The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Reconciliation Act of 2010 are collectively known as the Affordable Care Act along with the American Recovery and Reinvestment Act (ARRA) Part I
The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Reconciliation Act of 2010 are collectively known as the Affordable Care Act along with the American Recovery and Reinvestment Act (ARRA) Part 1
Over the next few articles in our June and July ezines, let’s explore these acts and their directives for healthcare. These Acts will “significantly impact and alter healthcare” per HHS and CMS. Knowing more about these Acts assists agencies to prepare for the radical changes coming in healthcare delivery.
The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Reconciliation Act (collectively known as the Affordable Care Act) and the American Recovery and Reinvestment Act (ARRA) have and will continue to have some of the most significant impact on how this nation will care for patients now and in the future, as well as store and access data on those patients. It was enacted in March, 2010 and was devised, per its writers, to move the nation’s health care system from a system based on volume to a system based on quality.
Besides the Home Health Face to Face requirement that has caused distress to the industry, but is forcing physician attestation of home health eligibility and need prior to clinician assessment in the home, there are reimbursement changes coming to all levels of healthcare. By 2015, up to 6% of hospital reimbursement will be at risk if hospitals poorly perform. In the acute care setting, several Value Based Purchasing programs are already underway with declining reimbursement linked to lower performance.
CMS is looking to the Affordable Care Act (ACA) mandated Value Based Programs (VBP) in the home health arena to improve quality by rewarding agencies with better quality outcomes across a comprehensive set of quality measures. Since the program is to be budget neutral, the dollars will come from agencies with poorer performance and poorer outcomes. CMS is looking to link quality and accountability to reimbursement.
In March, 2012, the Secretary of the Department of Health and Human Services submitted the VBP plan to Congress. Besides the required continuous quality improvement using a very detailed comprehensive set of quality measures, there will be payment incentives developed, and one funding proposal submitted by DHHS including payment withholds in home health similar to the acute care setting. That would mean agencies could have withholds and payment adjustments, both in the same year (net adjustment)
• PPACA and ARRA are designed to fundamentally expand access to healthcare for all US residents
In doing so, Congress has stated the new delivery models will require rapid engineering of the healthcare delivery system to consistently provide high quality care at an overall lower cost.
Home health agencies should monitor what the ACA impact is and will be on the acute care setting because, we recognize that for years where hospitals go, it seems, so goes home health.
Note that starting January of this year, and ending December 31, 2016, CMS has initiated another demonstration project. This time it is a process of bundling payments for acute care, post acute care, and physician care. It is believed that bundling this care under the oversight of the hospital will parallel care and reduce costs through reduction of readmissions, improved quality of care, and reduced fragmentation of care. Phase 1 applications were submitted by November, 2011. Applications for the remaining three phases must be submitted by June 28, 2012.
The next three phases will examine:
1. retrospective bundled payments for hospital stays, physicians, and post-acute providers by episodic payment
2. retrospective bundled payment for post acute care when there has been no hospital stay
3. retrospective bundled payment for hospitals and physician when there has been an inpatient stay
It is believed that bundling payments will allow providers to share the benefits of a better efficiency in resource use and streamlined processes. CMS expects that the efficiencies to grow and to protect quality has built in required quality measures.
For more information regarding the Home Health agency VBP plan please visit:
For more information regarding the Bundled Payment Program, please visit:
There are so many innovations coming our way. These new demonstrations mandated by the Affordable Care Act are expected to radically change health care delivery. Will you be ready?
Next article: The Accountable Care Organization…35 well underway nationwide. 50% of those are in California. They are expected to expand. Are you ready? Are you really ready?