How Will President Clinton's Health Care Reform Plan Affect Employers and CPA Firms?
How will President Clinton's health care reform plan affect employers and CPA firms? Maribess L. Miller, CPA, partner, Coopers, & Lybrand, Dallas. For health care organizations, which include hospitals, physicians and providers of home care, the need to lower costs as part of health care reform will promote consolidation. In the push for improved competitiveness and lower costs, high-quality providers will come out ahead. Employers with over 5,000 employees may choose to opt out of the proposed system of health care purchasing alliances and self-insure instead, but most of them will be forced, from a cost standpoint, to go along with the program. Of course, there will be exceptions. If a company's employees tend to be younger than the overall population, and therefore healthier than the norm, opting out could be cheaper. Also, companies that traditionally have dealt with organized labor, such as those in. the auto industry, may provide health benefits that are more expensive than those under the proposed plan. However, because of union contracts they will not be able to reduce coverage. For that reason, they may be forced to opt out. Service companies that operate across state lines also may opt out and self-insure, even if they don't have unions, rather than deal with the system of alliances. All our clients, particularly those that operate in multiple states and have to deal with multiple alliances, are going to need a lot of help sorting through the confusion. As CPA consultants, we generally deal with all aspects of the problem. We work with employers, providers, suppliers, carriers and states, so we see the problem from all angles. With this particular issue, companies will need to understand all the angles. Reed Tinsley, CPA, director, medical practice group, Haynes O'Neal, Houston. What ends up in the law will be nothing like what's been proposed. So what we're doing is helping physician clients prepare for integrated delivery, because that's what's coming down the pike. No matter whether we have reform or not, that's at the market is moving toward. Everyone is concerned about cost control, and the best way to do it is to develop integrated delivery systems that group health care providers. In some states, hospitals and insurance companies are buying physician practices. Hospitals and physicians are forming joint ventures. Physicians who don't want to be tied to a hospital are forming group practices or independent practice associations. To help clients, CPAs must assess what sort of cost-containment measures are prevalent in their areas. CPAs really need to be the eyes and the ears for the clients to determine what changes are happening in the local market. In some areas, the movement is very slow, but here in Houston, for example, change is coming quickly. If doctors don't react, there's a real concern they'll be left behind. Physician clients and hospital administrators are the two best sources of information on local trends in reshaping health care practices. Once CPAs have gathered this information, they will have to find different solutions for each client. A proactive approach will put clients in a stronger position in light of changes already taking place and those that will be mandated by any reform package, which I believe must include integrated delivery. CPAs should be aware that insurance companies seem to be a growing new source of consulting business for those with health care expertise. For example, Aetna has a pilot program in Atlanta in which it is buying physician practices and setting up its own primary care businesses. CPAs need to absorb as much information as possible and get as much health care expertise as they can to help clients and keep up with opportunities for new engagements. Because of the pace of change, practitioners need to take those steps now. William F. …