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Ding Dong, "Repeal and Replace" is Dead

Attempts by the Republican leadership in the U.S. Senate to "repeal and replace" the 2010 Patient Protection and Affordable Care Act (ACA), a/k/a Obamacare, were revived after the latest version of the Graham-Cassidy healthcare reform bill was introduced by Senators Lindsey Graham (R-SC) and Bill Cassidy, MD (R-LA) on September 24, 2017. This Senate Bill, H.R. 1628 proposed the repeal of numerous of ACA provisions, including: (1) individual and employer mandate penalties; (2) subsidies for certain individual out-of-pocket costs based on household earnings; (3) tax credits for individual policy premiums; and, (4) funding for state Medicaid expansion. Further, the bill granted more flexibility to the states through federal block grants and the regulation of health insurance plans.
 
On September 26, 2017, the non-partisan Congressional Budget Office (CBO) published a preliminary, partial scoring of the Graham-Cassidy bill, noting that the bill would likely reduce the federal deficit by $133 billion by the year 2026. However, the CBO has not yet estimated the number of individuals who would become uninsured as a result of the bill, although it stated that it would "...result in millions fewer people with comprehensive health insurance that covers high-cost medical events." Previous Senate "repeal and replace" bills were scored by the CBO, and were estimated to leave between 22 and 32 million more individuals uninsured, due in part to high household deductibles and those unable to obtain insurance due to pre-existing conditions.
 
Four Republican senators, including Senators John McCain (R-AZ), Rand Paul (R-KY), Lisa Murkowski (R-AK), and Susan Collins (R-ME), have stated opposition to the bill, rendering its passage unlikely. Republicans had been pushing for a vote on this bill before the end of September 2017, while its passage was still possible with only a 50-vote simple majority; otherwise, according to Senate reconciliation rules, the bill would need to pass with a 60-vote supermajority. To date, the Senate has decided not to move forward with voting on the proposal, as it has failed to gain enough support from Republican senators.
With the emergence of value-based reimbursement, such as accountable care organizations (ACOs), clinically integrated networks (CINs), and bundled payment models, which rely on achieving the "Triple Aim" of healthcare at lower cost, U.S. hospitals are increasingly looking to change how services are being delivered by seeking more collaborative relationships with physicians, including vertical integration strategies such as the acquisition of healthcare-related enterprises, assets, and services (e.g., physician practices), direct employment, co-management, and joint venture arrangements with physicians and other providers.
  
Therefore, now more than ever, conducting a level of due diligence appropriate to the scope and complexity of a given assignment is critical to the development of the valuation opinion. First and foremost, the appraiser serves in the role of a proxy for the universe of typical investors and buyers inherent in the requisite hypothetical transaction of the fair market value standard, which standard may not be exceeded in order to withstand regulatory scrutiny.
As stated in the first installment of this two-part series on rising pharmaceutical drug costs,healthcare expenditures constitute approximately 17 percent of the U.S. gross domestic product (GDP), more than any other country in the world per capita. However, the U.S. realizes poorer health outcomes than other developed countries on numerous measures.One of the main factors for high healthcare expenditures is the rising cost of prescription drugs,with drug net spending increasing by 20 percent from 2014. Overall, pharmaceuticals expenditures comprises an estimated 16.7 percent of all healthcare costs in the U.S. As discussed in the first installment of this two-part series, causes for these increased costs include: (1) the pharmaceutical industry's protection from competition; and, (2) uneven negotiating power among both government and private payors. In the second installment of this two-part series, three proposed solutions for lowering costs will be discussed. These three proposed solutions include: (1) increasing marketplace competition among pharmaceutical companies; (2) expanding government flexibility with pharmaceutical price negotiations; and, (3) implementation of VBR programs on the provider level.   
While the opioid epidemic has been the source of significant public health concern in the U.S., one aspect of this crisis that is often overlooked is the economic ramifications of prescription opioid misuse. A recent cost analysis found that prescription opioid misuse costs the U.S. approximately $78.5 billion in 2013. This economic loss stems from increased healthcare expenditures, criminal justice costs, and productivity loss. National health expenditures (NHE) as a percentage of the gross domestic product (GDP) has been trending upward in recent years, and opioid misuse has played a significant role in this by increasing health expenditures. 
Much of the dialogue surrounding the use of artificial intelligence (AI) has focused on its impact in the clinical section of healthcare, possibly as a direct result of the integration of AI start-ups, such as Flatiron Health, a healthcare technology company widely known for its cloud-based platform for oncology. In addition to investments in AI by healthcare enterprises, there has recently been a noticeable influx of investments, acquisitions, and overall interest in AI healthcare technology by some of the largest companies in the technology industry. For example, during the 60-day "sunrise period" for trademark holders prior to the domain launch of DotHealth (the registry for the .health domain extension), technology companies Alphabet (formerly known as Google), Amazon, Facebook, Apple, and Instagram each registered for a .health domain, in addition to well-known healthcare providers, payors, and pharmaceutical manufacturers, such as Mayo Clinic, Pfizer, and UnitedHealthcare. (Read more...)
ANNOUNCING
 
Advanced Distance Education to Launch in 2017

The Institute for Healthcare Valuation (IHV) & Consultants' Training Institute (CTI) are pleased to announce premier healthcare valuation training through a distance education program, the Certificate of Educational Achievement (CEA) for Advanced Education in Healthcare Valuation. The program will launch in the fall of 2017 and will bridge the interdisciplinary nature of healthcare valuation to include: the Four Pillars of Healthcare (regulatory, reimbursement, competition, and technology); the market forces shaping the U.S. healthcare industry; and the valuation of healthcare enterprises, assets, and services. Legal professionals and healthcare providers, as well as those wishing to expand their scope of activities in healthcare valuation engagements and those seeking to enhance their current healthcare valuation service lines, will gain comprehensive knowledge through completing the expansive program. The program has been developed and is being presented by industry thought leaders Robert James Cimasi, MHA, ASA, MCBA, FRICS, CVA, CM&AA, Chief Executive Officer, and Todd A. Zigrang, MBA, MHA, FACHE, ASA, President of Health Capital Consultants, alongside a blockbuster faculty of healthcare subject matter experts from the legal, federal regulatory, and valuation professions.
HCC CEO Bob Cimasi Recognized as a "Pioneer of the Profession" 
under NACVA's "Industry Titans" Awards

HCC CEO Robert James Cimasi, MHA, ASA, FRICS, MCBA, CVA, CM&AA, has been
named a "Pioneer of the Profession," by the National Association of Certified Valuators and Analysts (NACVA) and Consultants Training Institute (CTI) as part of their Silver Anniversary recognition luncheon of valuation "Industry Titans," which distinguishes those whom have had the greatest impact on the profession.  Mr. Cimasi joins valuation profession luminaries, including: Dr. Shannon P. Pratt, Chris Mercer, James R. Hitchner, Roger J. Grabowski, Richard Wise, Jay E. Fishman, Nancy Fannon, Honorable Judge David Laro, Howard Lewis, and Mel H. Abraham, along with fourteen others, in receiving this honor. Congratulations to Bob Cimasi and his fellow "Pioneer of the Profession" honorees from the HCC Team and Topics Staff!