In following the Becker Hospital Review (@hospreviewmag) this week, an organization dedicated to reporting on issues and news important to hospital executives, I came across this tweet:
“Great piece on healthcare reform: a look back and a look ahead.”
I typically cringe when I read anything describing a bit on healthcare reform as “great”, but as it turns out, the article this tweet links to is, in fact, a great overview of the legislative changes in healthcare that began in 2010. The article also outlines what to expect looking forward.
I encourage you to read the piece it in its entirety, but for a quick summary, I’ve compiled some key highlights below (a 101 view, if you will) of the legislation and its chronology:
2010 - President Obama signs the Patient Protection and Affordable Care Act (PPACA), a bill (974 pages in length) enacting changes now referred to in common vernacular simply as “healthcare reform”.
A highlight of some of the changes that are now in effect since the bill became law:
- Adults are now allowed to stay on their parents’ insurance until age 26.
- States now can provide options for those previously turned down for health care coverage due to pre-existing conditions.
- The beginning of regulating commercial payors by requiring insurers to pay 80-85% of the premium dollars, not on administrative costs, but on actual medical care.
- In an effort to put focus on preventative care, primary care doctors and general surgeons received 10% reimbursement increases from Medicare.
- Another preventative care move now allows Medicare enrollees to get annual check-ups and other preventative services for free.
2011 - Part of the PPACA law called CLASS Act was terminated. This act, termed the Community Living Assistance Services & Support (CLASS) Act, was formed to provide cash benefits through a long-term insurance program to adults who become disabled.
2012 – Upcoming milestones and programs in process of rolling out:
- Accountable care organizations (ACO) – 2012 is the year in which this new, proposed model of care is being defined. ACOs work to model care reimbursement based on patient outcomes. A few facilities around the country are testing this model and will be rewarded through increased Medicare reimbursement for more coordinated, outcome-based care.
- Bundled payments - This plan aims to pay providers a lump sum at a negotiated discount based on the estimated costs for a patient’s entire experience.
- Value-based purchasing program - This program begins in October 2012 and is designed to pay incentives to those facilities that prove quality improvements in care based on a set of measures. The article states an example of this for illustration: Hospitals that prove they more quickly get appropriate heart attack patients into artery surgery are eligible for a financial incentive.
- And finally, a critical milestone in 2012 is the US Supreme Court scheduled ruling to determine if PPACA is constitutional. Two of the most controversial aspects of PPACA are the plan to expand Medicaid and the mandate that most persons will be required to obtain healthcare coverage by 2014.
As you can see, 2012 will be a pivotal year for healthcare reform legislation. Regardless of the Supreme Court ruling and the resulting legislative changes, finding ways to improve and expand healthcare while shifting focus to patient prevention and outcomes is hot on the radar of politicians, clinicians, hospital and healthcare facility executives and America at large.
Stay connected. Stay informed. And check back for updates from me on the most sizzling of healthcare Twitter topics.
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