2/16/2012 6:58 PM ET|
Health care reforms coming in '12
From accountable care organizations to insurance rebate checks, changes are under way for both providers and consumers.
It will be a busy year for health care reform, as the Patient Protection and Affordable Care Act, commonly referred to as the Affordable Care Act, continues to reshape America's health care system. It became law in 2010.
"The broad consensus is that we need to move away from an outdated fee-for-service system that rewards volume and toward a system where doctors and hospitals are rewarded for improving quality, value and health outcomes," says Robert Zirkelbach, a spokesman for America's Health Insurance Plans, or AHIP, an industry trade group.
While this year's five major reforms lay the groundwork for a more efficient and sustainable health care system, "from the patient perspective, a lot of this is behind the scenes," says Dr. Glen Stream, the president of the American Academy of Family Physicians.
One change some consumers will welcome: a rebate check from those health insurers that failed to spend a sufficient portion of premiums directly on patient care last year.
A giant wrecking ball still hangs over this construction site, however: the Supreme Court decision on a 26-state constitutional challenge to the health reform. The justices will take up the issue in late March and are expected to rule by late June.
Here's what's going on with health care reform in 2012:
Accountable care organizations
Already in effect
On Jan. 1, the Affordable Care Act started providing a financial incentive for physicians, hospitals and health care providers that voluntarily join together to form accountable care organizations, or ACOs, and coordinate care for patients with Medicare. Under the law, ACOs that demonstrate improved quality and outcomes in care, lower costs and patient priority will share the savings with the Medicare system.
ACOs are expected to save Medicare $960 million over three years, according to HealthCare.gov.
"This addresses one of the main issues, which is the excess cost that we have compared to other First World countries," says Stream.
Today, more than 50% of Medicare patients have at least five chronic conditions, which may include diabetes, arthritis, hypertension and kidney disease, according to HealthCare.gov.
Zirkelbach says ACOs can drive down the costs of working with multiple doctors as well as improve care.
"We have a readmissions crisis in this country, particularly in Medicare, where 30% of patients that are discharged from hospitals end up back in the hospital within 30 days," he says. "A lot of that has to do with the fact that there is no incentive to ensure that they're getting the appropriate follow-up care."
ACOs are designed to change that.
Fewer disparities in health care
Effective: March 2012
Not all Americans have equal access to or similar outcomes from health care, according to HealthCare.gov. Depending on your race, ethnicity or income level, you may have a higher incidence of certain diseases, fewer treatment options and reduced access to care and insurance.
Countering decades of disparity is a tall order, but the Affordable Care Act aims to do so by accelerating data collection, funding community health centers, increasing racial and ethnic diversity in the health care professions and, by 2014, providing affordable health insurance for all through insurance exchanges.
"More and more health plans are tracking (these) data to first identify and then help address these gaps in care," says Zirkelbach.
"It's a huge issue," says Anna Lambertson, the executive director of the Kansas Health Consumer Coalition, a statewide advocacy group in Topeka. "Health disparities include women's access to health insurance and being charged higher premiums because of gender. If we can find a way to help people navigate the health care system so they are not going to the ER to receive routine care, we can actually lower costs."
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One point that was overlooked in this article is called personal responsibility...I work in healthcare and see it on a daily basis....we have no money to buy healthcare but we have the latest I-phone with fancy ring tones, we have expensive sneakers, we can buy our cigarettes etc but we have no money to pay for our own care. I am tired of being responsible for paying for those who could but chose not to...and now you want me to pay a tax on my healthcare benefits that I got to work for daily so I can give more to these kinds of people...I think not. My husband is self-insured and we manage to pay $650.00 every month for his healthcare and also pay what is not covered under his policy so don't tell me you have no money to pay!
About 10 years ago, when I was working as a visiting nurse, medicare (ie: the government) initiated a 37 page questionaire called OASIS....it was MANDATORY (and still is) for all home-care patients. It has to be filled out when a patient is admitted to service, again if the patient is transferred to a hospital, again when he/she is released from the hospital and readmitted for homecare, and again when the patient is discharged from care. These questionaires must be completed before the patient's insurance will pay for their medical care, and many of the questions have nothing at all to do with the person's medical condition.
On any given day I would spend 3 hours actually providing care to my patients...and 5 hours completing totally non-productive, bureaucratic paperwork... In other words... only 3 HOURS OF THE HEALTH-CARE DOLLAR GOES TOWARD PROVIDING ACTUAL MEDICAL CARE and 5 HOURS OF THE HEALTH-CARE DOLLAR IS GOING TOWARD PAYING FOR TOTALLY UNNECESSARY, NON-PRODUCTIVE, GOVERNMENT MANDATED BUREAUCRACY!!!!!
Hospitals are operating in the red... physicians are leaving the practice of medicine...nurses are being laid off ...and our entire medical care system is under attack from non-professional, political outsiders trying to dictate the way we practice medicine. The only way to bring health-care costs down is to GET THE GOVERNMENT THE HELL OUT OF IT!!!!!
Please tell me just one thing that big government does efficiently? We are so screwed.
It is absurd to suggest that if one doesn't support this legislation that he/she wants poor people to die. It just offends reasonable people who would be otherwise open to your point of view.
If you support the legislation, that's great, but this extreme attack-oriented stuff just discredits your opinion....you're definitely entitled to disagree/agree whatever, but this your with me or against me thing is something the Dems were awfully fond of attacking the last Admin over and that was in the context of terrorism, which was certainly more justifiable than in this case.
This year I will be paying more than DOUBLE for the exact same "health" insurance coverage I had last year. The Commie-wealth of Massachewshitts has determined the policy I had for over 6 years with an out of state insurance company does not qualify under the States Board of Health Insurance policy guidelines as "credible",even though it has worked perfectly fine for me for over 6 years.
Let's call it what it really is; Hospital insurance. Having a health care policy does NOT insure your "health"..all it does is allow you to pay the OUTRAGEOUS bills the hospitals charge you.
Funny how most hospitals are owned by insurance companies..no conflict of interest there! The hospital sets the fees,and the insurance companies cover the costs. One hand washing the other. Until insurance companies are NOT running hospitals, and hospital fees are lowered to normal levels,the only way you will be able to "pay" your bill,is to have their "insurance".
That is the ultimate goal of insurance companies: to have every single person alive paying premiums,period. They can show a loss every year by raising the costs of services on the hospitals end. Talk about a huge scam that is fully supported by the government.They can all sit back and say everyone is covered by "good insurance" ,while the premiums go up year after year after year for everyone,because the insurance companies can show losses,while their CEOs are making HUGE money.
The only choice you have is to pay whatever they are charging for premiums this year,or pay a substantial fine for not having their policy.
So much for personal choices and freedom!
The very idea of government provided healthcare comes right out of Mein Kampf. Government cannot provide "free" healthcare. It can only deny, or steal the the money to pay for it from someone else.
If this is not true why didn't Obama just MANDATE that those without healthcare be FORCED to buy it? The 30 million leeches on the rest of us will never let go. These are the risks that would drive the costs sky high for the rest of us.
Most employers will be dropping their healthcare coverages in the next few years. It will be far cheaper to pay the government "fines and penalties" than to provide coverage. I know I will be doing just that.
The quality of healthcare of course will be rationed eventually. Like Medicaid today, healthcare workers will not want to treat those with "government" insurance. I am sure then government will try to make it illegal to deny treatment. This of course will control healthcare workers pay.
Socialism always fails. One need only look to Europe. The USA is bankrupt and will collapse within 20 years. This will Obama and the Democrats legacy...
What the article doesn't say is they are gutting medicare to fund Obamacare. Talk about throwing granny off the cliff.
Also there are all kinds of taxes and fees that come along with the rest. The latest cost estimate is already double what was promised and it will only get worse. What a disaster!
hmmm... Medicaid patients with cell phones? Flat Screen TV's? Even fancy Laptops? Paying for live lobsters with Foodstamps? You can see this everyday! Ask any caregiver...
These people make choices. They choose to not BUY healthcare coverage, in favor of other items.
Sorry, if the go bankrupt. Maybe they should have chosen wisely?
Personally I am tired of paying for these deadbeats. How about this, the government will pick up your tab for healthcare, but then you must forfiet any and all assets you may have to the government. No estate may be passed on to your children. You made a choice and chose poorly. Quite trying to get the rest of us to pick up YOUR tab. These are the kind of people that skip out on the bar tabs or restraunt bills... They feel ENTITLED to leech off the rest of us...
Oh, wait I can sum that all up in one word... DEMOCRAT!
This week I slipped, hit my head on my piano, and the emergency room visit resulting in 13 stitches and a tetanus shot cost me a $50 copay and the antibiotic prescription cost $6. If I'd needed a cat scan, etc. there would have been no more out of pocket. If I'd had been admitted the $50 copay would have been waived by BCBS. I know of people who have covered bad cuts with butterfly bandages because the same trip for them would have cost much more. My experience should be, at least, the standard for everyone and it would be if we had a single-payer system instead of wasting 25% of healthcare on paperwork.
Once again were being fooled into thinking were getting something for nothing. These people stay up nights trying to find ways of putting it to us and there are dumb people out there who actually think the government is on our side .. Its all about control people this healthcare act lie. This is what socialism is all about. Government control of the production and distribution of goods. Is that getting threw to you big thinkers out there??? Let me ask all you asleep at the wheel thunder heads this,, Has your life improved under any of the last four presidents to the point you have more money in your pocket to spend and gas prices have improved or food prices and goods have stopped rising year after year.How about taxes have they gone down?? Oh and the biggest one, have you lost anymore of your freedom from these guys we send to Washington to protect that. If your not concerned about any of this then you will surely get the bone heads you elect. Have a nice day and be sure to tell the kids your watching over them so uncle sam doesn't take away there future.
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