Healthcare Reform - 2012

March 17, 2011



2011  /  2012  /  2013  /  2014  /  2015

20125010 implementation
All electronic claims must use core HIPAA transactions 5010; version 4010 claims no longer accepted by CMS.
Effective Jan. 1, 2012
UPDATE: After initially delaying enforcement until March 31, 2012, CMS announced it will not enforce 5010 conversion until June 30 2012.

ACOs
Incentives offered for physicians to join Accountable Care Organizations (ACOs), groups allowing doctors to work with others to coordinate patient care with the goals of quality improvement, prevention of disease and illness, and reduction of unnecessary hospital admissions; if ACO saves money, federal government will allow it to keep some of the savings.
Effective Jan. 1, 2012
UPDATE: In April 2012, CMS announced the first 27 ACOs as part of its Medicare Shared Savings Program.

Primary care at home
Independence at Home demonstration project created to provide high-need Medicare enrollees with primary care services in their own home.
Effective Jan. 1, 2012
UPDATE: In April 2012, the White House re-affirmed its commitment to the project, announcing $15 million in funding to support up to 50 practices later in the year.

End of 2011 EHR incentives
Last day for eligible professionals to register and attest to receive EHR incentive payments for calendar year 2011.
Last day – Feb. 29, 2012

Addressing care disparities
U.S. Department of Health and Human Services to collect data from federal health programs on ethnicity and languages served; HHS to use data to indentify and reduce care disparities.
Effective March 2012
UPDATE: HHS published request for comment on data collection in late 2011.

Hospital rewards
A Value-based Purchasing Program (VBP) is established for hospitals, offering financial incentives for improving quality of care; data is publicly reported, and starts with measures tied to heart attacks, heart failure, pneumonia, surgical care, healthcare-associated infections, and patient’s perception of care; HHS also to submit plan for similar program for home health agencies, skilled nursing facilities, and ambulatory surgical centers to Congress.
Effective for payments on discharges occurring on or after Oct. 1, 2012; report due to Congress by July 1, 2011
UPDATE: In May 2011, CMS published a final rule on the program.

Medicare pay ‘adjustment’
Certain providers to see a productivity adjustment to their annual market update, resulting in lower payment rates; includes ambulatory surgery centers in 2011, inpatient/outpatient hospitals, skilled nursing facilities in 2012, and home health agencies in 2015.
Effective calendar, fiscal, or rate year 2012, as appropriate

Medicare and hospital readmissions
Medicare payments to hospitals to account for excess/preventable readmissions are reduced.
Effective Oct. 1, 2012
UPDATE: In August 2011, CMS issued a final rule on the program's structure.

Reliance on EHRs
Health plans required to adopt and implement rules for secure, confidential, electronic exchange of health information; goals to standardize billing, reduce paperwork and administrative burdens, cut costs, and improve care.
First rules take effect Oct. 1, 2012