FEATURE EDITORIAL
PATIENT PROTECTION & AFFORDABLE CARE ACT
By Jacqueline Persandi The Patient Protection and
Affordable Care Act (PPACA) was signed in March 2010.
PPACA is commonly known as health care reform or health insurance reform, because the law modifies several elements of the United States health care and health insurance industries. Although the constitutionality of PPACA has been widely debated, the legislation brings many changes; some took effect immediately, and others will be effective in the coming years. In the following article we take a look at a few of the major provisions.
Expanding Coverage As it stands, there are two main ways people acquire health
insurance in the United States: through the company they work for and from government programs (Medicare and Medicaid). It seems this system would ensure most people are covered, but there is a large number left without insurance. PPACA works to eliminate the number of uninsured and provide affordable coverage to those who currently can’t afford, or simply don’t have coverage. The goal is to help Americans get the health care they need, affordably. There is no argument that PPACA will allow more people to have health insurance, but there are some setbacks to this system.
Some believe everyone having health insurance may create a
demand for physicians that we are not prepared for. If people who are not currently going to the doctor suddenly do, this can create a backup in health care. With more people able to go to a doctor, but no increase in physicians, patients will have to wait.
Supplementing Income With more people in the health care system, the system will
need more money to survive. Under PPACA, this money comes from a variety of places. One of the largest sources of income comes from a $500 million cut in Medicare. Another source is a Medicare tax increase, specifically for those who make more than $200,000 a year. Also, PPACA institutes a Medicare tax on unearned income—like stocks and dividends. Other avenues that will help generate money include fees for insurance companies, an elevated sales tax on indoor tanning and tax on manufacturers and importers of specific medical devices.
Physician Incentives Under PPACA, the way physicians are reimbursed will change.
At this time, physicians are paid based on volume. When a customer enters their office (whether it be a hospital, doctor’s office, etc.) they are paid each time they see a patient. If a patient leaves, but is readmitted days later for the same condition, physicians are paid again. Under PPACA, physician reimbursement is based on encounter using a bundle payment methodology. In this system there are incentives for physicians to focus on the quality of their work. The legislation also provides incentives for doctors to have healthy patients. This means physicians will work to keep their patients healthy, but also it means they are more inclined to take patients that are healthy. Under the current legislation, it is difficult for patients with chronic illnesses to receive coverage from insurance companies, because the insurers know these pre-existing conditions will be costly. Though PPACA improves coverage for patients with pre-existing and chronic conditions, the law also rewards physicians for having healthy patients. That means doctors may be less inclined to take chronically ill patients, just like insurance companies are now.
The law provides incentives for physicians and hospitals who
convert to electronic medical records (EMR). This means completely overhauling all information and, for many, purchasing all new equipment. This is a costly process. Physicians can earn money for going digital before the 2015 deadline, but after the deadline physicians face cuts in Medicare reimbursement for not using EMRs.
In late March 2012, the Supreme Court heard testimony
about the Patient Protection and Affordable Care Act. One of the main issues discussed in the Supreme Court hearing was the individual mandate, which states that all U.S. citizens not covered by their employer or government insurance plans (like Medicaid and Medicare) must have a certain level of health insurance coverage by 2014, or they will be fined. There are exceptions for those with dissenting religious beliefs or special financial situations. Though many parts of PPACA will not go into effect until 2014, some parts, like extended coverage of a dependant, have already been enacted. The court can decide to uphold all or part of the law, or they can conclude a decision cannot be made until the law takes effect.
10 2012-2013 The Greater Daytona Healthcare GuideTM
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