Crains New York - November 12, 2012 - (Page 13)

REPORT H E A LT H C A R E INSIDE The List NYC’s top health insurers PAGE 16 The Scoop The number of New Yorkers with private insurance drops as Medicaid fills the gap during tough times PAGE 16 Brokers face uncertain future Obamacare’s state health exchanges may put millions in commissions at risk BY JUDITH MESSINA Jamie Schutzer has been a health insurance broker for years, but he recently became licensed to sell property and casualty coverage. His firm, meanwhile, has developed alliances with property and casualty brokers. The moves are hedges against the potential impact of Obamacare health exchanges that have put hundreds of millions of dollars in commissions at risk. “Taking every penTHE MAX health ny out of insurers can spend our comon administration missions is under Obamacare. not going That will squeeze to solve the broker profits issue of the high cost of health insurance,” said Mr. Schutzer, a vice president with J.D. Moschitto & Associates Inc. in White Plains. Brokers have traditionally played a big role in helping small businesses buy health insurance—88% of small group coverage in New York is purchased through brokers, who reap $693 million a year in commissions,according to a study by Boston’s Wakely Consulting Group. But that could change. The state-run health care exchange could offer one-stop shopping experiences for small businesses,which usually pay more for insurance because they lack the buying power of bigger companies. The goal is to simplify and reduce the cost of buying health coverage by making it easy for them to compare insurance prices and services, forcing carriers to compete for their business. Brokers may find themselves irrelevant if the exchanges that must be online by January 2014 succeed in making it easier and cheaper for employees to shop on their own. Small firms may sim- PREVENTING INFECTIONS: Dr. Joseph Bosco is hoping to reduce knee-replacement readmissions by developing a model to identify patients who are at greatest risk of complications. 20% buck ennis Fix patients the first time New York hospitals face steep revenue cuts for readmissions that are preventable BY JUDITH MESSINA Three years ago, NYU Langone Medical Center noticed a problem. Half its patients who were readmitted to the hospital less than 30 days after undergoing knee replacements did so primarily because of infections. The hospital is fine-tuning its approach. NYU Langone doubled down on hand-washing, screened all incoming patients for staph germs and scrubbed rooms super-clean to short-circuit infections. Today, every surgeon has a scorecard that tracks readmission rates.The upshot: Readmissions after knee-replacement surgery are down by half since 2009. “We’re working to construct a computer model to predict who is at greatest risk for readmission,” said Dr. Joseph Bosco, vice chair for clinical affairs in orthopedic surgery. “We’re THE PENALTY BOX Average 2013 readmissions penalty Hospitals nationwide 0.31% New York state hospitals 0.55% New York City hospitals 0.71% Source: Kaiser Health News going to make sure they get good follow-up.” It was a critical discovery, not just for patients, but also potentially for the hospital’s bottom line. Government and private health insurers are tired of paying for medical care that doesn’t make patients healthy. Last month, the Centers for Medicare & Medicaid Services began penalizing hospitals that have excessive readmissions for three conditions: pneumonia, heart attacks and congestive heart failure. CMS will dock them as much as 1% of their total Medicare reimSee READMISSIONS on Page 14 See BROKERING on Page 17 November 12, 2012 | Crain’s New York Business | 13

Table of Contents for the Digital Edition of Crains New York - November 12, 2012

THE INSIDER
IN THE BOROUGHS
IN THE MARKETS
BUSINESS PEOPLE
CORPORATE LADDER
OPINION
GREG DAVID
REAL ESTATE DEALS
REPORT: HEALTH CARE
THE LIST
CLASSIFIEDS
SMALL BUSINESS
NEW YORK, NEW YORK
SOURCE LUNCH
OUT AND ABOUT
SNAPS

Crains New York - November 12, 2012