« BACK  |  PRINT

RS

MEMBER DIARY

What Comes Next in Obamacare: Medicare, 2012

PPACA, otherwise known as Obamacare, is a truly horrendous piece of legislation.  Even if the socialized health care model was actually successful, which we know for a fact based on the evidence seen in other nations that it isn’t…Obama and the left went for over-kill in what they had written into PPACA.   All we truly need is an effective system that wisely utilizes economic resources.  They went for the “Bentley” of socialized health care models!

It’s important that we keep this information front and center all the way through the election in 2012.  In an effort to do my small part, I’ll be posting diaries that provide data about the events scheduled to take place.  Some of the lists are long, so I’ll break it into smaller diaries, keeping the lists to approximately ten items per diary.

The general point of these diaries is to develop enough familiarity with the law to recognize and understand in what ways our lives will be impacted, what the projected costs influences might be, how to communicate the scope of change to our fellow citizens, and to identify the points at which another type of approach would be far more cost-effective.

Here’s a partial list of what will be taking place this year in the category of Medicare.  I’m drawing my information from this PPACA timeline, in case you want to check it out for yourself.  I’ve attempted to provide at least one link to each item.  What I will say about the links is CONSIDER THE SOURCE.  For example, if a link is to CMS, you’re likely to get only pro-policy statements from this source, which doesn’t imply totally objectivity about the topic matter.

Implementation Date: 01/01/12        Element: Data

Deadline for the Secretary to confidentially provide physicians with their benefits claims data for use in measuring the use of resources.

 

Implementation Date: 01/01/12        Element: Payment

For Medicare fee-for-service program, deadline for the Secretary to provide new value-based component for physician payment formula related to cost and quality of care

 

Implementation Date: 01/01/12        Element: Payment Cuts

Deadline for the Secretary to recommend to Congress options around expanding Medicare’s hospital-acquired condition payment policy to include other institutions: rehab facilities, long-term care hospitals, outpatient departments, inpatient psychiatric facilities, cancer hospitals, skilled nursing facilities, ambulatory surgical centers and health clinics.

 

Implementation Date: 01/01/12        Element: Cuts to Physicians

Cuts bonus payments for participating in PQRI (Physician Quality Reporting Initiative) to 1%.

 

Implementation Date: 01/01/12        Element: Transparency

HHS may give standardized extracts of Medicare claims data for specified geographic areas to qualified public and private entities to evaluate provider performance

 

Implementation Date: 01/01/12        Element: Accountable Care Organizations (ACOs)

Deadline for the Secretary to establish an “accountable care organization” whereby providers would accept a pre-determine reimbursement amount for treating at least 5,000 patients, and may keep some of the money if they provide care at less than the reimbursement amount.

 

Implementation Date: 01/01/12        Element: Home Health Demonstration

Note: the above link presents the HHA program in the state of Minnesota.

Deadline for the Secretary to begin a demonstration project testing a payment model for providers who give care in patient’s homes, particularly for chronically ill beneficiaries.

 

Implementation Date: 01/01/12        Element: Cuts to Medicare Advantage

Deadline for the Secretary to transition to a new formula for calculating benchmark payments in Medicare Advantage.

Note: The above is a Heritage Foundation sourced article.  Quote from the article:

Low-Income and Minority Seniors Hit Hardest. The deep reductions in MA payment rates and services covered will hit low-income and minority seniors disproportionately hard. Hispanic Americans are twice as likely to be enrolled in MA plans as is the average Medicare beneficiary; African Americans are 10 percent more likely. Almost 300,000 Hispanics and over 800,000 African Americans will lose access to MA. MA and would-be MA enrollees with incomes under $30,000 per year will lose a total of $38.5 billion in health care services from PPACA cuts.

 

Implementation Date: 01/01/12        Element:  Medicare Advantage

Medicare Advantage plans must start to allocate rebate payments according to the following in order of priority (1) reduce cost-sharing requirements , (2) cover preventive benefits , and (3) add fee-for-service benefits

 

Implementation Date: 01/01/12        Element:  Dual Eligibles

Start date for when the Secretary may eliminate cost-sharing for drugs to dispensed to dual eligibles receiving care in their home or community instead of in an institution

 

Implementation Date: 01/01/12        Element:  Prescription Drugs

Deadline for health plans participating in Part D to use utilization management techniques when dispensing drugs to enrollees in long-term care facilities.

 

Enough for one diary.  See ya’ next time.

Get Alerts