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With the Affordable Care Act comes medicare Reforms. Historically, Medicare has often led the entire health care system in the adoption of quality and payment innovation. The reforms that go into place will not only affect Medicare but could change the way the health care system is paid.
Meidcare reform means Reform our health care delivery system, appropriately price services and modernize financing systems, and fight waste, fraud and abuse.
Unnecessary hospital readmissions
The Affordable Care Act creates a “hospital readmissions reduction program,” which will help hospitals smooth transitions for patients and reward hospitals that are successful in reducing avoidable readmissions.
Hospital acquired conditions
The Affordable Care Act imposes payment penalties on the 25 percent of hospitals whose rates of hospital acquired conditions like bedsores, complications from extended use of catheters, and injuries caused by falls, are the highest.
Rewarding Better Care
CMS will expand payments for value—in 2013—by rewarding better care for five of the most prevalent conditions. Physician payments will also become more closely linked to value with the launch of a physician value-based payment system and the implementation of a “value-modifier” that rewards physicians who deliver better care.
Accountable Care Organizations
The Affordable Care Act promotes team-based health care through Accountable Care Organizations (ACOs) under the Medicare shared savings program
Center for Medicare and Medicaid Innovation
To support the ongoing development of new models of payment and delivery, the Affordable Care Act establishes the Center for Medicare and Medicaid Innovation
Independent Payment Advisory Board
The Affordable Care Act also establishes the Independent Payment Advisory Board, or IPAB, to monitor the fiscal health of the Medicare program and to recommend payment policy revisions to contain Medicare cost growth.
Improvements to productivity and market basket adjustments in certain provider settings
The Affordable Care Act ensures that Medicare more accurately accounts for productivity when determining provider payments and revises annual payment updates in certain health care settingsTo support the ongoing development of new models of payment and delivery, the Affordable Care Act establishes the Center for Medicare and Medicaid Innovation
Ending Overpayments to Medicare Advantage Plans
A major inefficiency that the Affordable Care Act addresses is overpayments to private insurance plans that serve Medicare beneficiaries, known as Medicare Advantage plans
Modified equipment utilization factor for advanced imaging
Provisions in the Affordable Care Act address widely recognized areas of overutilization, such as advanced imaging services, which not only wastes resources but may also pose a danger to beneficiaries from needless exposure to radiation
Bidding for Durable Medical Equipment
CMS also continues to implement competitive bidding for durable medical equipment (DME), which the Affordable Care Act accelerated
Targeted and efficient anti-fraud activities
The new law gives CMS the authority to target anti-fraud activities to geographic areas, provider types, or services based on the type or level of risk posed to the program.
Ensures transparency of ownership and ensures provider compliance with Medicare’s requirements
The Affordable Care Act includes new protections that require all providers to have compliance plans. This will ensure that providers are abreast of Medicare requirements and in compliance with them and can focus their attention on patient-care.
