The Affordable Care Act

Transcription

1 The Affordable Care Act Medical City, Dallas, TX October 26, 2012 Presented by Cheryl West, MPH Director, Government Affairs, AARC

2 Affordable Care Act (ACA) 2

3 What I m Not Going to Talk About 3

4 What I Am Going to Talk About 4

5 Provisions of the ACA Title I: Title II. Title III. Title IV. Title V. Title VI. Title VII. Title VIII. Title IX. Title X. Quality, Affordable Health Care for All Americans The Role of Public Programs Improving the Quality and Efficiency of Health Care Prevention of Chronic Disease and Improving Public Health Health Care Workforce Transparency and Program Integrity Improving Access to Innovative Medical Therapies Community Living Assistance Services and Supports Act (CLASS Act) Revenue Provisions Reauthorization of the Indian Health Care Improvement Act Addressing insurance reform is basically in Titles I, II, and IX 5

6 Example of Provisions Under Each Title This is Just Part of Title III Title III Improving the Quality and Efficiency of Health Care Subtitle A Transforming the Health Care Delivery System Part I Linking Payment to Quality Outcomes Under the Medicare Program Sec Hospital Value-Based purchasing program Sec Improvements to the physician quality reporting system. Sec Improvements to the physician feedback program Sec Quality reporting for long-term care hospitals, inpatient rehabilitation hospitals, and hospice programs Sec Quality reporting for PPS-exempt cancer hospitals Sec Plans for a Value-Based purchasing program for skilled nursing facilities and home health agencies Sec Value-based payment modifier under the physician fee schedule Sec Payment adjustment for conditions acquired in hospitals 6

7 Example of Provisions Under Each Title This is Just Part of Title III Part II National Strategy to Improve Health Care Quality Sec National strategy Sec Interagency Working Group on Health Care Quality Sec Quality measure development Sec Quality measurement Sec Data collection; public reporting Part III Encouraging Development of New Patient Care Models Sec Establishment of Center for Medicare/Medicaid Innovation within CMS Sec Medicare shared savings program Sec National pilot program on payment bundling Sec Independence at home demonstration program Sec Hospital readmissions reduction program Sec Community-Based Care Transitions Program 7

8 Example of Provisions Under Each Title This is Just Part of Title III Subtitle A Part III (continued) Sec Extension of gainsharing demonstration Subtitle B Improving Medicare for Patients and Providers Part I Ensuring Beneficiary Access to Physician Care and Other Services Sec Increase in the physician payment update Sec Extension of the work geographic index floor and revisions to the practice expense geographic adjustment under the Medicare physician fee schedule Sec Extension of exceptions process for Medicare therapy caps Sec Extension of payment for technical component of certain physician pathology services Sec Extension of ambulance add-ons Sec Extension of certain payment rules for long-term care hospital services and of moratorium on the establishment of certain hospitals and facilities Sec Extension of physician fee schedule mental health add-on 8

9 Example of Provisions Under Each Title This is Just Part of Title III Subtitle B Part I (continued) Sec Permitting physician assistants to order post-hospital extended care services Sec Exemption of certain pharmacies from accreditation requirements Sec Part B special enrollment period for disabled TRICARE beneficiaries Sec Payment for bone density tests Sec Revision to Medicare Improvement Fund Sec Treatment of certain complex diagnostic laboratory tests Sec Improved access for certified nurse-midwife services Part II Rural Protections Sec Extension of outpatient hold harmless provision Sec Extension of Medicare reasonable costs payments for certain clinical diagnostic laboratory tests furnished to hospital patients in certain rural areas 9

10 Example of Provisions Under Each Title This is Just Part of Title III Subtitle B Part II (continued) Sec Extension of the Rural Community Hospital Demonstration Program Sec Extension of the Medicare-dependent hospital (MDH) program Sec Temporary improvements to the Medicare inpatient hospital payment adjustment for low-volume hospitals Sec Improvements to the demonstration project on community health integration models in certain rural counties Sec MedPAC study on adequacy of Medicare payments for health care providers serving in rural areas Sec Technical correction related to critical access hospital services Sec Extension of and revisions to Medicare rural hospital flexibility program. Part III Improving Payment Accuracy Sec Payment adjustments for home health care 10

11 Example of Provisions Under Each Title This is Just Part of Title III Part III Improving Payment Accuracy Sec Hospice reform Sec Improvement to Medicare disproportionate share hospital (DSH) payments. Sec Misvalued codes under the physician fee schedule Sec Modification of equipment utilization factor for advanced imaging services Sec Revision of payment for power-driven wheelc Sec Revision of payment for power-driven wheelc Sec Treatment of certain cancer hospitals Sec Payment for biosimilar biological products Sec Medicare hospice concurrent care demonstration program Sec Application of budget neutrality on a national basis in the calculation of the Medicare hospital wage index These are just 2 Subtitles - Title III continues through Subtitles C - G 11

12 The Foundation of the ACA 12

13 The Foundation: Why the 2,000+ Page Law?? - Many Factors Involved In 2000, health care was 17.6% of US GDP In 2010, US spent $2.6 Trillion overall on health care that s just in 1 year 13

14 The Foundation of the ACA Premiums jumped 11% in 2011; wages increased 2% Avg. family policy now costs $15,

15 The Foundation of the ACA taxpayer dollars are perpetuating current misaligned financial incentives that result in poor quality care 15

16 The Foundation of the ACA 16

17 The Foundation of the ACA 17

18 If You Want to Read the ACA Law This link takes you to the law.. it s just the law, no editorializing The Kaiser Family Foundation- non partisan health reform website on the ACA 18

19 If You Want to Read the ACA Law The Kaiser site also has an easy-to-follow timeline for when key provisions are implemented healthreform.kff.org/home/khs/timeline.aspx? source=fshttp:// 19

20 Changing the Health Care Paradigm Better Health, Better Care, Lower Costs 20

21 What Provisions Most Directly Impact RTs? Let s Take A Look 21

22 Hospital Readmissions 22

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24 Hospital Readmissions Source: Kaiser Health News: Medicare to Penalize 2,211 Hospitals for Excess Readmissions August 13, 2012 By: Jordan Rau, KHN Staff Writer 24

25 Hospital Readmissions 25 Source: Kaiser Health News: Medicare to Penalize 2,211 Hospitals for Excess Readmissions August 13, 2012 By: Jordan Rau, KHN Staff Writer

26 Hospital Readmissions By Hospital How well did Texas hospitals do overall? State Total No. of Hospitals Evaluated Avg Hospital Reduction Penalty Texas % California % New York % Florida % Check out Specific Texas Hospital Readmission Penalties icare%20readmissions%20penalties% pdf 26

27 Texas Readmission Penalties by Hospital 27

28 Value-Based Purchasing What is it? 28

29 Value-Based Purchasing How does it Work? * Payment that would have been made for a discharge in the absence of VBP program 29

30 VBP Medicare Spending per Beneficiary 30

31 Value-Based Modifier and Physician Quality Reporting 31

32 ACA Changes Can Improve Access to RTs in Physician Office Setting 32

33 Center for Medicare and Medicaid Innovation Pilots and Demos 33

34 Community-based Care Transitions Program (CCTP) 34

35 Accountable Care Organizations Medicare Shared Savings Program 35

36 Bundled Payment Program 36

37 Comprehensive Primary Care Demo 37

38 Patient-Centered Medical Home Demo 38

39 Patient-Centered Medical Home Demo 39

40 Independence at Home Demo 40

41 What Does All This Mean for RTs? Providers Will Value the Care RTs Provide 41

42 What Does All This Mean for RTs? RTs Can Make A Difference 42

43 What Does All This Mean for RTs? Be Proactive Help Save Medicare $ and Increase Payment for Your Provider 43

44 Where Are We With the ACA? 44

45 Where are We With the ACA? 45

46 Keep in Mind.. 46

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