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SCPHCA State Policy and Issues Forum Presentation Presented by: Cynthia Williams Health Sciences South Carolina February 7, 2012

54 of the 92 provisions (60%) required to be enacted by 2014 have been or are in the process of being implemented. 26 out of 48 states are significantly lagging in the implementation of ACA. South Carolina is one of the states.

The Supreme Court will make a decision on the constitutionality of the individual mandate provision of the law.

Medicare Accountable Care Organizations can be formed and share in cost savings. Further reductions in Medicare Advantage plan will occur. Bonuses will be paid to high quality plans. Medicare provider payment changes based on productivity will be phased-in. Medicare “Independence at Home� Demonstration projects will be started.

Medicare Value-based purchasing programs will be established for hospitals, skilled nursing facilities, health agencies, and ambulatory surgical centers.

Hospitals will receive reductions in Medicare payments for preventable readmissions. Fraud and Abuse prevention efforts will be increased. Consumers will receive uniform information about their health plans benefits and coverage.

Medicaid Payment demonstration projects will be started in 8 states. Annual fees will be levied on the pharmaceutical industry. Data collection standards must be met when gathering data on disparate groups.

Accountable Care organizations are growing in number nationwide. Many of the major hospitals in SC have formed ACOs. Over 3,000 patient-centered medical homes have formed nationally. 20% are pediatric-related per the National Committee for Quality Assurance (NCQA). Non-traditional players (i.e. Wal-Mart, Walgreens, Target, CVS, Rite-Aid, etc.) have opened health clinics. Employers are breaking traditional health provider relationships to create internal health clinics for their employees.

A recent national study shows a new surge in the training of nurses in the 24-29 year old age group. South Carolina is seeing a similar trend. A gap continues to grow in the number of physicians being added to the system. The number of independent primary care practices is also shrinking. Recruitment and training is beginning to grow in other allied health professional fields. US DHHS is placing particular emphasis this year on funding for more dental professions.

Nationally, the industry is rapidly adopting the use of IT tools. Nurses, younger doctors, and allied professionals are the groups most easily adapting to the technology introduction. South Carolina is following this trend. Over 166 primary care offices in the state are receiving American Recovery and Reinvestment Act (ARRA) funds for Electronic Health Records (EHR) implementation.

Many SC health professionals are now using iPad 2s and health-related software applications in their work processes. Telemedicine and mHealth projects targeting rural communities are being started across the state.

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The expansion of Medicaid and the implementation of health insurance exchanges remains a controversial area of change. South Carolina has decided not to implement an health insurance exchange at the state level. SC DHHS is working internally to improve operations. Uninsured and underinsured consumers remain illinformed of their forthcoming options. Some states have held thousands of open forums training the public on the upcoming changes in health information access. SC has had a limited campaign for educating the public.

The industry, nationwide, continues to move forward with changing the health care industry. Progress is being made in some areas, but not in others. States like SC that are slow in implementing policy changes in support of the effort run the risk of future high cost burdens if ACA is upheld. Our family, friends, and neighbors will be the ones most affected by their lack of knowledge.

The Overview of Health Care Reform in 2012 (SC)  

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