Have You Asked How ACA Will Change Medicare?

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Affordable Healthcare Act

About a month ago, the Centers for Medicare & Medicaid Services (CMS) released its final rules outlining how Medicare will pay major health care providers and suppliers in 2015. The Affordable Healthcare Act (ACA), also called Obamacare, has provisions designed to reward higher quality, patient-centered care at a lower cost. The final rules include Medicare payments to physicians and non-physician practitioners, hospital outpatient departments, ambulatory surgical centers, home health agencies and dialysis facilities.

CMS intends to have health care providers shift their focus from volume of services to better health outcomes for patients, coordinating care, and ultimately spending dollars more wisely. The rules, says CMS, are a national strategy to move the health care system to one that values quality over quantity and spends taxpayer dollars more wisely by finding better ways to deliver care, pay providers, and distribute information:

Better coordination of care for beneficiaries with multiple chronic conditions. Often, seniors with multiple conditions see a number of specialists which may cause duplicate tests and other “wasteful spending”. Care management is often thought of a way to control this “wasteful spending”; but historically, Medicare has not paid for services that support care management which are not delivered face-to-face. Under this year’s rulemaking, the Medicare Physician

Fee Schedule will include a new chronic care management fee beginning 2015. This separate payment for chronic care management will support physician practices in their efforts to coordinate care for Medicare beneficiaries with multiple chronic conditions. This helps improve the way care is provided by supporting providers coordinating care for patients, including outside of regular office visits.

Paying providers for quality, not quantity of care. In 2015 Medicare is continuing to phase in the Value-based Payment Modifier, which adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.

Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes provisions that promote greater packaging of payments for items and services rather than making separate payments for each individual service.

Better information for providers to understand the total scope, cost, and quality of care that the Medicare beneficiaries they serve receive. To assist physician groups and physicians in improving quality of care for their Medicare beneficiaries, CMS recently made Quality and Resource Use Reports available.

Expand and add new measures to the Physician Compare website. This website allows consumers to search for information about physicians and other health care professionals who provide Medicare services. The intent is to have a tool to allow patients to make informed decisions about who delivers their care.

New quality and performance measures for dialysis facilities. Last year rules address COPD and cardiac patients being readmitted to a hospital; within 30 days of discharge. The End-Stage Renal Disease (ESRD) Prospective Payment System rule introduces new quality measures for outpatient dialysis facilities. The rule incorporates in 2017 a Standardized Readmission Ratio, which assesses the rate at which ESRD dialysis patients return to an acute care hospital within 30 days of discharge from an acute care hospital.

This is the 2015 answer for people asking what changes for Medicare patients are being implemented by ACA (Obamacare). As always, feel free to contact our office if you have questions at 309-693-1060.

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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