As employers, employees and the unemployed across America continue to wrap their heads around new federal health insurance mandates – known to many simply as Obamacare — owners of local businesses, both large and small, were asking plenty of questions last week at a symposium designed to clue them in to the new rules and regulations and how it could affect their business models moving forward.
Experts at the event, “Taming Healthcare 2014,” gave a dose of advice to the business community Oct. 16 at the Inn & Spa at East Wind, offering tips for navigating the newly reformed health care system — which they described as a “moving target.”
Starting in 2015, businesses employing 50 or more full-time equivalent workers will be required to offer those employees affordable health insurance coverage or face penalty fees.
Andrew Mitchell, CEO of PBMC Health, delivered the keynote speech at the event – presented by the Riverhead Chamber of Commerce, the Riverhead Industrial Development Agency and Peconic Bay Medical Center. He said employers are required to offer an insurance plan that covers at least 60 percent of medical expenses, which is the same percentage covered by the lowest plan on the public health insurance marketplace. At the same time, the plan’s monthly premium must be no more than 9.5 percent of the employee’s household income – otherwise it is considered “unaffordable,” according to the reform law.
This means what is affordable to one employee may not be to another, which in turn means added paperwork and oversight for employers to ensure they are in compliance, said Alysia Doerbecker, senior district manager for ADP payroll services.
“There is a laundry list of information that you need to be prepared for,” Ms. Doerbecker said.
As a result, she said, a proficient human resources system to keep tabs on all the information could be vital.
Should a company slip up, it may be subject to penalties or open itself to a lawsuit, said John Hudson, president of True Benefit, LLC, an employee benefits brokerage and consulting firm.
After 90 days, new employees become eligible to join the company’s health care plan, should they offer one, Mr. Hudson said. “You better track [those] employee[s] accurately. If they should have been offered coverage, it’s going to come back to you as an employer from a lawsuit perspective.”
To enforce the new regulations, Michael Vigliotta, an attorney at The Law Offices of Thomas M. Volz, said the Internal Revenue Service is hiring more than 6,500 new employees to ensure businesses are in compliance.
Susan Flatley, manager of North Fork Radiology, which has 60 full-time employees, said she was expecting added oversight, “but not to the extent of what I heard here today.”
And for those considering not offering affordable care, “the penalties are larger than I had anticipated,” she said. The penalty is generally equal to $2,000 for each full-time employee, excluding the first 30 employees. Should an employee enroll in the marketplace and qualify for a government subsidy, additional fees could be incurred.
Bruce Talmage, owner of Talmage Agway in Riverhead, has about 17 full-time employees, which puts him in the small business category.
“It sounds like I am not required to provide a health plan, but I currently do, and I am trying to understand the rules,” Mr. Talmage said. He said many of his questions have to do with his ever-changing work force because the store gets busier during the spring and summer landscaping seasons.
Talmage wears an interesting couple of hats, as he’s also involved with the nonprofit Riverhead Volunteer Ambulance Corps, which has about 17 full-time employees. While the nonprofit has not offered health coverage in the past, he said they are looking into getting it.
As a small business, he is not required to offer health insurance, but there are tax incentives for small businesses that do so, according to the Small Business Assistance Program, a state-run nonprofit supporting affordable health insurance.
“If I do continue to offer one, does it have to be to every single employee? Is there a limit on the number of hours they work?” Mr. Talmage asked.
According to the law, as long as his work force does not exceed 50 full-time workers for more than 120 calendar days, he will still be considered a small business.
Raising even more questions for Talmage, the insurance plan he currently offers his employees will no longer be offered come Jan. 1, so it’s as if he is starting at square one, he said.
There are also unanswered questions on the health care provider side.
An estimated 57 million uninsured people stand to gain access to affordable health care, however there are already shortages of primary care physicians to provide it, said Dr. George Ruggierio, chief of family medicine and director of medical education at PBMC.
“Primary care physicians are already under strain. Who’s going to see these people?” Dr. Ruggierio said.
The U.S. Department of Health and Human Services estimates that the physician supply will increase by only 7 percent in the next 10 years, far less than the more than 36 percent increase in the patient population, according to the Association of American Medical Colleges.
“There are concerns across the board – the insurance industry, hospitals and doctors trying to deliver care,” Dr. Ruggierio said.
Unfortunately, not all of the questions are answered yet, said Randy Blum, a representative from United Healthcare – an insurance provider offering coverage on New York’s insurance exchange. “At this point nobody knows what’s going to happen.”
While much remains uncertain for health care providers, small business owners seeking the right plan and employees themselves, Lauren McKissick, owner of Prominent Swimming Pools Inc. of Calverton – which has just a handful of employees – said that either way, she believes offering health benefits is important to keeping loyal employees.
“You don’t want to lose good people over insurance issues,” she said. “But is it going to be more affordable to workers if we break off and no longer offer it?”
Peconic Bay Medical Center has been recognized nationally for its partnership with physicians, allowing each to deliver high quality care at low costs to patients, according to a global health care consulting firm.
The Advisory Board Company, the health care firm, awarded PBMC the Southwind Transformation Award in Cost Effective Community Care.
As costs of providing care continue to rise, the margins hospitals work within have begun to tighten, according to The Advisory Board Company. Partnerships with physicians allow hospitals to coordinate care, lowering costs, the firm said.
“PBMC developed a plan to ensure the hospital’s financial sustainability, mobilizing a system-wide effort analyzing all departments and divisions to identify improvement opportunities,” a press release from the firm reads. “The initiative included optimizing care coordination, leadership structure, emergency services, ancillary services, supply chain, perioperative services, and the physician enterprise.”
The changes help reduced operating costs by improving the flow of patients and reducing readmission rates, and improving the financial stability of the hospital’s physician employment program, according to the release.
“[The organization’s] work to deepen their collaborative partnerships with physicians makes [it a] national leader in executing key initiatives for value-based care strategy,” said John Deane, chief executive officer of the firm’s consulting division.
To learn more about the hospital’s initiate, visit the firms website.
Paumanok Vineyards celebrated its 30th anniversary Saturday night with a gala party to thank local chefs for their years of support. The Massoud family, owners of the Aquebogue vineyard, will donate all proceeds from the event to Peconic Bay Medical Center.
Several hundred guests gathered under a festive white tent at the edge of the vineyard and were treated to tastings from some of Long Island’s most celebrated chefs, including many from the North Fork.
Master of Ceremonies Doug Geed, anchorman for News 12 and host of The East End, spoke of his affection for the North Fork and for the Massoud family, whom he has known for over 25 years.
Peconic Bay Medical Center president and CEO Andrew Mitchell gave a short and sometimes funny history of the Massoud family’s journey and of winemaking on Long Island.
Suffolk County legislator Al Krupski presented the Massouds with a proclamation and brought the entire family up to the stage to receive it.
Peconic Bay Medical Center officials joined employees and community members for a night of dinner and dancing to benefit the hospital Friday.
Hospital CEO Andrew Mitchell, PBMC Health board of directors president Sherry Patterson and Marguerite Strauss, the first member of the hospital’s foundation, spoke at the event.
The night featured a silent auction with vacations, tickets to restaurants and golfing events – including 18 holes with Michael J. Fox.
Four people were sent to the hospital after a four-door sedan crashed into a telephone pole shortly after 3 p.m. in Jamesport.
According to Riverhead police, the car was heading eastbound, just east of Jamesport Vineyards, when it veered off the road and into the pole.
Police are still investigating the cause of the crash, which shut down Main Road for close to an hour while traffic was diverted around the scene.
Police said the driver and passengers of the car were sent to Peconic Bay Medical Center by Mattituck Ambulance for non-life threatening injuries.
LIPA was on scene repairing the pole, and as of 4:15 p.m., Main Road had been cleared back up.
PBMC Health’s Manorville ambulatory campus is officially open to patients.
The opening was marked by a ribbon cutting ceremony led by hospital officials on Thursday.
Manorville area residents have long lacked access to nearby medical care, having had to travel to Riverhead or Stony Brook in the case of an emergency, PBMC Health officials said.
The much-anticipated center currently offers patients urgent care, primary care, urology, internal medicine and orthopedic care in one building, but the campus will ultimately grow and become a four-building comprehensive healthcare center.
“We want the community to know we are here and ready to care for them,” said Jacqueline Selva, executive director of the Riverhead Management Company.
The urgent care center is designed to handle health issues such as sprains, stitches, sore throats and broken bones, said Ms. Selva said.
It is fitted with 13 exam rooms, a radiology room with a full body x-ray machine, and two procedure rooms.
It is currently open from 8 a.m. to 7 p.m., and once it becomes more established, officials intend to keep the urgent care center open 24 hours, she said.
The campus has been designed for “one-stop medical shop,” Ms. Selva said.
Patients can come not only for urgent care, but can have primary care physicians assume their care moving on. Should patients need a referral to a specialist, the hope is that, once the campus is finished, the patient will just have to walk a few steps away for the specialized care.
“We wanted it to be convenient,” she said. “Where patients are going to want to establish their care.”
Caregivers have already seen the model’s convenience in action, Ms. Selva said, pointing to a recent example in which an urgent care patient who came in complaining of a swelling hand.
“The person had came in with a swollen hand, we sent them down the hall for an x-ray and it turned out to be a broken hand,” Ms. Selva said. “After that the patient was referred to our orthopedist who was also down the hall.”
Many primary care and urgent care facilities are not equipped with radiology and X-ray equipment, she said.
The next building is slated to open about eight months from now, and will house a center for digestive disorders and space for general surgery.
Plans for the other buildings are currently being developed, hospital officials said.
“ [The campus] provides us with an opportunity to offer services well beyond just hospital care,” said Andrew Mitchell, president and CEO of PBMC Health and Peconic Bay Medical Center in Riverhead, which falls under the PBMC Health umbrella.
“These four buildings will be dedicated to the care of this community,” Mr. Mitchell said.
The completion of the campus was made possible by a $5 million donation from The Louis Feil Charitable Lead Annuity Trust. The center has been named The Gertrude & Louis Feil Campus for Ambulatory Care, in appreciation of the Feil family’s donation.
The Trust has given philanthropic gifts to other health institutions, including South Nassau Hospital in Oceanside.
The new medical center also brings new job opportunities to the area. The center has hired five new employees to fill reception and medical assistant positions. As the patient population grows, they anticipate several other positions opening as well, Ms. Selva said.
Helene Davison, a new employee working both reception and as a medical assistant, said she has 10 years of experience in private practice, and has never worked at such a “high spirited” place.
One person was taken to Peconic Bay Medical Center with minor injuries after two cars crashed at the intersection of Route 58 and Osborne Avenue in Riverhead Saturday afternoon, Riverhead Town Police said.
Police couldn’t specify the cause of the accident, which occurred about 2:30 p.m.
A black Cadillac sedan was extensively damaged and parts of the car were scattered on Route 58, where traffic was moving steadily at 3 p.m. Police said the second car involved in the accident was in fair condition and that the driver was able to drive away safely from the scene.