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The 2016 Election and the ACA: 
A Report Card on Healthcare Reform 
(Part One of a Two-Part Series)
With Republican presidential candidate Donald Trump's victory in the 2016 election and Republican majorities in both chambers of the U.S. Congress, questions regarding legislative priorities for the incoming administration are dominating political discourse. In particular, the 2016 election has been viewed by political commentators, in part, as a referendum on the ability of the 2010 Patient Protection and Affordable Care Act (ACA), i.e., "Obamacare," to resolve many of the fundamental issues affecting the delivery of, and payment for, healthcare services in the U.S., including rising health insurance premiums in the individual health insurance market and increased beneficiary cost-sharing under such plans.  President Harry S. Truman once said, "The only thing new in the world is the history you don't know."  Through this lens, a reflection on the ACA six years after passage, including an examination of its successes and shortcomings, may serve to guide assessments of future healthcare reform efforts. This two-part Health Capital Topics series will discuss the current status of the ACA and its potential for evolution in light of the recent election, with this first installment examining the impact of the landmark legislation during its six years of existence.

With Republican presidential candidate Donald Trump's victory in the 2016 election and Republican majorities in both chambers of the U.S. Congress, questions regarding legislative priorities for the incoming administration are dominating political discourse. In particular, the 2016 election has been viewed by political commentators, in part, as a referendum on the ability of the 2010 Patient Protection and Affordable Care Act (ACA), i.e., "Obamacare," to resolve many of the fundamental issues affecting the delivery of, and payment for, healthcare services in the U.S., including rising health insurance premiums in the individual health insurance market and increased beneficiary cost-sharing under such plans.  President Harry S. Truman once said, "The only thing new in the world is the history you don't know."  Through this lens, a reflection on the ACA six years after passage, including an examination of its successes and shortcomings, may serve to guide assessments of future healthcare reform efforts. This two-part Health Capital Topics series will discuss the current status of the ACA and its potential for evolution in light of the recent election, with this first installment examining the impact of the law during its six years of existence. (Read more...) 
In 2015, there were approximately 250 hospitals across the United States that were completely or partially physician owned.  These physician-owned hospitals (POHs) can offer a variety of services, from general care to specialty services, such as cardiovascular or orthopedic care. Despite the prevalence of POHs, healthcare providers and policymakers have not reached a consensus regarding the effects of POHs on the healthcare industry, which include: (1) concerns regarding POHs "cherry-picking" the most profitable patients; (2) questions over the quality of care offered at POHs; and, (3) conflicts of interest due to the financial incentive for physician owners to refer patients to their POHs.  Such concerns have led to policies restricting the purview of POHs in their communities, such as limiting the application of POH exceptions in the Stark Law and the Anti-Kickback Statute. However, recent studies published in academic journals, including: the British Medical Journal;  the Journal of Arthroplasty;  Contemporary Economic Policy;  and, the Journal of Healthcare Finance,  challenge the assumptions that led to these policy restrictions, and suggest that a significant difference in the quality of care provided and the type of patients treated between POHs and non-POHs does not exist. This Health Capital Topics article will explore the extent to which recent research supports or debunks the central arguments underlying regulatory policies concerning POHs, and how those findings may influence future policy governing the operation of POHs.  (Read more...) 
As discussed in Part One of this series, healthcare services may be divided into two general categories, i.e., clinical related and nonclinical related, with these categories further defined by the specific tasks, duties, responsibilities, and accountabilities (TDRAs) involved in each.  Due to the many permutations and combinations of TDRAs that may be present in various healthcare service roles, careful analysis is warranted to ensure that the subject services (i.e., those services under consideration in the valuation engagement) are classified into an appropriate category for benchmarking and other valuation related purposes.  One subcategory of healthcare services that mandates careful consideration by the valuation analyst is physician on-call services, which denotes the requirement that a physician be responsible for providing professional clinical services to patients who may need care during a time other than typical physician practice office hours (e.g., on evenings, weekends, and holidays) at various sites of service, including hospital emergency departments, trauma centers, and birthing centers.  This third installment in the four-part Health Capital Topics series on the classification and valuation of compensation for healthcare services will focus on physician on-call services.  (Read more...)
Regression analysis entails the use of statistics to investigate the relationship between a dependent variable, i.e., the variable of interest, and one or more independent variables, also referred to as explanatory variables.  It is important to note that standard regression techniques cannot conclude that a causal relationship between the dependent and independent variable exists, but merely that a correlation exists between the changes in the variables; however, more advanced regression techniques possess the capability to show more causal relationships.  A valuation analyst may employ regression analyses to attain a better understanding of the relationships between variables, which may have an impact on the consultant's opinion of value. However, regression analyses take many forms, and carelessly employing an incorrect model, would, in all likelihood, render the resulting estimates, and the conclusions drawn from them, inaccurate, thereby impacting the efficacy and validity of the valuation analysis. This fifth installment of the six-part Health Capital Topics series on statistical methods utilized in valuation reports will discuss, at a high level, how regression analyses can inform healthcare valuations, and the considerations analysts must keep in mind when developing and interpreting the estimates of regression models.  (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 summer 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!