Allergy & Immunology

Young Cho, Researcher

Eileen Rifkin, Researcher

Endocrinology and Metabolism

Sophie Hussey PhD, Researcher (Post Doctoral Scholar)

John Malone MD, Faculty (Professor)

Evidence Based Medicine

Yessenia Keith, Administrative Specialist

Hematology/Oncology

Damian Laber MD, Division Director (Professor)

Nathan Visweshwar MD, Faculty (Assistant Professor)

Hospice & Palliative Medicine

Lindsey Davidson, Graduate Research Assistant

Hospital Medicine

Anna Fountain MD, Faculty (Assistant Professor)

Cairine McNamee MD, Faculty (Assistant Professor)

Melissa Newman DO, Faculty (Assistant Professor)

Anh Nguyen DO (Assistant Professor)

Elimarys Perez-Colon MD (Assistant Professor)

Jose Rodriguez-Castillo MD (Assistant Professor)

Infectious Disease & International Medicine

Jamie Morano MD, Faculty (Assistant Professor)

Obesity, Diabetes & Aging Research Center

Cassandra Mary Nicotra, Research Assistant

Monica Segura, Research Assistant

Pulmonary

Emilie Foltz MBA, Education Coordinator

Rheumatology

Yih Chang Chen Lin MD, Faculty (Assistant Professor)

Translational Medicine

He Li, Research Associate

Cutting through the "hype" or "spin" to get to the core issues of health care reform under the ACA is important not just for consumers, but for us as physicians and other health providers, too.

Patients and their families are now beginning to regularly seek advice from their doctors and providers on what they should do about this nebulous health reform. This, therefore, seems like an opportune time to revisit some of the key provisions of the ACA. For this article I've chosen 10 of the most common and important areas of the ACA to reflect on, as they also happen to be some of the most misunderstood areas of concern to patients as well as well as physicians.

1. What is the "individual mandate", or, who is it that must have health insurance? Well, essentially all persons who are American citizens or permanent residents of the U.S. There are, however, a few important exceptions. For example, American Indians, prisoners, those who don't have to even file a federal tax return, and undocumented immigrants, are all exempt from the individual mandate for health insurance, that for everyone else will begin on January 1, 2014.

2. What if I already have health insurance? Persons who are already covered by Medicare, Medicaid, Children's Health Insurance Program (CHIP, or Title XXI), or a qualified health plan, do not have to do anything new (other than renew their current plan during the yearly open enrollment period). Most, but not all, current private insurance will remain in effect. There are cases where a health insurance plan has not had the minimal essential health benefits required under the ACA. In these cases the plans will have to change their benefits, or else not be eligible to qualify for purposes of the ACA's rules, or participate in the new Health Insurance Exchanges.

3. What if I can't afford health insurance? There are subsidies available for persons that qualify. These are based on a "sliding scale" of income. People that make either individually or as a family up to as much as 400% of the federal poverty level (note: for 2013 this was $45,960 for an individual; $94,200 for a family of four) may qualify to have their health insurance premiums either fully or partially subsidized. Since the subsidy is also related to other factors (eg. age, geographic location, tobacco use), its best to go to an independent website, such as the Kaiser Family Foundation (www.kff.org), to get an estimate of your particular subsidy eligibility and approximate amount.

4. What happens if I don't get health insurance coverage by 2014? Unless you are in one of the exempt categories noted above, you will receive a penalty. The penalty amount is based on your total yearly income and the number of people in your family.   Some have noted that even the maximum possible penalty for not having individual health insurance is actually much less than the cost of buying health insurance policies in many cases, which might cause some people to choose purposely to pay the fine (and not get coverage).

5. If I get health insurance will that cover all my medical expenses? Unfortunately, no. In fact the health insurance industry has been given a set of benchmarks to meet for different levels of insurance called, bronze, silver, gold, and platinum plans. If, for example, a person chooses a bronze plan, it is actually set up to cover 60% of total yearly health care costs for that individual. By comparison, the platinum plans cover about 90% of total costs. Also of note, persons that are younger than age 30, can choose a category called catastrophic coverage. As the name suggests, it would have high deductibles and other out of pocket costs, but would be expected to kick-in with a major medical illness or injury.

6. Where do I find out about health insurance options that might be available to me? While eligible persons can buy health insurance on the open market, most of the recent attention has focused on the Health Information Exchanges (HIE). These are state-based websites that help consumers compare health insurance policies. Thirty-six states have opted to have the federal government build and run these HIEs (including Florida); 14 states are handling their own HIEs. The federal government has just opened their website (www.healthcare.gov) which has information and links to help with the important decisions about which plan may be best for you, or your patients.

7. Do all employers have to offer health insurance now? No. This is a very frequently misunderstood aspect of the ACA law. Only employers who have more than 200 employees are actually required to offer them a qualifying health insurance plan. Employers that have between 50 and 200 employees have to offer health insurance OR pay a penalty.  This penalty is $2,000 per employee (after the first 30 employees). Interestingly, this penalty is again much less than the average cost of actually buying insurance (over $15,000 per year for an employee and family of four), leading some businesses to decide to either not provide health insurance, or to even drop coverage that they had already offered. Additionally, this requirement of the ACA has been delayed by the administration in Washington until 2015, leaving the odd and undesired situation where individuals are required to have health insurance coverage (by Jan. 1, 2014), but these employers are not required to offer it until 2015. Also of note, employers with less than 50 employees (who make up most businesses in the U.S.) are NOT required to offer health insurance under the ACA.

8. What impact will the ACA have on Medicare? There are a number of provisions of the ACA that deal with important aspects of Medicare.  The ACA will phase out the part of Medicare drug costs that is known as the "donut hole." This is the part of Medicare drug coverage that currently results in patients having to pay 100% of their prescription drug costs once their yearly drug expenses reach a certain amount. Seniors will be pleased to have this somewhat confusing aspect of Medicare phased out by 2019. The ACA also builds on earlier work on what are called "bundled" payment models, to expand to what are now called Accountable Care Organizations (ACOs). This trend towards paying for whole episodes of care will result in doctors and hospitals working more closely together to ultimately result in better quality of care for seniors at a lower total price to them and to taxpayers. Another important aspect related to Medicare is decreased funding for Medicare Advantage plans under the ACA. This sizable decrease in payments could potentially effect the many Medicare patients (note: about 33% of all Medicare patients in Florida) who get their care through managed care- usually an HMO or PPO. To adapt these plans may have to decrease coverage benefits, or even leave a geographic area completely.

9. What impact will the ACA have on Medicaid? Probably the single largest impact of the ACA on the Medicaid program is the expansion of access to care. States have been given the option to expand their Medicaid programs to all persons who make less than 138% of the federal poverty level (2013: $15,856 for an individual) in that state. Approximately one-half of the states have chosen to expand Medicaid access; one-half (including Florida) have not. If this expansion does occur in Florida in the future, it would add between 1 - 1.2 million new persons on to our Medicaid program. A second area that relates to Medicaid is the ACA provision that increases the pay for primary care physicians who care for Medicaid patients up to the "Medicare level." While this pay increase is only guaranteed for two years (2013 and 2014), it will stimulate much needed access to care for current Medicaid persons.

10. So, after all this (and much more that we didn't have space to discuss) what does the ACA mean for the future of health and health care in the U.S.? Probably most important to understand is that the ACA law is primarily focused on increasing access to care through new insurance mandates and focus. While there are some good provisions that relate to prevention and quality, many health economists in the country have expressed concern that even with the original plan of adding 32 million additional Americans to the health insurance market (18 million through expanded Medicaid; most of the rest through the health care marketplace) the bill doesn't do enough to "bend the cost curve", that is, to really address why health care costs are so high in the U.S. Nonetheless, this, the largest change to the U.S. health care system in almost 50 years, will take a step towards having more people covered, a step that is known to improve quality of life. There are concurrently parts of the law which require revisiting and reshaping, and more attention will need to be given to areas such as the health care workforce needed to care for these new patients. Even with this, our challenge as physicians and health care providers will be to continue to provide high quality cost-effective health care services for our individual patients, while continuing to advocate for a much needed national debate on the why of health care cost increases.

Thursday, October 24th

HIV Highlights for Internists

By: Charurut Somboonwit, MD

Infectious Disease

Thursday, October 31st

A Focus on Angioedema: Key Insights in Diagnosis and Management

By: Richard F Lockey, MD, FACP

Division Director, Allergy & Immunology

Thursday, November 7th

Heparin Induced Thrombocytopenia

Awareness Can Save Lives

By: Damian Laber, MD, FACP

Division Director, Hematology/Oncology

Thursday, November 14th

TBA

Thursday, November 21st

TBA

The Department of Internal Medicine is excited to launch the first of our international initiatives, working with the International Health Student Collaborative (IHSC) and the Patel College of Global Sustainability.

Our program will utilize a cross-disciplinary global community approach to resolving medical issues in the United States and abroad. By embracing a more preventive evidenced-based approach to include clinical care blended with population-based and environmental science, we seek to develop lasting and sustainable solutions that complement the efforts of the Patel College of Global Sustainability and blend efforts with the College of Public Health and other members of USF Health.

This program will bridge sustainable development and clinical care internationally. To fulfill our medical college goals of clinical care, research and education we will be forming country-specific teams.

A needs assessment for the Panama program and India program is planned for completion around February 2014.

This Spring we will be sending a team to a developing country with the IHSC. To amplify this effort a grant from the Kiran and Pallavi Patel Family Trust will support the travel of:

• 1 student from the Patel College of Global Sustainability
• 1 or 2 faculty in Internal Medicine or Internal Medicine Peds
• 1 or 2 Internal Medicine trainees
• 2-3 medical students from Internal Medicine and International

Through this initiative, the Department of Internal Medicine and the Patel College of Global Sustainability will link to each others' web sites and demonstrate we are the clinical arm of the Kiran C. Patel College of Global Sustainability.

The selection committee for reviewing applicants will be:

• Cuc Mai, MD                                          Residency Director
• John Sinnott, MD, FACP                       Chair, Internal Medicine
• Lynette Menezes, PhD                          Assistant Vice President, USF Health International
• Margarita Cancio, MD, FACP                Founding Trustee, USF
• Dr. Kiran C. Patel, MD, FACP               Cardiologist, Philanthropist

As part of the selection process, we will ask applicants to provide a 300 word personal statement explaining what they hope to gain/learn from the experience and how it will enhance their professional or personal growth. Applications will be due Nov 15th and notification of awards will take place January 15th.

• Nominations for those who go above and beyond
• Faculty, Research, Resident or Fellow feature (including patient-centered focus)
• Accomplishments, Awards and Accolades
• Publications
• International Activities
• Socializing/Networking Opportunities 
• Interesting articles you think the DOIM would benefit from
• Questions on policies, procedures or general inquiries