facilities in the Premier Hospital Quality Incentive Demonstration (HQID), a program launched in 2003, and 975 hospitals participating in the Hospital Value-Based Purchasing program, which began in 2011.

The study's findings concluded there was no evidence that hospitals that had been operating under pay-for-performance programs for more than a decade had better process scores or lower mortality than other hospitals.

Quote of the Week

When Physicians are Owners AND Employees

"Revenue cycle is centralized. A lot of the economies of scale and business functions are centralized…but it still recognizes the inherent value of having the physician being an owner in a group practice."

- Scott Fowler, MD and CEO of the Holston Medical Group on how physicians can be employees and owners.