Becker's Spine Review

19 The CORE Institute, Louisiana Orthopaedic Specialists Partner: 4 Important Observations By Anuja Vaidya Phoenix-based e CORE Institute partnered with Louisiana Orthopaedic Specialists in Lafayette. Here are four important observations: 1. Since its inception in 2005, e CORE Institute has grown to include more than 150 care providers and more than 700 employees. 2. e institute's first expansion was into Michigan with Porretta Cen- ter for Orthopedic Surgery in 2013. 3. Louisiana Orthopaedic Specialists is a comprehensive musculo- skeletal practice comprised of eight orthopedic surgeons and one interventional physiatrist. e practice will be renamed e CORE Institute at Louisiana Orthopaedic Specialists. 4. e CORE Institute also has plans to open in other states and abroad. n 3,900 Physicians Earn Millions From Medicare in 2013: 3 Things to Know By Carrie Pallardy C MS recently released data on Medicare payments to healthcare organizations and providers. Approximately, 3,900 healthcare providers received at least $1 million each in 2013, according to a Bloomberg Business report. Here are three things to know. 1. e CMS data covered $90 billion in payments to 950,000 healthcare providers and organizations. 2. Physicians received average reimbursement of $74,000. Just five physicians received more than $10 million in Medicare payments, according to the report. 3. Two individuals, cardiologist Asad Qamar, MD, and ophthal- mologist Salomon Melgen, MD, received $15.9 million and $14.4 million in Medicare payments, respectively. Both physi- cians are now facing legal scrutiny. n Practice Management P roposed premium rates for health plans under the Patient Protection and Afford- able Care Act continue to attract attention. Here are eight things to know about the requested 2016 rate increases. 1. e PPACA includes a June 1 deadline for insurance companies to inform government regulators when they request rate hikes of more than 10 percent for health plans sold on the ex- changes. e deadline for all states to publish final rates for health insurance is Nov. 1. 2. Information about proposed price increases of less than 10 percent, or even price decreases, was not disclosed. is makes it difficult to forecast how much insurers will raise premi- ums overall for 2016. 3. Of the requested price increases that have been dis- closed, a majority fall in the 15 percent to 20 per- cent range. Most insurers justified these increases as needed for covering older and less-healthy in- dividuals. 4. e premium rate requests presuppose recog- nize the King v. Burwell Supreme Court chal- lenge to the premium subsidies in the states using the federally run exchange were unsuc- cessful. Health plans will propose higher rates if the Supreme Court were to eliminate the sub- sidies in 34 or more states. 5. e fact that the big carriers are asking for in- creases is an important predictor of the rate in- creases across the board. While some argue that people only have to switch plans to save money, "the big guys know something" about the chang- ing premium rates for health plans, according to Robert Laszewski, president of Health Policy and Strategy Associates. Mr. Laszewski wrote a piece in Forbes saying smaller carriers are bound to follow in the big payers' footsteps. Overall, the big carriers' increases forecast where the cheaper plans will and won't be next year. 6. Some of the highest proposed rate increases include: • Iowa's Wellmark Blue Cross is asking for a 43 percent increase, even though Iowa has one of the lowest rates of enrollment in health plans under the PPACA. • Blue Cross and Blue Shield of Kansas, which is asking for a 39 percent increase. Less than 40 percent of the eligible have enrolled. 7. Some of the lower proposed rate increases include: • e dominant Blues plan in Vermont is seeking increases averaging 8.3 percent and ranging from 4.7 percent to 14.3 percent. Vermont is the state with the highest market penetration for the PPACA exchanges — 75 percent have signed up. • In Connecticut, the biggest insurer on the market, Anthem, is asking for a 6.7 percent increase, while the second biggest insurer, Connecticare, is asking for a 2 percent in- crease. Other increases range from 5.2 per- cent to 33 percent. Forty-five percent of the market has enrolled. 8. Insurers have indicated more rate increases are coming, and they are going to be widespread. For the past few months, market warnings have been issued about these premium rate increases being far-reaching, affecting insurers across the nation. Additionally, according to Mr. Laszewski, none of the top insurers knew what rate increases their competitors were going to submit when they prepped their rate actions. n 2016 PPACA Insurance Rates: 8 Things to Know By Erin Marshall

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