San Francisco Marin Medical Society Blog

Health Care Reform You Can Expect in 2012



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. Here’s what lies ahead for health care reform in 2012.

Accountable Care Organizations

Effective: January 1, 2012.  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 (ACOs) and coordinate care for patients with original Medicare. Under the law, those 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.

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.

Insurance rebates

Effective: June 1, 2012. The biggest impact from health care reform consumers may feel in 2012 is actually the result of an initiative that began last year called the medical loss ratio (MLR). This formula requires health insurance companies to spend at least 80 percent of their premiums on direct medical care or quality improvement or 85 percent for large group-based plans. Those that don’t meet the mark must provide a rebate to policyholders.

Electronic records

Effective: October 1, 2012. Health care remains one of the few industries still tied to paper records. The new law kicks off a series of changes to usher in electronic records. The savings from non-duplication of services alone could be staggering. One physician points out, “Say a patient comes to me with a painful knee, and I take an X-ray. And tomorrow, their knee is worse, and they go to the emergency room. If the ER physician can't see the X-ray I did yesterday, they're going to do another X-ray. The patient is going to get double X-ray exposure and double expense.” If the information is available to other physicians, it helps both on cost and patient safety.

Value-based purchasing

Effective: October 1, 2012. Another piece of health care reform that starts in 2012 under the law is Medicare’s new Value-based Purchasing program (VBP) which is designed to improve the quality of patient care by linking provider payments to the cost and quality of the care they provide. It also requires that hospital performance statistics be made publically available for the first time. Some physicians believe VBP is the payment paradigm of the future. The idea is to pay better for quality medical groups and doctors who have low infection rates (and) high scores on quality measures for care of diabetes, asthma, heart failure, low hospital readmission rates. The model pays for quality—meaning value—as opposed to just volume. Source: Jay MacDonald, January 06, 2012, Bankrate.com

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