Obamacare Co-op fails: This is what you could do with the money lost!

Today there is more fallout from the collapse of a New York state insurance Co-op set up to offer health insurance as part of the Affordable Care Act.  Health Republic Insurance ceased to exist today and has left a whole bunch of people (okay, a few more than a bunch - 200,000 patients!) without insurance.  

If you have been following my posts on the ACA and music therapy (just type in Obamacare into the search box for a list of articles), you may remember that the insurance co-ops are joint ventures with a given state and the federal government that acts like an insurance company to offer insurance plans on the state exchanges.  

Of the 23 co-ops set up around the country, 12 of them have gone bankrupt this year.  Part of the problem is that these co-ops set artificially low prices for monthly premiums on their insurance plans.  There was a fund set up by the federal government to reimburse these co-ops for the first few years until their subscriber pool became stabilized with the right mix of young and old, and sick and healthy customers.  Unfortunately for the co-ops, this pool of money has been cut back and it will not be able to bail out the co-ops as originally intended.

So this brings us back to the most recent failure: Health Republic Insurance.  The news reports that $265 million dollars in federal loans has virtually disappeared through this company!  Hospitals and doctors that offered services to patients on this health insurance do not expect to get reimbursed for any of the services they have rendered.

So I did some quick calculations based on the 2014 workforce analysis by the American Music Therapy Association and came up with the following as a better use for the wasted $265 million dollars:

• $265 million would have paid for 4,152,954 hours (yes, that is over 4 million hours!) of direct music therapy services at the average hourly rate of $63.81/hour for 2014!
• $265 million also would have paid the average yearly salary of $50,808 for 5,215 music therapists! 

 I don't know about you, but I think the money would have been much better spent on music therapy!  And that is only one of the 12 failed co-ops this year.  Only one co-op out of 24 did not lose money in 2015.  I guess I should keep my calculator handy for next November!           

Hey Justice Roberts! Can We Get Some Music Therapy With That??

Obamacare = SCOTUScare

If you are a regular reader, you know that I have been following the Affordable Care Act for the last several years.  My goal has always been to try to help music therapists and other related professionals figure out what the law actually might mean for access to music therapy and whether or not it will help or hurt our profession on the whole.  

This is obviously a huge task!  And not without peril!  Over the last few years I have found that many people are reluctant to engage in the conversation simply because there are so many strong opinions on both sides of the issue.  I have tried to to be very even-handed in my treatment of the topics discussed here on Music Makes Sense, and generally have kept things focused on the impacts the law may have for music therapy.  I believe I have been pretty successful so far and I appreciate the dialogues that have been opened up about the topic within my professional field.  

So let me break down the latest ruling for you:

Many people have been waiting on the Supreme Court decision King vs. Burwell that was handed down this morning.  This case basically asked the question, "Do words matter?"  

... and the justices have answered the question, "No!"  The Affordable Care Act specifically stated that federal subsidies for low income participants to help them pay for premiums purchased through the Health Care Exchanges could only be provided through exchanges "established by the States."  This was intentionally written into the original law as a way to encourage individual states to set up their own marketplace exchanges.  As it turned out, 27 states decided not to develop their own exchanges.  The federal government decided to step in and created Healthcare.gov for participants in those states to use.  In King vs. Burwell, states sued the federal government because the law did not say that people in these states should be able to receive subsidies.  

Now, whether you oppose or support the law, you can see the conundrum here.  If the Court ruled that the law meant what it said (and what Congress had intended), there would be a lot of people who have been receiving subsidies for almost two years, who would lose their subsidies and be unable to pay for their premiums.  These same people would then suffer a tax penalty for not having insurance.  What a mess!

(...I could digress here and point out that perhaps it is a good idea to write laws clearly, in a bi-partisan manner, and allow public review before voting on it...but, we'll leave that for a different blogger!)

But alas, we have been "saved" by SCOTUS!  The 6-3 ruling today explained that although the law was badly written, it was meant to help people.  Therefore, the court ruled that it will be okay for subsidies to extend to people signed up under the federal exchanges.  Basically, six unelected and unaccountable (except maybe to history) individuals have written a new law that applies to every citizen. 

Under the Big Top: Building a Successful Integrative Care Program

This Powerpoint was presented as part of a concurrent session at the 2014 National Conference of the American Music Therapy Association in Louisville, KY. I invite you to ask questions and make comments regarding the presentation or your own experience with integrative care programs.  I will add notes to key topics on the slides soon in a separate Scribd box.

 

Under the Big Top: Building... by Daniel Tague

Deciphering the Affordable Care Act: Its Effect on Music Therapy

• Here is the Prezi from our presentation at the 2013 American Music Therapy Association national conference in Jacksonville! This is just an outline, so please let me know if you have questions. 

• You can also join in the conversation at our Obamacare and Music Therapy Discussion Forum by clicking here or by clicking on the tab at the top of the page. Let's keep the discussion going! It is very important for music therapists to get and stay informed regarding the Affordable Care Act!

References: Deciphering the ACA

Statements Related to Survey

Adding my Voice to the Voices of the Sea

American Music Therapy Association National Conference

Jacksonville, FL

November 20-24, 2014

I will have the opportunity to speak three times at this year's national conference for music therapy. 

Here is a sneak preview:

November 20, 2013 

12:30 pm - 6:30 pm

Institute: Medical Music Therapy for Infants & Children

*Chair: Jayne M. Standley, PhD, MT-BC

This session will feature prominent clinicians and researchers who specialize in medical music therapy for infants and children. It will include presentations on NICU MT research and innovations, music therapy for soothing infants with Neonatal Abstinence Syndrome, music therapy for burn treatment and other serious illnesses, pediatric and pediatric intensive care music therapy, use of music therapy in the Emergency Room with children, outpatient pediatric rehabilitation and early intervention, music therapy in physician offices, clinics, and/or day-care for medically fragile children. Counselling methods for stressed parents and teens with serious illnesses will be included. Program development and reimbursement issues for medical music therapy services will be reviewed. 

* I will participate in this institute by explaining some of the effects of the Affordable Care Act on healthcare for Women and Children. 

Friday, November 22, 2013  

7:30 AM to 9:00 AM

Deciphering the Affordable Care Act: Implications, Perceptions, and Current Knowledge within Music Therapy 

Elisa Aven, MT-BC; Daniel Tague, PhD, MT-BC

Saturday, November 23, 2013 

10:45 AM to 12:15 PM

21st Century Tools for Educators and Supervisors: There's an App for That!

Abbey Dvorak, PhD, MT-BC; Daniel Tague, PhD, MT-BC

I hope to see you there!
 


 

Obamacare: The Effect of the Affordable Care Act on Music Therapy, Part I

This is a huge and scary beast to tackle!  Now that the election is over, however, the ACA (Affordable Care Act) looks like it will begin its inexorable creep into the healthcare system.  I present it like this only because the law is scheduled to be implemented in stages.  The first of these new policies began in 2010. The rest of the new regulations will begin over the next few years.  

I will not necessarily be presenting my point of view, although my bias leans against the government being able to do much of anything with efficiency and receive an A grade (I can think of the U. S. Post Office and Amtrak as good examples of government inefficiency which are in constant need of bailout money!).  My goal is to try and give you a sense of the key points of the law and then break it down into some possible influences on how the changes will affect patients with disabilities as well as their access to services like music therapy.  

I also see the bigger picture as something important to examine.  It seems like most people discuss or highlight the benefits or negatives of the new law, but fail to note that actual implementation will not look like the ideal presented on paper.  This is something we can no longer ignore, or put on the mental backburner for another day.  Unfortunately, the ACA is incredibly complicated and many members of congress who voted it into place haven't even read the full document or claim to not understand it!  

At the 2010 Legislative Conference for the National Association for Counties, then House Speaker, Nancy Pelosi said, "But we have to pass the bill so that you can find out what is in it...".   

I have nominated myself to bring you as much detail as a primer for your own investigation!  I will attempt to cite a variety of sources from both sides of the ideological aisle.  I hope that you will join me in the discussion and provide a sounding board as we try to figure this out together.

The music therapy profession is really in its infancy in terms of reimbursement and payment from third-party sources.  Some local and regional success stories exist regarding payment for music therapy services through private insurance companies.  There has also been some progress in getting music therapy included in group billing to Medicare for music therapy occurring as part of daily services in certain types of rehabilitation and care for older adults.  
How will this recent success in third-party billing be affected by the ACA?  Good question!  I am not sure anyone knows exactly, but shouldn't we get at the front end of this?  

Music Lifting Spirits Among Patients with Cancer

This story is not about a music therapist, but definitely about someone who is using music in a therapeutic and uplifting way.


Charlie Lustman is a cancer survivor who is giving back to others some of the care and spirit that helped him get through his own illness.  I love his colorful guitar and commitment to visiting so many cancer centers around the country to help inspire patients!  He has written an entire album of songs about his fight with cancer and you would never know that he lost half of his jaw due to Osteo Sarcoma.  


You can read the story or watch the video news story here.     

The Paperwork Blues?

The Daily Muse

 Welcome to the Daily Muse feature of Music Makes Sense!  This daily update brings you up to the minute news about music and music therapy as it relates to our professions, events and individual lives.  You can follow the daily entries by subscribing to Music Makes Sense on Twitter or by "Liking" the Facebook page for Music Makes Sense.  Enjoy, and thanks for reading!

Do you love paperwork?  Isn't that the favorite part of your job as a music therapist??


I actually think we, as music therapists, don't have it too bad with the paperwork load.  Sure, there are some agencies that require more reports than are really necessary, but we can often just keep our session notes and write up quarterly reports of progress and annual reviews and be done.  


What do you think?  Does paperwork get you down?  Do you have a strategy for dealing with it?  Perhaps you have gone hi-tech and do everything on a tablet??  Or are you old-school and still keeping track by hand?


When I worked in private practice, we had one person that did office work and took care of all the contracting, payroll and paperwork requests.  This left the therapists to do the weekly chart notes, progress reports and annual reviews.  This arrangement really seemed to work out well.  


For those of you that are a "one man/woman show," how do you keep a balance?  Do you feel like the paperwork is getting you down or is it about right?  


Dr. Christopher Chang at KevinMD.com talks a little bit about the crazy world of medical paperwork that seems to be haunting doctors in his blog post titled, "Paperwork Causes Unintended Distractions for Physicians and Nurses." 


Can you relate to his discussion?  I don't think many music therapists are getting calls in the middle of their Hello songs to answer paperwork questions, but I think the trend might be in that direction. 

Music Makes Sense Featured Again on All Things Healing

The Daily Muse

 Welcome to the Daily Muse feature of Music Makes Sense!  This daily update brings you up to the minute news about music and music therapy as it relates to our professions, events and individual lives.  You can follow the daily entries by subscribing to Music Makes Sense on Twitter or by "Liking" the Facebook page for Music Makes Sense.  Enjoy, and thanks for reading!

Music Makes Sense will be featured again on the All Things Healing online community!  I think it is great that they try to represent music therapy in their discussions.  You can see one of my other articles that was published here.  I will link to the newest article once it is live on their site.  


Don't you love the suspense! 

Consumerism in Healthcare: Shopping for Answers.

The Daily Muse

 Welcome to the Daily Muse feature of Music Makes Sense!  This daily update brings you up to the minute news about music and music therapy as it relates to our professions, events and individual lives.  You can follow the daily entries by subscribing to Music Makes Sense on Twitter or by "Liking" the Facebook page for Music Makes Sense.  Enjoy, and thanks for reading!

The Trouble With Treating Patients as Consumers

(click title for full article)

Many hospitals and health institutions have been treating patients as "consumers."  This mindset seems to help institutions provide better customer service and increase the prominence of patient's rights, but as the article points out, it may be causing some breakdowns in efficient treatment. 

Many music therapists work in institutions or facilities where patients are talked about as consumers.  Since MTs are part of treatment teams, we should be aware of the pitfalls of pretending that patients are like regular consumers in a retail setting.  

The authors of the article accurately point out that patients are not like regular consumers.  They usually don't choose to "shop" at a hospital or other health facility.  They are usually obtaining treatment for a problem or situation that is not of their choosing.  

Many patients and families are also under stress and emotional duress.  Although some people (myself included!) might consider shopping to be stressful, these people can probably choose to stop shopping or take a break to reduce their stress!  The article makes a good point that you cannot expect people under stress to make clear, quick and correct decisions about their health by putting them independently in the driver's seat as a consumer.

I think that this topic is something to be considered by MTs.  Can we make the decision-making process easier for patients?  What kind of road-map can we provide patients to help guide them through treatment?         

Medical Doctor Advocates for Music Therapy!

The Daily Muse     


Welcome to the Daily Muse feature of Music Makes Sense!  This daily update brings you up to the minute news about music and music therapy as it relates to our professions, events and individual lives.  You can follow the daily entries by subscribing to Music Makes Sense on Twitter or by "Liking" the Facebook page for Music Makes Sense.  Enjoy, and thanks for reading!

January is advocacy month for music therapy.  Many of the music therapy blogs will be writing about the power and effectiveness of music therapy with different populations.  I will join in this effort with my own post in the near future, but I thought this story combined nicely with our promotion this month.  


Music therapists often do presentations and have discussions with medical professionals in their efforts to expand music therapy in hospitals and medical care.  It was nice to see this doctor in Ontario pick up the torch for us!  

Music Is Good For You!

(Article in the Standard Freeholder)