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David Brooks

David Brooks

HHS Announces 89 New Accountable Care Organizations

Health and Human Services (HHS) announced on July 9, 2012, that 89 new Accountable Care Organizations (ACOs) began serving 1.2 million people with Medicare in 40 states and Washington, D.C. on July 1, 2012. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. These 89 new ACOs have entered into agreements with Centers for Medicare and Medicaid Services (CMS), taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high quality, well-coordinated care.

Participation in an ACO is purely voluntary for providers. The Medicare Shared Savings Program (MSSP), and other initiatives related to ACOs, is made possible by the 2010 Affordable Care Act. Federal savings from this initiative could be up to $940 million over four years.

Beginning this year, new ACO applications will be accepted annually.


Written by Pulse

Department of Treasury Proposes Limitations on Patient Debt Collections

On June 22, 2012, the U.S. Department of Treasury released proposed regulations on a provision in the Affordable Care Act that addresses the collection of unpaid hospital debt. The proposed rules require non-profit hospitals, as a condition of receiving a tax-exemption, to establish billing and collections procedures for patients eligible for financial assistance. It also requires non-profit hospitals to provide patients with the information needed to apply for such assistance.

According to the proposed rule, nonprofit hospitals must:

- Provide patients with a plain language summary of the financial assistance policy before discharge and with the first three bills;

- Give patients at least 120 days following the first bill to submit an application for financial assistance before commencing certain collection actions;

- Give the patient an additional 120 days (for 240 days total) to submit a complete application;

- If a patient is determined eligible for financial assistance during these 240 days, refund any excess payments made before applying for aid and seek to reverse any collections actions already commenced.

The proposed rule also outlines requirements for providing financial assistance, seeks to limit charges and mandates a non-discriminatory emergency medical care policy.

According to the American Hospital Association, approximately 2,900 out of all 5,750 U.S. hospitals are classified as nonprofit institutions.

ACA International will prepare comments in advance of the comment period deadline on Sept. 24, 2012.


Written by Pulse

Election Aftermath: What Effect on ASC’s & Health Care?

The recent Presidential election and subsequent Inauguration clearly had serious implications for the field of health care and ASC’s regardless of one’s political leanings. The liberal wing of the Democratic Party was concerned that a Romney administration would put an end to one of the most noteworthy pieces of social legislation in recent memory. At the same time, the Conservative arm of the Republican Party believed that a second term for President Obama would prove to be the catalyst for the implementation of a monstrous entitlement program. For those in the field of health care though, the biggest source of anxiety as Election Day drew near was the thought that this issue would leave the system in total chaos.

Some Reform but More to Come

Even though the Affordable Care Act will not be fully operational until 2014, there has already been a massive amount of money exchanged since the first phase of reform was put in place in 2010. For example, many young adults who are up to 26 years of age have been added to their parent’s health insurance policies. Another new option available was that people under the age of 65 who are covered by private health insurance have now been offered an array of free wellness benefits; and in 2012 a report from HHS showed about 54 million had taken advantage of them. Also, some states have already begun to set up consumer assistance bureaus for the benefit of consumers and to create the infrastructure for an exchange that will facilitate the purchase and sale of private health insurance options. Putting an end to what had already been set in motion would very likely have created a sense utter pandemonium.

But when the Supreme Court upheld the constitutional nature of the health reform in 2012, the challenge of legitimacy was effectively squelched. With the re-election of President Obama, Administration officials will now be in place during the full-scale implementation of the law, which should imply that patients and providers alike can expect the Affordable Care Act to be put into effect methodically in the coming years. It has also been reported recently that new regulations regarding reform were held back prior to the election to avoid added controversy. Because of this, it can be expected that a stockpile of regulations will be quickly released in the near future; with some of them possibly addressing the question of what expenses and services will be required under the new reform.

The governors of many states will now have to make the choice of whether or not they wish to create an insurance marketplace to regulate small business and individual health plans. If a state chooses not to set up such an exchange, the federal government will step in instead. Governors and legislatures on the state level will also have to decide whether they wish to allow wider eligibility for the public option insurance program. It has also been reported that some Republicans are expected to get on board with certain aspects of the law now that it has firmly been set in place.

Leaders of Ambulatory Surgery Centers across the country seem to be in agreement that the currently divided Congress should prevent any further funding by the Government. Some suggest that ASC lobby efforts should be promoted. Others ponder whether or not the new Act could be good for ASCs, since it will require that a greater number will be insured. Will a greater number of insured patients increase the volume at ASC facilities? If so, will these facilities find a way to prosper even though the reimbursement level has decreased? A majority of the leaders in the ASC world appear to agree that whatever adversities arise; they can be overcome once the rules have been fully revealed. What the rules are and how they will be carried out should become ever clearer in the near future.

Final Rule Increases Payments to Hospitals

On Aug. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates fiscal year (FY) 2013 Medicare payment policies and rates for inpatient stays at general acute care and long-term care hospitals (LTCHs), and builds on the Obama Administration's work to slow growth in future health care costs by improving patient care.

The final rule also implements key elements of the Affordable Care Act's hospital value-based purchasing and hospital readmissions reduction programs. The rule advances Administration efforts to tie Medicare payments to quality health care across the delivery system, with new quality reporting measures for general acute care hospitals in FY 2015 and FY 2016; new measures for long-term care hospitals in FY 2016, and new quality reporting programs for psychiatric hospitals and cancer hospitals. In addition, the rule establishes new reporting and other requirements for the Ambulatory Surgical Center Quality Reporting (ASCQR) Program.

Under the final rule, payment rates to general acute care hospitals will increase by 2.8 percent and LTCH payments are expected to increase by $92 million or 1.7 percent in FY 2013.

To provide hospitals with an incentive to reduce hospital readmissions and improve care coordination, the Affordable Care Act created a Hospital Readmissions Reduction Program that will reduce payments beginning in FY 2013 (for discharges on or after October 1, 2012) to certain hospitals that have excess readmissions for three selected conditions: heart attack, heart failure and pneumonia. The rule finalizes a methodology and the payment adjustment factors to account for excess readmissions for these three conditions.

For further information, please visit http://www.cms.gov/apps/media/press_ releases.asp.

Written by Pulse

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