2. Introduction
Background
Goals
Familiarization of Terms
Underpayment/Compensation(lack thereof)
Impact on Rehab Service Providers
Questions
3. The Patient Protection and Affordable Care
Act was signed into law on March 23, 2010
Health Care and Education Reconciliation Act
on March 30, 2010
4. The Affordable Care Act provides Americans
with better health security by putting in place
comprehensive health insurance reforms that
will:
Expand coverage*
Hold insurance companies accountable
Lower health care costs
Guarantee more choice
Enhance the quality of care for all Americans
5. Accountable Care Organization
Bundled Payment Models
Marketplaces (Exchanges)
Navigators
Essential Health Benefits
Grace Period
6. Combined underpayments were $56 billion in
2012
This includes a shortfall of $42.3 billion for Medicare
and $13.7 billion for Medicaid
Medicare
86 cents for every dollar spent by hospitals
Medicaid
89 cents for every dollar spent by hospitals
7. Since 2000, hospitals of all types have provided
more than $413 billion in uncompensated care
to their patients
8.
9. Increased amount of insured
citizens
Increased demand for
rehabilitation services
Increased demand for PT,
PTA, OT, SLP
Physical Therapist jobs
(39%)
Physical Therapy Assistant
jobs (46%)
Occupational Therapy jobs
(33%)
Certified Occupational
Therapy Jobs (41%)
Speech Language
Pathologist Jobs (23%)
10. Expected increases in efficiency, productivity
Increased computer reporting and
documentation expectations
Continued decline in reimbursement rates
11. How will we as healthcare providers keep up
with the demands?
Will the increase in demand affect our way of
implementing autonomous, evidence-based
practice?
What will the long-term consequences be?
The comprehensive health care reform law enacted in March 2010. The law was enacted in two parts: The Patient Protection and Affordable Care Act was signed into law on March 23, 2010 and was amended by the Health Care and Education Reconciliation Act on March 30, 2010. The name “Affordable Care Act” is used to refer to the final, amended version of the law.
*Prior to the passing of the PPACA roughly 91 million people were either uninsured or under-insured, now with the passing of the PPACA it is expected that roughly 95% of all Americans will have some sort of health insurance policy (critical for the aging population “baby boomers”)
An important aspect under the Affordable Care Act (ACA) is the establishment of the essential health benefits (EHBs). EHBs are a package of benefits that assure health plans offered in the state Health Insurance Marketplaces (also referred to as exchanges) provide a baseline of coverage, benefits, and services to their enrollees.
Navigators are individuals or organizations that have been trained to help consumers as they search for coverage in the Marketplace, including completing eligibility and enrollment forms. Navigators cannot be health insurance issuers and are prohibited from receiving direct or indirect compensation from any health insurance company as a result of enrollment by individuals or employees.
Health insurance marketplaces (Marketplaces), also known as exchanges, are a fundamental component of the Affordable Care Act (ACA). Section 1311 of the ACA created the exchanges to provide a competitive marketplace for individuals and small employers to directly compare available private health insurance options on the basis of price, quality, service, and other factors. The primary purpose of the Marketplace is to enhance competition among payers, improve choice of affordable health insurance, and give small businesses the same purchasing power as larger businesses.
Under the Affordable Care Act (ACA), if an insured individual who qualifies for advance payment of premium tax credits does not pay his or her portion of the premium, qualified health plans (QHPs) sold in the health insurance marketplace are required to “allow a 3-month grace period of nonpayment of premiums before discontinuing coverage.” This grace period protects low-income individuals who experience temporary difficulty in paying premiums during a given time period by affording them an opportunity to catch up. Under this protective measure, an individual’s inability to pay insurance premiums must be sustained for 3 months before the ACA will permit QHPs to terminate coverage. During the first 30 days of the grace period, the individual’s cost sharing subsidies will remain intact.
Underpayment is the difference between the costs incurred and the reimbursement received for delivering care to patients. Underpayment occurs when the payment received is less than the costs of providing care, i.e., the amount paid by hospitals for the personnel, technology and other goods and services required to provide hospital care is less than the amount paid to them by Medicare or Medicaid for providing that care.
Uncompensated care is an overall measure of hospital care provided for which no payment was received from the patient or insurer. It is the sum of a hospital's "bad debt" and the charity care it provides.
According to the United States Bureau of Labor Statistics, from 2010-2020, the following therapy professions are expected to grow at the following rates:
