Thursday, December 30, 2010

2011 Affordable Care Act (ACA) Implementation

I just caught three, hopefully helpful, reports in the NEJM {New England Journal of Medicine} that many might find helpful.

I'm not going to break them down, more just passing along the information as well if interested there are other links at the sites, not a Doctor nor in the Medical Professions. Now if you needed surgery on your house, in your offices or office buildings or industrial buildings, I did make house calls. But alas being forced into early retirement and the outlook for even supplementing that right now doesn't look to good {anybody know anyone who wants a van, that stays with me, full of construction trade tools plus more not in the van, give me a whistle}.

This was the first one I read, and watched the short video with, which led me to read the other two.

Rethinking Safety-Net Access for the Uninsured

December 29, 2010 - Now that health insurance reform has begun, safety-net programs throughout the United States are struggling to adapt their missions to suit the post-reform composition of the uninsured population. Most such programs are organized at the local level, with funding largely premised on their serving low-income uninsured residents. Examples include well-structured comprehensive care programs in some major cities, more than 1000 limited-service free clinics, and dozens of volunteer physician-referral programs.

When the Affordable Care Act (ACA) is fully implemented, 8% of the U.S. population is projected to remain uninsured. Other than undocumented immigrants, however, most such people will be eligible for Medicaid or highly subsidized private insurance and will be subject to tax penalties if they don’t obtain coverage. So beginning in 2014, most people who are currently served by access programs for the uninsured will have insurance, be eligible for insurance, or be undocumented immigrants.


First, health care reform’s chickens should not be counted until they’ve hatched. During the 3 years before full implementation begins, constitutional challenges and conservative politicians threaten to upend the ACA.2 Safety-net programs must remain intact at least until reform takes effect — and just in case it never does. Second, even after reform, the newly insured will face barriers to access arising from provider shortages, transportation difficulties, and language differences — all of which safety-net organizations can help to overcome.

Third, the future uninsured population will probably deserve more safety-net support than one might imagine. {continued}

Michelle Andrews speaks with KFF about insurance policy changes set for 2011.

These next two were written earlier, a month previous, then the first.

Physicians versus Hospitals as Leaders of Accountable Care Organizations

November 10, 2010 - Enactment of the Affordable Care Act (ACA) was a historic event. Along with the Recovery Act, the ACA will usher in the most extensive changes in the U.S. health care system since the creation of Medicare and Medicaid. Under this law, the next few years will be a period of what economists call “creative destruction”: our fragmented, fee-for-service health care delivery system will be transformed into a higher-quality, higher-productivity system with strong incentives for efficient, coordinated care.1 Consequently, the actions of physicians and hospitals during this period will determine the structure of the delivery system for many years. The implications will be profound for hospitals’ dominant role in the health care system and for physicians’ income, autonomy, and work environments.

The ACA aims to simultaneously improve the quality of care and reduce costs. Doing so will require focused efforts to improve care for the 10% of patients who account for 64% of all U.S. health care costs.2 Much of this cost derives from high rates of unnecessary hospitalizations and potentially avoidable complications,3 and these, in turn, are partially driven by fee-for-service incentives that fail to adequately reward coordinated care that effectively prevents illness. The ACA includes numerous provisions designed to catalyze transformation of the delivery system, moving it away from fee for service and toward coordinated care (see table). {continued}

Patients’ Role in Accountable Care Organizations

November 10, 2010 - If ever there were a crisis moment that crystallized the need for reforming the U.S. health care delivery system, this is it. The 2010 Affordable Care Act (ACA) promises to expand health insurance coverage, a key first step toward improving health equity. But newly insured Americans will gain access to a strained, fragmented system that often fails to deliver effective, efficient care. Meanwhile, the burden of chronic disease, coupled with incentives that reward providers when preventable complications occur, continue to drive up health care spending.

To address these escalating problems of quality and affordability, many analysts and policymakers support the development of accountable care organizations (ACOs). ACOs could take various forms, but they have generally been conceived of as groups of primary care physicians, specialists, and sometimes hospitals, joined together in either vertically integrated systems or networks that are accountable for improving the quality and affordability of care for a defined patient population and that are eligible for financial bonuses if performance goals are met. The ACA takes a first step in this direction by allowing Medicare to contract with ACOs; interest in this concept is also growing among commercial payers, Medicaid agencies, and several state legislatures (e.g., Colorado, Vermont, and Washington).


There has been little discussion about binding patients to ACOs, however, largely because the freedom to choose one’s providers is highly valued in U.S. health policy. The managed care backlash and the rise of preferred provider organizations in the late 1990s have been partially attributed to patients’ unwillingness to accept closed physician networks. Most Medicare beneficiaries have not enrolled in private plans that restrict patients’ choice of physicians, even though these plans offer more generous benefits than does the fee-for-service Medicare program. These consumer preferences suggest that policymakers should focus on creating incentives to build patients’ loyalty to an ACO (see table). {continued}

These seem to cover at least some of the important information related to all of us involved on this issue.

Myself, was hoping the passed bill was a first step and more reforms were coming. But with the House changing hands, thus all related to whatever ideology those folks follow, besides chasing constantly changing ambulance chasing meme's fed to them {by the think? tanks,fox,rush,rove,whoever} so they look like they stand for something, we'll be seeing more in rollback attempts of any progress made since they last welded power and did nothing but empty the treasury and look the other way as to regulation etc.!

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