The Patient Protection and Affordability Act of 2010 (PPACA) has been signed into law. New requirements of the law include the expansion of healthcare insurance coverage to all Americans, including approximately 45 million uninsured. Americans will be required to carry health insurance and employers will be required to offer coverage. The law calls for the expansion of Medicaid, Medicare, and CHIP (children’s health insurance program). It also has several provisions dedicated to keeping a lid on government spending on healthcare, with the goal of reducing funding by $500 billion over the next 10 years. The PPACA includes grants for states to develop alternatives to malpractice litigation, which could rein in high malpractice insurance premiums (although the law does not address tort reform, disappointing many doctors). The law focuses on wellness, with several programs devoted to wellness and affordable preventive care. It also calls for resources for training and educating doctors and nurses.
The law has ramifications for all aspects of the healthcare sector. Here’s how it will affect the industry.
Physicians offices: With the expansion of coverage, doctors will have a larger pool of prospective patients, theoretically increasing revenues. If many of those patients are on Medicare or Medicaid, low reimbursement rates could offset those revenues. Under the Sunshine provision in the law, doctors must disclose every payment from drug and biotech companies over $100, including drug samples. This could add complexity to office accounting. The law gives precedence to primary care doctors, which could put specialists at a disadvantage. The law also effectively prohibits doctors from having an ownership interest in a hospital.
Hospitals: Hospital emergency rooms could see a drop-off in uninsured patients as the requirement for health insurance coverage kicks in. As emergency room care is the most expensive form of care, this could result in cost savings for hospitals. Non-profit hospitals will be required to submit a community needs assessment. They will also need to tread carefully when billing patients on financial assistance; hospitals must first limit charges to such patients and then avoid extraordinary collections actions. Medicare and Medicaid patients account for more than 50 percent of the care provided by hospitals. The expansion of these programs and the government’s cost-cutting initiatives may impact hospital revenues.
Nursing homes and assisted living facilities: Nursing homes receive the bulk of their revenues from Medicare and Medicaid, and the PPACA will cut reimbursements. At the same time, the new law encourages patients to receive care in their homes, which is less expensive, creating additional competitive pressure. To remain profitable, facilities may have to raise prices for private-pay patients.
Managed healthcare: The PPACA requires all Americans to have health insurance, either through their employers or through health insurance exchanges. This will have the effect of increasing the eligible pool of customers, but may also increase the number of high-risk individuals. MCOs will not be allowed to place lifetime limits on coverage for individuals and cannot deny coverage for a pre-existing condition of a child. Adults with pre-existing conditions will be covered under a temporary national high-risk pool. Coverage for dependent children is expanded to age 26.
~
“The PPACA includes grants for states to develop alternatives to malpractice litigation, which could rein in high malpractice insurance premiums (although the law does not address tort reform, disappointing many doctors).”
The states don’t have either the time or money to fight private attorneys without the possibility of going bankrupt, so to state this as a fact in your article is a joke and a slap in the face to the American public. The law does NOTHING TO curtail malpractice litigation.
Just to clarify for anyone who is interested, the above comes from the source document, linked above in my post:
“Medical malpractice • Award five-year demonstration grants to states to develop, implement, and evaluate alternatives
to current tort litigations. Preference will be given to states that have developed alternatives in
consultation with relevant stakeholders and that have proposals that are likely to enhance patient safety
by reducing medical errors and adverse events and are likely to improve access to liability insurance.
(Funding appropriated for five years beginning in fiscal year 2011)”
I read at http://www.ppbmag.com/Article.aspx?id=5537 that “A grant program established under the healthcare reform law will likely not be funded in 2011 as planned.”
Have not seen the same anywhere else and wondering if that’s the case?