Download to read offline
PPACA and affects on PT
- 1.
- 2. Introduction Background Goals Familiarization of Terms Underpayment/Compensation(lack thereof) Impact on Rehab Service Providers Questions
- 3. The PatientProtection and Affordable Care Act was signed into law on March 23, 2010 Health Care and Education Reconciliation Act on March 30, 2010
- 4. The AffordableCare 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 CareOrganization Bundled Payment Models Marketplaces (Exchanges) Navigators Essential Health Benefits Grace Period
- 6. Combined underpaymentswere $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
- 9. Increased amountof 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 increasesin efficiency, productivity Increased computer reporting and documentation expectations Continued decline in reimbursement rates
- 11. How willwe 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?
- 12. http://myptsolutions.com/the-affordable-care-act-is-here- to-stay/ http://www.apta.org/HealthCareReform/ http://www.webpt.com/blog/post/5-ways-affordable- care-act-impacting-physical-therapists http://www.emory.edu/ACAD_EXCHANGE/2010/fall/k apasi.html http://www.aha.org/research/policy/finfactsheets.shtml http://www.medicare.gov/about-us/affordable-care- act/affordable-care-act.html http://www.heritage.org/research/reports/2014/03/the- impact-of-the-affordable-care-act-on-the-health-care- workforce http://kaiserfamilyfoundation.files.wordpress.com/2011/0 4/8061-021.pdf
Editor's Notes
- #4 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.
- #5 *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”)
- #6 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.
- #7 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.
- #8 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.
- #10 According to the United States Bureau of Labor Statistics, from 2010-2020, the following therapy professions are expected to grow at the following rates: