Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts

Monday, September 28, 2009

The Baucus Healthcare Plan: What Small-Business Owners Need to Know

Every day I get in my email inbox something called the “NFIB Smartbrief”. NFIB is the acronym for National Federation of Independent Businesses. This is the organization that champions small businesses throughout the U.S. and in every single state through extensive lobbying efforts. It is an organization totally dedicated to helping the small business owner.  The NFIB Smartbrief contains links to timely articles concerning any important and relevant news that effect small businesses.  It is a great way to stay on top of news that can effect us all as small business owners.


The clients of Silkin Management Group are all small business owners, and it is therefore important to me to stay abreast of the news about the issues that are most relevant to our clients.  As I’m sure any reader knows, the healthcare legislation that is changing daily while winding its way through Congress will significantly effect small businesses. And, as Silkin clients are both small businesses and health care providers, anything having to do with this legislation is important to stay on top of. Today, while reading the Smartbrief, I found a very good article summarizing the latest potential effects that the legislation, in its existing form, will have on small business. I therefore thought it would be of benefit to our readers to provide that article, published on line by U.S. News and World Reports and written by Mathew Bandyk.  The article is reproduced below or you can link to it by clicking here: The Baucus Healthcare Plan.


I hope this article helps you see the latest that is going on with the healthcare legislation.  Comments on this are welcomed by clicking on the comments link at the end of this blog.


Larry Silver
President, Silkin Management Group

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The Baucus Healthcare Plan: What Small-Business Owners Need to Know



What business owners should look out for as healthcare reform moves ahead


By Matthew Bandyk


In the battle to pass some form of healthcare reform, small business is a major player.  Earlier this year, Congress proposed reform bills that would put in place heavy fines on businesses that fail to provide healthcare for their employees, with the exception of those that have just a few employees. Small-business political associations in Washington quickly denounced these provisions as too burdensome for too many businesses. Now, what's on the table for healthcare reform has changed. In early September, the SenateFinance Committee put forth a new healthcare bill that removes those penalties on businesses. Instead, it offers carrots to employers that provide healthcare, while keeping a few sticks. The bill, associated with its main sponsor, Democratic Sen. Max Baucus of Montana, seeks to expand insurance coverage through the creation of nonprofit insurance exchanges at the state level. These exchanges, under recent amendments Baucus accepted, will be open to small businesses with up to 100 employees.



Although the Senate is currently debating numerous amendments to the bill, many of the most relevant pieces that apply to small business don't seem to be points of contention. One thing is for sure: Many elements of the bill will have a profound impact on how employers seek out and pay for insurance for their employees.  4 Conundrums That Impede HealthcareReform.



Here are, from the perspective of small-business owners, some of the most important pieces of the current plan to reform healthcare.



Tax credits.



The new carrots in the bill are in the form of tax credits for employers that provide their employees health insurance. But not every employer can cash in on these incentives. Only businesses with 25 or fewer employees would qualify. However, about 92 percent of small businesses with employees fall into this category, according to the SBA. There's one further qualification: The average wage of all of the business's employees must be no greater than $40,000. Most business owners will want to pay attention to how much these credits could save them, and when. In 2011 and 2012, the bill would allow employers to deduct from their taxes an amount equal to the dollar amount the employer contributes for each employee's coverage, multiplied by a certain percentage. This percentage would be based on the amount of the employee's total premium contributed by the employer, or the average premium in the employer's state.



Starting in 2013, the state insurance exchanges kick in, and the credit applies only to businesses that purchase insurance through those exchanges. So would these write-offs revolutionize the way small businesses provide employee healthcare? Bill Rys, tax counsel for the National Federation of Independent Businesses, says expectations shouldn't be too high. The size and length of the credit—just four years—aren't high enough for businesses that are strapped for cash to suddenly consider buying healthcare. But the credit could make a difference for business owners "on the cusp"—those unsure if they can afford employee coverage. "It does provide some immediate cost relief," he says. The relief is especially large for the smallest businesses.



Businesses with fewer than 10 employees and less than $20,000 in average wages get to keep the tax credit in full. For larger businesses, it begins to phase out starting in 2013.  But there are also some potential problems. If a business owner starts paying employees more and the average wage surpasses the $40,000 mark, the business could no longer be eligible for the credit. That wage requirement could make employers reluctant to give out raises. Rys says that this is a real concern, but he's not too worried. There isn't much incentive for employers to keep average wages down for the same reason that the tax credits won't have small businesses rushing out to buy health insurance. The length of the credits is just too short. "The concern would be greater if the credit were longer, but the credit is for only two years before the exchange starts," Rys says.



Tax penalties.



Although no employer will be automatically punished for not providing coverage, there are still some fines in the bill that apply to firms with 50 or more employees—only 4 percent of all businesses that hire. But for businesses included in that 4 percent, the tax penalties can be hefty. That's because the bill provides subsidies for individuals and families who make up to 300 percent of the federal poverty level to help them buy insurance through the state health exchanges. Employers that don't provide coverage will have to pay a tax penalty for each employee who receives these subsidies. This has been dubbed the "free rider" provision because it is intended to deter employers from "free riding" off the new health insurance exchanges. The penalty is either the average cost of subsidies that year multiplied by the number of employees receiving subsidies or $400 per employee—whichever number is lower. But business owners won't be told what they owe. They'll have to crunch the numbers themselves to determine if they owe the full amount or the minimum, says Judith Solomon, senior fellow at the Center on Budget and Policy Priorities. There are many administrative burdens that could come with this provision. For example, a business owner would have to keep track of which employees qualify for subsidies, if they suddenly become qualified, or if they drop out of the exchange altogether. Some business that want to avoid the penalty can expect disputes with the tax man—it will be up to them to inform the IRS that some former  employees who received health insurance subsidies were laid off or no longer work there, says Solomon.



Another complicating factor of the "free rider" provision for employers is that it might make them think twice about whom they hire. "It does distort the hiring decisions in the direction of employers who don't need coverage," says Solomon. A business owner might be inclined to look for potential employees who already get health insurance through their spouse, for example, in order to avoid dealing with the tax penalty. Choosing to hire or not hire someone on that basis could land a business owner in legal trouble.



Insurance taxes.



One of the most controversial aspects of the Baucus bill is that, if passed, it would be partially funded by an excise tax on health insurance companies. In 2013, a 35 percent tax would kick in on insurance policies in which premiums are above $8,000 for single people and above $21,000 for families. It might not seem as if a tax on insurance companies would have much to do with small businesses, especially considering that few small businesses have the type of gold-plated, "Cadillac" health insurance plans to which the tax applies. But Keith Ashmus, the chair of the National Small Business Association, says these taxes could be passed down to all employer health insurance plans—not just the gold-plated ones—in the form of higher premiums. "The tax will be part of the entire cost structure of the insurer," he says. "[So] the trigger will be a high-cost plan by company Y, but the impact will be felt by everyone." The good news is that as the Senate has negotiated aspects of the bill this week, Baucus appears to be willing to ease the impact of the excise tax—but not eliminate it.

Tuesday, April 7, 2009

THE FOUR COMPONENTS OF GREAT SERVICE

Great service to your patients/clients is one of the most important factors required for building a successful practice. During these difficult economic times, health care can become much more of a discretionary purchase than it should be. As health care providers you all know that health care is factually not a discretionary activity, like buying a new TV. At the same time you have to realize that, in your marketing activities, you are dealing with a public that often sees no difference in their purchasing choices between buying that new TV, or new clothes and their need to purchase the needed health care service. What we have found is that if patients experience superior service and are properly educated they will make the proper health care decision and understand the priorities of their health versus the new TV. Below are four key components of good service that, if applied, will help you get and retain new patients and clients.

Under the heading of great service, you will find the following key components: convenience, communication, cost and quality, and importance of your service as perceived by the patient/client.

CONVENIENCE: Consider the location of your practice. People generally select a service based on how convenient it will be for them to get to the location. Surveys and studies show that well over half of the public selects their health care services because of a conveniently located facility.

Are your hours structured to meet the needs of your patients/clients? Most people operate on a very hectic schedule and will actively seek out those practices that offer convenient or flexible hours. Practices that really work at ways to make it more convenient for their patients/clients to use their services will surely reap the rewards for their efforts.

COMMUNICATION: Words are not the only way in which communication occurs. Appearances and actions weigh equally as important in conveying an idea or concept to your patients/clients. Look at your staff, building, reception area, signs, business cards, letters, etc. What do these communicate to the public?

Decide exactly what it is that you wish to communicate to your patients/clients and prospective patients/clients. Then convey that in not only verbal communication, but in all of the above categories as well. Teach your staff to do the same.

COST AND QUALITY: The cost of your services is directly related to the quality of service that you deliver to your patients/clients. Your patients/clients will never feel that your fees are too high (or even really think about it for that matter), if they perceive the quality of service to be valuable. If you provide inferior or slow service, it will almost automatically make your fees appear to be too high. Again, patients/clients will take into account the amount of time they had to wait, the appearance of staff and facility and the demeanor of those servicing them.

Communication ties in with this area. Ensure that your patients/clients know what you are doing. Talk to them during the examination and explain what you are doing and why. This impacts the patient/client's impression of the fairness of your fees. Clear and professional communication with your patients/clients helps to ensure that they go away feeling satisfied that they have received excellent value for what they paid.

IMPORTANCE: Although you may perform valuable services, it is most important that the patient/client perceives how important the service is. This presents you with a "marketing" challenge. A large percentage of the population does not visit their doctors often enough.

This only indicates that the importance of regular exams has not been conveyed effectively to the public at large (or even to some of your patients/clients).

National health educational campaigns are designed to increase the public's perception about health and the importance of regularly visiting all of their family doctors. You cannot, however, rely solely on that type of campaign alone. It is vital that you take every opportunity to provide education to your patients/clients and to raise their "IQ" in the area of good health. The more they know, the more likely they are to use and appreciate your services and to tell others about you.

Provide a variety of brochures, put out a monthly newsletter, create your own handouts. Train your staff to educate the patients/clients. Maintain awareness in the practice that an educated patient/client is a more compliant patient/client and one who is much more likely to refer new people to your practice.

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Larry Silver
President Silkin

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