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The Patient Protection and Affordable Care Act [PPACA = ACA]. ASAP Meeting Austin, Texas July 22, 2010 Norman H. Chenven CEO & Founder Austin Regional Clinic. Dr. George’s Charge:. “Give a 20-25 minute talk on the implications of healthcare reform
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The Patient Protection and Affordable Care Act[PPACA = ACA] ASAP Meeting Austin, Texas July 22, 2010 Norman H. Chenven CEO & Founder Austin Regional Clinic
Dr. George’s Charge: “Give a 20-25 minute talk on the implications of healthcare reform for the care of patients with chronic disease and/or congenital abnormalities.”
Problems: American Health Care 2010 • 45 million Americans uninsured • Too expensive • Quality is erratic • Inadequate information systems • Lack of “System” • Shortage of primary care access
What Did We Get? • The Short Answer: • An expansion of coverage • Some health insurance regulatory reform • Incentives to improve information systems • Incentives to reward quality • Pilot projects to: • Encourage the development of integrated/coordinated delivery systems. • Encourage transparency with reporting on access, quality, service and cost. • Reward efficiency and reduce cost.
Problem #1: 45 Million Americans Uninsured • Expand Medicaid • Mandates for employers and individuals. • Subsidies for employers and individuals. • Health insurance exchanges. • High risk pool mandate. • Residual uninsured: 10 – 20 million (illegal immigrants, penalty payers, other).
Problem #2: Too Expensive • Pilot programs to encourage accountable care organizations (ACO) and payment bundling. • Minimal concessions from the hospital and pharmaceutical industries for price reduction. • A grab-bag of tax increases on insurers, very wealthy individuals, Medicare tax increase, “Cadillac” plan taxes, etc. • Reduce Medicare Advantage subsidies. • Tax on sun tanning salons. • But, in reality, the ACA does not adequately address increasing costs.
Problem #3: Erratic Quality • Supports medical research and comparative effectiveness research. • Mandates incentive payments for physicians and hospitals to measure and report on quality. • Various pay-for-performance programs.
Problem #4: Inadequate Information Systems • Fiscal Stimulus Bill provided $20 billion to install electronic medical records (EMR) and develop community based health information exchanges (HIE). • Financial reward for quality reporting which will require more sophisticated IT systems.
Problem #5: Health Care System is Not a System • Encourages the development of Accountable Care Organizations (ACO). • Encourages the development of Patient Centered Medical Homes (PCMH).
Problem #6: Shortage of Primary Care Access • Increase Medicare and Medicaid payments to primary care doctors. • Increase payments for behavioral health. • Promote Patient Centered Medical Homes (PCMHs). • Fund primary care, Nurse Practitioner & Physician Assistant training programs. • Administrative simplification mandates. • Encourage and fund medical and nursing school expansions.
Patients with Chronic Disease or Congenital Abnormalities • Prohibits insurance companies from denying coverage to children with pre-existing conditions (Fall, 2010). • Prohibits insurance companies from denying coverage to any individual with a pre-existing condition (Jan, 2014). • Limits premium variation to no greater than 3:1…except for age, geography, family size to tobacco use (Jan, 2014). • Eliminates lifetime caps on insurance payments.
Patients with Chronic Disease or Congenital Abnormalities, cont’d: • Extends ability of young adults to stay on parents insurance until age 26 (Fall, 2010). • Preventive Health Services (U.S. Preventive Service Task Force) covered with no cost. • Creates state based insurance exchanges and tax credits for low income individuals. • Prohibits insurance policy rescissions unless well justified.