Health C are Reform

1. Health Care Reform Keith Tintle, CEO Timpanogos Regional Hospital

2. Agenda • Overview of The Patient Protection and Affordable Care Act • In-Depth Look at Key Parts of Reform • Potential Impact of Reform on Emerging Healthcare Professionals • Q & A

3. How We Got Here A Broken System Access Issues 49 million uninsured 14,000 Americans lose health insurance coverage everyday Insurance companies operate as monopolies in certain states 45 states allow insurance companies to deny patients with pre-existing conditions (Exceptions: MA, ME, NY, NJ, VT) Cost Issues The cost of health care for the average American family is $16,771 Half of all bankruptcies are related to medical expenses Health spending almost 2x as much as other industrialized countries Projected Medicare bankruptcy by 2017 Worse health outcomes (according to the World Health Organization)

4. A Quick Look at History 1934 – FDR’s New Deal. 1970s – Attempts by Presidents Nixon and Carter, Sen. Ted Kennedy 1950s – Growth of employer-sponsored insurance 1997 – SCHIP 1912 – TR calls for universal coverage 1940s – Truman: public subsidies 1965 – Medicare and Medicaid 1993 – Clinton proposal defeated

5. The New Health Reform Law: Patient Protection and Affordable Care Act http://bcove.me/9znevk5o

6. Key Concepts • Expanded Coverage • Exchanges and Subsidies from Gov’t • Medicaid Expansion • Shared Responsibility to Increase Coverage • Individual Mandate • Employer Incentives/Fines • Insurance Regulation • Payment Reform • Incentives for PCP & General Surgery • Incentives for Prevention & Wellness • Cost Containment & Reform Financing Measures

7. Keys to the Future: Reduced Fragmentation and Comprehensive Integration Future State: Patient Centric Care Present State: Fragmented Care

8. Expanding Coverage Estimate = 30 million newly insured State Insurance Exchange = Easy to use, “Orbitz-like” virtual marketplace Substantial subsidies to consumers buying insurance at exchange (eligibility up to 400% of Federal Poverty Level) Major Medicaid expansion w/ Federal subsidies for low income individuals/families (eligibility up to 133% of Federal Poverty Level)

9. Shared Responsibility * If not ruled unconstitutional by Supreme Court • Individual Mandate starts in 2014* • No employer mandate but… • Fines for medium & large employers who do not offer health insurance • Tax breaks to small businesses who choose to offer health insurance

10. Insurance Regulation Requires all new plans starting in 2013 cover pre-existing conditions (starts in 2010 for children) Requires that at least 85% of premiums go towards medical care in small group and individual markets (starts in 2014, though regulation development in 2010) Prohibits lifetime limits on dollar amounts of coverage (2010) Prohibits dropping patients from coverage (rescission) except in fraud (2010) Sets minimum benefit standards in the exchange (2014) Limits premium variation based on age, gender, etc. (2012)

11. Wait a minute… who’s going to take care of all these extra patients?

12. Medicare and MedicaidPayment reform 10% bonus payment to all primary care physicians 10% bonus payments for general surgeons in rural areas 5% bonus for mental health providers Increase in Medicaid payment rates for primary care physicians to equal Medicare rates (2013-2014) Are you interested in Primary Care?

13. Physician Workforce Investment Residency programs will be requiredto redistribute 65% of unfilled slots to primary care or general surgery Expanded scholarships and loan repayment through the National Health Service Corps Tax relief for those health care workers paying state-issued student loans for working in primary care or high need areas Additional low-interest student loans, scholarships, loan repayment programs for primary care and general surgery Increases funding for Community Health Centers

14. This sounds expensive – are we going to rein in costs?

15. Offsetting the Cost of Reform • Cost Containment and Quality • Independent Payment Advisory Board (IPAB) to make cost saving recommendations to Medicare. • Creates a Center for Innovation to test payment/delivery system reforms • Pilot programs for Medical Home, Bundled Payment, and Accountable Care Organizations (ACOs) • Reduces hospital payments for Preventable Readmissions & Infections • Financing Mechanisms • Fees to Insurers and Pharmaceutical Companies • Increased taxes to high wage earners • Reductions in payment to hospitals Estimated Offset +/- $500 Billion

16. Cost analysis by the CBO Net cost of $938 billion over 10 years Reduce the Deficit $140 Billion The First 10 Years & $1.2 Trillion In The Next 10 Years Average premiums will stay the same for the majority of Americans who get their insurance from their job Costs will go down for those who buy in the exchange and qualify for subsidies Elmendorf, D. (2010, March 18) Preliminary Cost Estimate for Pending Health Care Legislation. Retrieved 5 April 2010 from Congressional Budget Office Website: http://cboblog.cbo.gov/?p=508

17. Where Are We Right Now? • Health Care Reform Is a Major Election Year Topic. • Supreme Court Beginning Deliberations Over Constitutionality of Individual mandate. • SGR “Fix” Still Looming for Docs. Potential 26% Cut. • States Preparing Health Insurance Exchanges for 2014. • Providers Participating in Pilots on Various “Bundled Payment Models”. • Hospitals & Docs Already Participating in Pay-for-Quality Initiatives

18. How Will All of This Impact Me? • Decline in Physician Income (SGR?) • Over 50% of Physicians Believe Their Income Will Be Negatively Impacted By Reform. • Less for PCP, Gen Surg, Peds & Rural Docs • Big Declines in Oncology, Cardiology and Some Sub-Specialties • Possible Physician Shortage Looming • Combination of Docs Retiring Early & New Grads Not Choosing High Demand Specialties • Projected Shortage of 150,000 – 200,000 Physicians By 2020 (mostly in Primary Care, Rural Areas and General Surgery) • Incentives to For Graduating Physicians Who Choose PCP, Gen Surg or Rural Medicine.

19. How Will All of This Impact Me? • Expect to Practice in Large Physician Groups and/or Hospital Owned Practices • No More Paper – Proliferation of EMR & Inter-Connectivity • Expect CONSTANT CHANGE!