Implementing the Patient Protection and Affordable Care Act in Your Practice

Transcription

1 Implementing the Patient Protection and Affordable Care Act in Your Practice Richard Honsinger, MD, MACP, FAAAAI President Joint Council of Allergy, Asthma & Immunology

2 The Patient Protection and Affordable Care Act was signed into law on March 23, And the Health Care and Education Reconciliation Act of 2010 was signed into law on March 30, 2010 and amended the PPACA and changed the student loan programs. These two acts will affect Health Care Reform for years to come.

3 Implementation Timeline 2010 Biosimilar Biologics: Allows generic equivalents of biologic drugs. New biologics get a 12 year patent Tax Credit to Buy Insurance Insurance Reform: Uninsured risk pools for patients with preexisting illness. Dependent coverage to age 26, even if not living at home or not in school No lifetime benefit restrictions on new insurance policies (extends to all in 2014) Dependents under age 19 eligible for coverage even if ill or disabled. Must allow appeals for denied services Physician Owned Hospitals: Must accept Medicare Prohibit Insurance Companies from Rescinding Coverage Pre-existing Illness Insurance Plans

4 2010 Drug Benefit: Starts to close the gap on Medicare Part D benefits (donut hole finally closes in 2020) PQRS: Computerized practices will receive rewards for meeting guidelines. Outcomes measures will be developed for asthma and other allergic diseases. Primary Care Training and Federally Qualified Health Centers: Increased funding. However this will likely detract from specialty training. Independent Payment Advisory Board: Replaces the Medicare Payment Advisory Commission (MEDPAC), but does not take effect until GPCI floor: Rural areas will continue to receive 100% of GPCI until 2014, unless repealed No Medicare Discounts: Physicians who treat Medicare patients will be paid full Medicare

5 2011 Medicare Preventive Care: Vaccinations and a free prevention visit Insurance Reform: Insurance companies must spend 85% (80% for small companies) of premium on health care benefits. Th Long Term Disability Care: A voluntary program is offered. Medicare bonus for underserved areas Center for Medicare and Medicaid Innovation: Developing new payment and delivery models. Accountable Care Organizations; Patient Centered Medical Home

6 2012 Value Based Purchasing (hospitals) Accountable Care Organizations Voluntary long-term care insurance program (CLASS) not implemented

7 2013 Preventive Care extended to Medicaid Bundling Payments Medicaid Primary Care Services at 100% Medicare Continue Funding SCHIP Health Insurance Exchanges by states (19) or by Feds. October enrollment Increase payment for E/M codes (PCP & subsp)

8 Medicaid pays bonus for E/M Codes for two years Providers certified by ABIM, ABP, ABFP And Subspecialty Boards of Above. Osteopathic Subspecialty Boards of A/I Not ABAI as it is a conjoint board ABAI Allergists must sign attestation as certification of ABIM or ABP Currently under appeal

9 2014 Insurers Cannot Deny for Pre-existing Conditions Expand Medicaid to 133% of Federal Poverty Level (State Option) Federally funded mandate overturned by Supreme Court 100% funding until 2017, decreasing to 90% by 2020 States that opt out still lose Disproportionate Share Hospital (DSH) funding Subsidy for Health Exchange % of Federal Poverty Level Federal Health Insurance Exchanges for states that have not established. Reduce Funds for Safety Net Hospitals: As patients will have insurance coverage. Employer Mandate: Employers of over 50 must provide insurance to full time employees. MANDATORY HEALTH INSURANCE (upheld by Supreme Court) No Upper Limits on Coverage Personal and Small Business Tax Credits

10 Feb 11,2013

11 Likelihood of U.S. Governors' Support for Expanding Medicaid under the ACA. Sommers BD, Epstein AM. N Engl J Med 2013;368:

12 Common Themes in Governors' Statements on Expanding Medicaid, Stratified by Support for or Opposition to the Expansion. Sommers BD, Epstein AM. N Engl J Med 2013;368:

13 2015 Independent Advisory Payment Board: makes recommendations to Congress for physician payment. These have the effect of law unless overturned by a supermajority. Pay for Value, not Volume

14 Allergy Practice Electronic Health Records needed to take full advantage of rewards Be Vigilant for Coding Changes Continue to Fight for Adequate Reimbursement Know Meaningful Use Look for Opportunities with ACOs, PCMH, etc. Be Involved