Affordable Care Act Implementation and Information

In March 2010, President Obama signed comprehensive healthcare reform, the Patient Protection and Affordable Care Act (ACA), into law.  The law aims to make health coverage more accessible and affordable for many Americans, while improving quality and reducing costs.  While some provisions of the law have already taken effect, many more provisions will be implemented in the coming years.

Accountable Care Organizations
AMGA believes that our current system of healthcare delivery does not adequately hold providers accountable for the care they provide, nor for providing the full spectrum of care. Creating accountability is impossible until we transform the current volume-based system into one that pays providers based on outcomes (quality) and value (efficiency). Once a link has been made between compensation and results, provider accountability will grow. To promote accountability, and build on existing medical practice patterns, Congress has taken an important step in the creation of Accountable Care Organizations (ACO) in health reform law.

ACOs are one of the key efforts of the recent healthcare reform legislation that address the two greatest challenges facing U.S. health care: unsustainable escalation of costs that threaten the affordability of care and care that is fragmented, poorly coordinated with little accountability for the outcomes of care. It is widely believed that the current volume-based payment system is part of the problem and needs to be restructured to support paying for value rather than paying for delivering services and procedures. The ACO concept couples payment and delivery systems reforms that may have the opportunity to bend the cost curve while improving access and quality.

AMGA has been a longtime leader in reform efforts that foster the creation of community-based entities accountable for comprehensive healthcare services, referred to as ACOs, that promote accountability and build on the practice patterns of high-performing organizations. It provided guidance to congressional leaders on the appropriate language regarding ACOs and lobbied aggressively for its inclusion.

To view AMGA’s recommendations for making ACO programs more workable and helping to ensure their future success, click here.

AMGA’s comments in response to the CMS Request for Information on the Evolution of ACO Initiatives are available here.

Centers for Medicare and Medicaid Services Rulemaking on the Affordable Care Act
CMS is developing new programs and tools to help with the implementation of the Affordable Care Act.

Electronic Health Records/Health Information Technology/Meaningful Use
An electronic health record (EHR)—sometimes called an electronic medical record (EMR)—allows healthcare providers to record patient information electronically instead of using paper records. However, EHRs are often capable of doing much more than just recording information. The EHR Incentive Program asks providers to use the capabilities of their EHRs to achieve benchmarks that can lead to improved patient care.

The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.

Value Based Modifier Payment
Section 3007 of the Affordable Care Act mandated that, by 2015, CMS begin applying a value modifier under the Medicare Physician Fee Schedule (MPFS).  Both cost and quality data are to be included in calculating payments for physicians.

Physicians in groups of 100 or more eligible professionals who submit claims to Medicare under a single tax identification number will be subject to the value modifier in 2015, based on their performance in calendar year 2013.

Medicare Advantage
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. Most Medicare Advantage Plans offer prescription drug coverage.

ICD-10 is the general term for the International Classification of Diseases, Tenth Revision.  The healthcare delivery system, by law, must transition to these diagnosis code sets by October 1, 2015. The Centers for Medicare and Medicaid Services (CMS) website has several resources to assist healthcare providers with this transition.