WHAT WEIGHS 20 POUNDS AND STANDS ABOUT 9 INCHES TALL; IS WORDY - 400,000 OF THEM IN A “LANGUAGE” UNDERSTOOD BY FEW; AND HAS AN ESTIMATED 10-YEAR COST OF $894 BILLION, OR ROUGHLY $2,240,000 PER WORD? ANSWER: A PRINTOUT OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010, THE PPACA (SAY PEA-PACKA), APPROACHING ITS FIRST BIRTHDAY IN MARCH. FEEL LIKE PERUSING THE NEARLY 2000 PAGES OF TEXT FOR YOURSELF? THE U.S. CONGRESS WEBSITE POP-UP CAUTIONS: “THIS BILL IS VERY LARGE AND LOADING IT MAY CAUSE YOUR WEB BROWSER TO PERFORM SLUGGISHLY OR EVEN FREEZE,” – NO DOUBT AN UNDERSTATEMENT. THE BASICS
Health care reform was enacted through passage of two bills. The PPACA or “Senate bill,” became law on March 23, 2010, and was amended by the Health Care and Education Reconciliation Act of 2010, signed into law March 30, 2011. The provisions are phasing in over the next five years. The first year’s changes included prohibiting insurance companies from dropping sick people and from denying coverage for pre-existing conditions in children under 19. Coverage of adult children on their parents’ policies until their 27th birthday, regardless of their student, dependency, or marital status, became a requirement. Medicare drug plan beneficiaries who fall into the Medicare Part D coverage gap now get a $250 rebate. A 10 percent tax was imposed on indoor tanning services that use ultraviolet lamps to help pay for the reform. EFFECTIVE IN 2011
UNDERSTAND G THE AMENDEDIN BY GAIL HEIN SYSTEM
• Medicare begins 10 percent bonus payments to doctors who specialize as primary care physicians and general surgeons. Think “family doctor.” • Medicare covers annual wellness visits. New health plans cover preventive services with little or no cost to patients. • Payments to insurers offering Medicare Advantage services are frozen at 2010 levels and gradually reduced to bring them more in line with traditional Medicare. In other words, some
of the Advantage “perks” will be dropped. IRS W-2 forms must show employer health insurance benefits. The W-2 reporting requirement verifies to the IRS that people have coverage. • A Medicaid plan for the poor goes into effect in October 2011, allowing states to offer home and community-based care for the disabled who might otherwise require institutional care. “CUSTOMER SATISFACTION” IS PIVOTAL TO PAYMENT
Instead of fee-for-service, where Medicare payments were formerly collected for every separate test and treatment, the new model is “outcome based.” In other words, only better care producing better results will be rewarded, explained Dr. Mike Schweitzer, vice president of Medical Affairs at St.Vincent Healthcare. Imagine a “medical home” where everybody knows your name. “Your primary care physician, nurse practitioner, registered nurse - your team - coordinates your care,” Schweitzer said. After a patient leaves the hospital, follow-up phone calls and electronic monitoring, for example, give the “medical home” ongoing information to ward off crisis return trips to the emergency room. This evolution will also apply to new health care technologies. A new technology infrastructure is vital to data tracking and population health management, Schweitzer said, Undaunted by the magnitude of reinventing health care, Schweitzer said “If you don’t start changing the vision, you’ll never get there.”
HIS EVOLUTION WILL ALSO APPLY TO NEW HEALTH CARE TECHNOLOGIES. A NEW TECHNOLOGY INFRASTRUCTURE IS VITAL TO DATA TRACKING AND POPULATION HEALTH MANAGEMENT...IF YOU DON’T START CHANGING THE VISION, YOU’LL NEVER GET THERE. —DR. MIKE SCHWEITZER VICE PRESIDENT OF MEDICAL AFFAIRS, ST.VINCENT HEALTHCARE. PHOTO BY CASEY RIFFE
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