Health Care Law Blog

1. ACA Subsidies. Challenges to the Affordable Care Act will continue to take center stage in 2015, with both supporters and opponents of the law focused on the upcoming U.S. Supreme Court decision in King v. Burwell. The Supreme Court will decide whether tax subsidies can be provided when health insurance coverage is purchased through the federally facilitated marketplaces, rather than state operated exchanges. Under the ACA, federal subsidies—in the form of tax credits—are generally available to taxpayers with income between 100% and 400% of the federal poverty line, depending on family size, to help them purchase health insurance through “an Exchange established by a State.” In May 2012, an IRS ruling made subsidies available to individual purchasers on the federally facilitated marketplaces in 34 states. The ruling triggered several lawsuits arguing that this interpretation is contrary to the ACA’s language. The Supreme Court held oral argument on March 4. A decision is expected by the end of June. In the meantime, Republican lawmakers are drawing up contingency plans should the Court hold that subsidies may not be provided when insurance is purchased on the federal marketplaces.
2. Medicare ACOs at Crossroads. This year began following three important developments regarding accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP): 1) the Centers for Medicare & Medicaid Services released the final results of the first performance year for the original group of 220 ACOs that commenced operations in 2012 or 2013; 2) all 89 new ACOs that entered the MSSP on January 1, 2015, elected the one-sided, upside-only risk model; and 3) CMS published a proposed rule detailing the first major proposed revisions to the MSSP since its implementation. While every indication is that ACO-type initiatives in the commercial market will continue to reshape health care delivery, 2015 promises to be a pivotal year for the success of the MSSP.
3. “Big Data” in Health Care. An important trend will continue in 2015, with large-scale efforts to mine and analyze the enormous amount of electronic health information gathered and maintained by healthcare facilities, systems, providers, and payers, in a search for insights about ways to improve care and reduce costs. While the potential benefits gained from careful study of outcomes and costs could bring fundamental change to healthcare, there are also risks and compliance issues. The most obvious risk involves privacy and security breaches like those seen in prior years. Organizations are well advised to undertake risk and compliance assessments as electronic health information is assembled, analyzed, and shared.
4. Emergency Preparedness. The recent experience with Ebola demonstrates the need for healthcare facilities and providers to adopt, implement, and review emergency preparedness protocols. The first step is determining what level of emergency and disaster preparedness is sufficient in one’s community and what other governmental and private resources would be available.  Consideration must be given to potential disruptions in the availability of workers, products, parts or services in those situations. Emergency preparedness policies and procedures should be continually reinforced and updated in 2015.
5. Fraud and Abuse Enforcement. It is no surprise that fraud and abuse will once again be a top issue in 2015, as it has been every year in recent decades. The Department of Justice collected more than $2 billion in healthcare fraud cases during 2014. Over 700 qui tam actions under the False Claims Act were filed. The government’s commitment to fraud and abuse enforcement will be combined with expansion of its investigative tools and sanction authorities.

Your business or organization may be contemplating or managing these issues already. We’ve explored these topics in the past on our blog and in conversations with our clients. We will continue to keep you updated about how these trends play out this year.

Interested in the other five trends rounding out this “Top 10” list? Stay tuned for the second part of this article.

If you have questions about any of these trends, please contact a Foster Swift healthcare law attorney to discuss.