This page will bring you news and notes from the business world of Pediatric Therapies.  Please check for frequent updates.
  • 23 Jul 2012 12:35 PM | Anonymous
    So many parents say they had a gut feeling something was off way before there was any type of diagnosis or confirmation, but they weren't able to quantify that feeling. Now it looks like there might be a tool for assessing this and perhaps getting an accurate diagnosis earlier. has more information, please click here for the article.
  • 16 Jul 2012 2:02 PM | Anonymous
    In what may be good news for Florida therapists, it has been reported that WellPoint is buying Amerigroup, which runs Medicaid in Florida. It is hoped that this will increase inefficiencies, increase coordination of care and make applying for reimbursement easier.  Click here for the entire article from the Lexington Kentucky Herald Leader.
  • 09 Jul 2012 10:26 AM | Anonymous
    The individual mandate of the Affordable Care Act was just part of the Supreme Court's ruling. The other part, the one that will impact many of our therapy practice members, is the expansion of Medicaid coverage by the states. In Florida, Gov Scott is fighting against it while the state legislature is working on a "Plan B." According to research, there are three options: a state-based exchange, a state partnership exchange in which the federal government operates the exchange but the state retains some regulatory functions, or a federal facilitated exchange in which the feds control virtually all aspects.

    This leaves therapeutic practices that are Medicaid providers uncertain about the future of this source of revenue. The Alliance for Pediatric Therapies will continue to provide information regarding this important topic as it becomes available.
  • 29 Jun 2012 9:54 AM | Anonymous
    We've heard a lot about the Supreme Court ruling upholding the constitutionality of the Mandated Care portion of the ACA. Another bit of news is the Court's ruling overturning the Medicaid expansion that would have states covering individuals up to 133% of the poverty level. 

    For more information, check out this article from Health News Florida.
  • 19 Jun 2012 10:26 AM | Anonymous
    There is a momentous decision pending when the Supreme Court announces its decision regarding the legality of the Affordable Care Act. The only thing for certain is that it will impact employers, providers and consumers alike. It's important to be aware of the consequences for your practice so you can start planning appropriately.

    An article from USA Today outlines four possible outcomes such as upholding the law as it is, retracting the individual mandate, invalidating more provisions and killing the law entirely. Each outcome is examined for its potential impact and consequences.

    The Alliance for Pediatric Therapies is monitoring this case and will let you know more as it progresses.

  • 14 Jun 2012 2:45 PM | Anonymous
    What's wrong with this picture? A article reported that the U.S. spent $102 million in auditing fraud and recouped less than $20 million. Surely there has to be a better way to catch the fraudsters without harming the good guys!

    Click here for the complete article.
  • 11 Jun 2012 3:02 PM | Anonymous
    By Carol Gentry
    06/11/12 © Health News Florida

    Fee-for-service medical practice is dying, even if the Supreme Court strikes down the entire federal health law, an increasing number of health-business analysts say.

    The current system – rewarding doctors who run the most tests and operate on the most patients  --  is inherently inflationary and increases risks to patients, they say. 

    Future rewards will go to doctors who spend their time listening to patients, keeping them healthy and quarterbacking a team of allied health professionals, they predict.

    “Ten years from now, fee-for-service is going to be a thing of the past,” said Stephen Siegel of Broad & Cassel’s Health Law Practice Group.

    If so, the effects in Florida will be sweeping, said Linda McMullen, chief strategy officer of the Florida Medical Association. Most Florida doctors still practice on their own or in small groups of four or fewer, she said.

    "They're going to have to collaborate to contain costs and improve quality," she said. "That's going to change the way they do business."

    Whether that's a change for the better or worse depends on "who is setting the benchmarks," she said.

    Fee-for-service is being replaced by “fee-for-value,” said Mark Dubow of The Camden Group, a national consulting company to hospitals.

    “It almost doesn’t matter what the court decides” about the Affordable Care Act, Dubow said Friday at a South Florida hospital conference.  “The nature of change that is coming – that is already here…is increasingly focused on value.” 

    That means providing the right care in the right place at the right time, Dubow said. It means doctors and hospitals making more money when patients stay healthy.  And when illness or injury strikes, it means a bundled-payment system that offers financial rewards to keep costs under control.

    “We’re all striving for the same goals: improved care at lower costs,” said Philipp Ludwig, vice president for operations for Baptist Health Medical Group in Miami. “It should be fairly simple. It’s not.”

    The last time the industry tried to rein in overspending by putting doctors and hospitals on a budget – the switch to managed care that ramped up in the 1990s – backfired. Patients complained they were denied care they needed because of strong financial incentives for cost-cutting.

    While consumer groups still harbor some suspicions of managed care, the landscape looks different now, given that electronic health records make it easier to detect attempts to short-change patients.

    Also, costs for coverage are now so high that more than 50 million Americans are uninsured, according to the Centers for Disease Control. The Patient Protection and Affordable Care Act, signed into law two years ago, would cover about 32 million of those.

    Florida is leading more than two dozen other states in contesting the law’s constitutionality. A Supreme Court ruling is expected any day.

    The law uses the considerable buying power of Medicare to encourage the change in the payment system, rewarding collaboration that leads toward "accountable care" and clinically-integrated networks. Even if the law is struck down, private payers have climbed on board.

     Hospital executives who attended the Fort Lauderdale health summit on Friday said they have their fingers crossed that the court will uphold the law  because so many of their patients lack insurance.

    If it is struck down, they will still be required  be required to take all comers, insured or not, while staggered by budget cuts.

    The Florida Legislature has cut Medicaid pay to hospitals each of the last two sessions. Their Medicare pay will take a hit if Congress doesn't act to forestall automatic cuts at the end of the year.

    "We're in for a roller-coaster ride," said University of Miami President Donna Shalala.

    Shalala, who served as health secretary in the Clinton Administration, said she thinks the law will be upheld when the court issues its ruling later this month.

    "Most people think the worst that can happen is the mandate will be thrown out," she said, referring to the requirement that all Americans buy health insurance.

    Odds are against the mandate, said a legal expert who attended the Supreme Court arguments in March on behalf of the American Hospital Association.

    Dominic Perella of Hogan and Lovells, the firm that wrote the AHA amicus brief supporting the law, told the summit audience he thinks it's about 60 percent likely that the court will strike the mandate.

    It's less likely that the whole law will go away, he said: "The Supreme Court has never struck down a law this big and sprawling."

    The insurance industry is worried that only the mandate will disappear, leaving them with a requirement to accept all applicants. Without the mandate, insurers worry that only the sick will apply.

    But Shalala said the law's subsidies for insurance policies will bring in a lot of healthy people to balance it out.

    --Health News Florida is an independent online publication dedicated to journalism in the public interest. Contact Editor Carol Gentry at 727-410-3266 or by e-mail.
  • 07 Jun 2012 11:56 AM | Anonymous
    The Florida Center for Fiscal and Economic Policy (FCFEP) has published a comprehensive issue brief that examines the impact of proposed changes to the Medically Needy component of the Medicaid program.  According to the FCFEP, these changes have the potential to result in the loss of coverage for thousands of Floridians who won't be able to afford the premiums.

    Click here for the complete issue brief.
  • 01 Jun 2012 1:42 PM | Anonymous
    Finally, something good to be said about video games!  This USA Today article addresses the possible therapeutic benefit of video games to children with autism.

    By Jack Gruber, USA TODAY 

    ASHBURN, Va. – Onscreen, Michael Mendoza's digital avatar stands before a wonderland of cakes and sweets, but his message is all business: "I. Get. Frustrated when people push me and call me undefined and call me undefined a teacher's pet!"

    Technology resource teacher Adina Popa works with student Michael Mendoza using the Xbox Kinect. Motion sensors have become a big deal in the world of autism therapy and education.

    Technology resource teacher Adina Popa works with student Michael Mendoza using the Xbox Kinect. Motion sensors have become a big deal in the world of autism therapy and education.

    In another classroom at Steuart W. Weller Elementary School, nearly an hour's drive west of Washington, D.C., two students stand side-by-side, eyes riveted on a big-screen TV. They jump, duck and swing their arms in unison, working together as they help their digital doppelgangers raft downriver.

    In real life, 9-year-old Michael has autism, as do his two classmates. All three have long struggled with the mental, physical and social rigors of school. All three now get help most days from video-game avatars undefined simplified digital versions of themselves doing things most autistic children don't generally do. Click here for the entire article and video.
  • 30 May 2012 3:33 PM | Anonymous
    Yet another good article on the status of the health insurance exchange.

    By Sara R. Collins and Tracy Garber

    The Affordable Care Act requires each state to establish by 2014 a new health insurance marketplace or “exchange” where individuals and small businesses can purchase affordable health insurance plans. The exchanges are the centerpiece of the reform law: they will be the main portals where people without employer-sponsored health insurance will go, either in person or online, to both find a health plan and learn about and apply for any federal subsidies for which they are eligible. The Congressional Budget Office estimates that by 2020, 22 million people will enroll in health plans offered through their state exchange. 

    For the rest of the article, please click here.

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