The Future of Healthcare: How to Comply, Survive, and Ultimately Thrive

1. The Future of Healthcare: How to Comply, Survive, and Ultimately Thrive North Carolina Chapter – October 11, 2012 Justin Moore, PT, DPT Vice President, Public Policy, Practice, and Professional Affairs American Physical Therapy Association

2. Source: Kaiser Family Foundation. Health Care Reform. 2012

3. Public: Split 2 year after ACA January 2010 January 2011 Jan 12 June 12 Sept 12 http://www.kff.org/kaiserpolls/8315.cfm

4. Health Care Reform: Ideas and Implementation(2010-2018)

5. Health Care Reform:Achieving the Three Part Aim

6. Health Care Reform • The Patient Protection and Affordable Care Act (ACA) signed into law on March 23, 20101 1 Coverage & Insurance Market Reform Make insurance more accessible and affordable for all individuals 2 Delivery & Payment System Reform Pay for quality instead of volume of care 3 Financing Strategies for Health Reform Find sustainable funding to pay for reform provisions 1) The Affordable Care Act is the combination of the Patient Protection and Affordable Care Act (PPACA), P.L. 111-148, enacted on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010 (HCERA), P.L. 111-152, enacted on March 30, 2010.

7. Overall Reform Aims to Expand Coverage and Reduce Spending Over Time Source: Congressional Budget Office, Score of ACA, March 20, 2010

8. Estimated Effect of HCR in 2019 Source: Office of the Actuary – Centers for Medicare and Medicaid Services – April 22, 2009

9. Implementation at a Glance

10. 2010

11. 2011

12. 2012-13

13. 2014

14. 2015-18

15. Health Care Reform 2.0 - Moving Forward Following the Supreme Court

16. What’s Next: The Cliff of 2012 Doc Fix Rural Payments (GPCIs) Therapy Cap Extension June 29, 2012 5-4 Decision to Uphold - Legislative Changes Required Medicare Physician Fee Schedule MedPAC Long Term: Entitlement Reform, Tax Reform, Revenue/Spending Trade-Offs Tight Race for President and US Senate

17. Overview of Supreme Court Decision • Four (4) Questions Considered: Anti-injunction, Individual Mandate, Severability, and Medicaid Expansion • Individual Mandate: The Court held that the individual mandate is a constitutional exercise of Congress’s power to levy taxes • Medicaid Expansion: The Court held that forcing states to expand Medicaid is unconstitutional • States must be give a choice about whether or not to move forward on the ACA’s Medicaid expansion, federal government can not cut off existing funds to states that do not proceed with expansion • Medicaid expansion requirement is severable from the rest of the ACA, so remainder of law remains in effect • Court Majority Opinion: Chief John Roberts joined by Breyer, Ginsberg, Sotomayer, and Kagan • Court Minority Opinion: Scalia, Kennedy, Thomas, Alito

18. Legislative Action

19. Election 2012: Health Care Impact Senate Elections 2012 30 11 8 3 6 5 37 Solid Likely Lean Toss-Up Lean Likely Solid

20. Therapy Reform: Here and Now • October 1 – Therapy Cap Exception Process Changes • Manual Review and Hospital Outpatient Exceptions • November 1 – Medicare Physician Fee Schedule (Jan 1) • Functional Measures - NPI • December / January – Medicare Payment Advisory Commission • Short Term Reform • Long Term Reform • Legislative / Regulatory Changes • Therapy Cap Extension • SGR / Payment Reform • Quality • Bundling

21. The Pending Fiscal Cliff • Medicare Extenders Policy (December 31, 2012) • Doc Fix / Sustainable Growth Rate (SGR) • 30% reduction in Part B Payments • Therapy Cap Extension • Exceptions Process (2 Tiered / Expanded to Hospitals – Oct 2012) • Sequestration (1 Trillion – January 2, 2013) • 11 Billion from Medicare (2% across the Board Cut) • 52.4 Billion for non-Defense (NIH projects 7.8% cut – 2.39 B) • Medicaid and SCHIP exempt • Entitlement Reform (Medicare and Medicare) • Tax Cut Expiration

22. Health Care Reform 2.0 - Implications for Rehabilitation Professionals

23. The Next Decade in Health Care

24. Next Decade In Health Care:

25. Physical Therapy and Rehabilitation at a Crossroads

26. Value: A Need for Focus • Need for Right Rehabilitation Professional (PT, OT, Physician) for Right Patient at Right Time • Focus on Differentiation • Need to Meet Society's Need Today • Focus on Disability, Chronic Care, Populations as well as Patients • Need to Embrace Current Scope not New Scope • Focus on Rehabilitation • Need To Invest in the Development of Data • Focus on Research

27. Common Theme: Need to Prove Value • Value-based health aims to improve quality, lower cost, and drive toward value in healthcare delivery • The demand for value requires greater accountability on the part of all stakeholders within healthcare Identification of best practices Provider adherence to best practices Measurement of provider performance Benefit design Cost-effectiveness Value

28. Defining Value in Health Care Performance Measures Assessment of provider performance to ensure quality care Evidence Definition of value Value-Based Health Care Realigning provider payments to incentivize the provision of high value care, where value is a function of both quality and cost Health Information Technology* Facilitation of information collection and exchange Transparency Demonstration of value for consumers and purchasers Payment Models Incentives to deliver valuable care ACA relies on HIT provisions authorized in ARRA to enhance infrastructure necessary to support efforts around care coordination and VBP

29. APTA In Action Innovation Implementation

30. Contact Information Justin Moore, PT, DPT American Physical Therapy Association Public Policy, Practice and Professional Affairs Unit 1111 North Fairfax Street Alexandria VA 22314 703-706-3164 advocacy@apta.org www.apta.org