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Uci 2010 Physician Impacts.Barcellona.

Uci 2010 Physician Impacts.Barcellona.



A presentation to the UCI health system on impacts to physicians from the new PPACA health reform bill.

A presentation to the UCI health system on impacts to physicians from the new PPACA health reform bill.



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    Uci 2010 Physician Impacts.Barcellona. Uci 2010 Physician Impacts.Barcellona. Presentation Transcript

    • HEALTH REFORM 2010 – How Will it Impact Physicians?
      Bill Barcellona © 2010 California Association of Physician Groups
    • The Old vs. The New
      Old Health Care System
      New Health Care System
    • The Timeline to Reform
    • Access to Care
      Coverage is expanded to 38 million Americans between 2010 and 2015
      Achieved through a combination of market reforms and premium subsidies
      Uninsured “cost shift” is systematically eliminated through almost universal coverage
      Exchanges are created as one-stop shops for insurance coverage
    • Market Reformsexpand coverage
      • No pre-ex condition exclusions for kids
      • Temporary national exchange for high-risk uninsured opens in 90 days
      • Ban on rescissions commences
      • Ban on lifetime and annual coverage caps based on dollar amounts
      • Medicaid coverage expansion begins
      • Free preventive care for seniors
      • Small business tax credits
      • Early retiree coverage pool begins
      • Employers must offer coverage
      • State insurance exchanges open
      • Individual mandate begins
      • Adult Medicaid expansion
    • Affordability
      Market reforms do not eliminate private insurance – they make it more responsible
      Insurers must prove their value proposition
      Providers will be incented and mandated to decrease cost and improve quality of service
      New Practice models will be evaluated on this basis and given the “go/no go”
      Employers & the States will be incented to provide more wellness incentives for patients
    • Cost Controls exist in the legislation
      • CMS will experiment with a variety of new provider payment models from 2010 to 2016
      • Hospitals will face tough curbs on FFS billing
      • Health Plans will have to meet 85% MLR
      • Physician payments will move away from pure fee-for-service
    • Quality
      Provider electronic reporting of data will fuel research and evaluation of best practices
      Performance metrics will be established and implemented – pay will be linked to them
      Incentives will be initiated and maintained, but penalties will be imposed on outliers
      Fee-for-service will give way to outcome-based payment systems
    • Qualityand transparency
      • CMS will begin to publish physician performance on a new website called “Physician Compare” for Medicare
      • Providers must contribute best practices innovations as a part of qualifying as ACOs
      • New shared decision making tools will be distributed
      • Innovations in community-based and home-based treatment of chronically ill patients will be tested
      Evidence-based medicine research will not be applied mandatorily
    • The Health System in 2016
    • Physician’s Role in Reform
      Capitalization of HIT adoption
      Coping with new performance measures
      Shifting from FFS to outcome-based pay
      Shifting to integrated provider models
    • New Tools
      Task Forces on Clinical Preventive Services and Community Preventive Services
      Update the Guide to Clinical Preventive Services
      CMS Best-Practices Website
      ACOS will contribute innovations to CMS
      Patient Centered Outcomes Research Institute
      New research and testing of evidence-based medicine and shared decision making tools
    • New Payment Models
      Shared-Savings “Performance Target” Model
      Value-Based Purchasing and Reimbursement
      Bundled-Payments Model
      Bonus Payments for Quality
      Risk-Adjusted Capitation for Chronic Patients
      Increased Payments for Medi-Cal Primary Care
      Increased Payments for Medicare Primary Care
      Medicare Pay-for-Performance Model
    • New Mandates
      CMS Physician Compare Website for Medicare
      Health Insurer Administrative Simplification
      Increased False Claims Penalties
      Meaningful Use Reporting Penalties after 2015
      CMS Quality Payment Modifier after 2015
    • New Practice Models
      Medicare Advantage transition to outcome-based performance
      Accountable Care Organizations will integrate doctors, hospitals and post-acute care
      Pediatric ACOs in Medi-Cal
      Medical Home Model in Medicare/Medi-Cal
      Community-Based Transitional Care Model
      Home-Based Primary Care Demonstration
    • Accountable Care Organizations
      CMS Pilot project commences in 2012
      ACOs will qualify for assigned Medicare patients
      by offering integrated care management, data reporting on performance metrics and demonstrating cost savings over FFS system
      Primary Care ACOs will be formed in Medi-Cal
      ACOs will provide the infrastructure for doctors to meet new reporting and outcome-based payment structures
    • The Result
      Mad As Hell?
      I’ve Found Nirvana
      Peter Finch, Network, 1976
    • Thank YouBill Barcellona, VP Government Affairs