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New Health Insurance Law Requires Doctor, Hospital Reporting

Ernie Shannon's picture

With the drama surrounding the Supreme Court’s decision to decide the constitutionality of the Affordable Care Act – the nation’s health insurance reform law, or at least the mandated feature, many other provisions of the law are going unnoticed by the general public. One of those, the part that links hospital Medicare payments to “quality outcomes” deserves attention
Known as Title III, Subtitle A, Part 1, “Linking Payment to Quality Outcomes Under the Medicare Program”, this portion of the statue focuses on hospital care and the reporting process these facilities and doctors will need to meet starting later this year.

For instance John E. McDonough, a Harvard professor and advisor to Congressional Democrats and the Obama Administration during the development of the Affordable Care Act, said beginning in October 2014, a new national quality-reporting system is established for long-term care hospitals, inpatient rehabilitation hospitals, inpatient psychiatric hospitals, hospice programs, and certain cancer hospitals. These reports will be tied to a hospital value-based purchasing program beginning in 2013 connecting hospital payments to performance on quality measures. Hospitals not participating will see Medicare payment reductions.

Another potential sore point for hospitals will concern readmissions. Hospitals that have high readmissions will face reduce payments based on the cost of each hospital’s potentially preventable Medicare readmissions. How that judgment is made and how a balance will be found among the many factors affecting readmissions is yet to be seen.

Physicians will also feel the burden of HHS reporting requirements. The Physician Quality Reporting Initiative is designed to assess the quality of care delivered by practitioners. Doctors will be required to provide data regarding the care they provide and failure to do so will result in a reduction in Medicare reimbursements in 2015 of 1.5 percent and a 2 percent drop in 2016. For providers already feeling the sting of slim Medicare payments, the added decline in reimbursement could be painful.

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Another provision of ACA is the Center for Medicare and Medicaid Innovation, the impact of which is yet to be seen. The organization resides within the Centers for Medicare and Medicaid Services (CMS) and a high calling according to its mission statement:

“The Innovation Center’s mission is to help transform the Medicare, Medicaid and CHIP programs to deliver better healthcare, better health and reduced costs through improvement for CMS beneficiaries and in so doing, help to transform the healthcare system for all Americans. The Center carries out this mission by being a constructive and trustworthy partner in identifying, testing and spreading new models of care and payment.”

In operation since November 2010, its new administrator, Donald Berwick, highlighted three principle endeavors for the new organization:

Better Care for Individuals: Improving care for patients in formal care settings like hospitals, nursing homes and doctors' offices, and developing innovations that make care safer, more patient-centered and more efficient. The Innovation Center will also promote the use of "bundled payments," an approach to paying for care where providers collaborate to manage multiple procedures as part of a single episode with a single payment, rather than the current fee-for-service method of submitting separate bills for each procedure, which leads to higher costs.

Coordinating Care to Improve Health Outcomes for Patients: Developing new models that make it easier for doctors and clinicians in different care settings to work together to care for a patient. Examples include identifying and widely deploying the best advanced primary care and health home models, and supporting innovations in accountable care organizations.

Community Care Models: Exploring steps to improve public health and make communities healthier and stronger. The Innovation Center will work to identify and address major public health crises and the appropriate interventions for areas of great concern, such as obesity, smoking and heart disease.