Healthcare Reform Passed – Now What?

October 25, 2010

Healthcare reform has passed, and many provisions are being implemented. But future milestones in the legislation are still very much up in the air. So what should you be doing now? And what will happen to the reform after the November elections? Two MGMA experts offer some guidance.

Healthcare reform legislation has passed, and many provisions are being implemented. But future milestones in the legislation are still very much up in the air.

So what should you be doing now? And what will happen to the reform after the November elections?

Considerable uncertainty surrounds some future provisions of the law, particularly given the rightward-leaning political landscape, according to Patrick Smith Jr., senior vice president of government affairs at MGMA. If Republicans take control of Congress in November, Smith said, they could seek to pass legislation that would deny funding to enforce some of the reform law’s key provisions. However, Smith, speaking Monday at the MGMA 2010 annual conference, offered a short list of steps practices can take now to be better prepared for the future healthcare landscape:

• Examine specific incentive programs in the legislation, and consider how your practice might take advantage of them.
• Determine your ability to qualify for bonus programs, such as the one that provides 10 percent bonuses to physicians whose Medicare services constitute 60 percent of the payments.
• Prepare for the 5010 and ICD-10 coding transitions.
• Review the expansions of preventive and screening benefits for all patients.

These items, Smith said, "will in effect be mandatory down the road," because both sides of the political aisle have stated their commitment to quality improvement programs.

There are also a few reimbursement models being introduced in the healthcare reform legislation, which practices should start keeping an eye on, said Anders Gilberg, vice president of public and private economic affairs at MGMA, speaking in the same session. One example is the Accountable Care Organizations (ACOs) program, which is a Medicare Shared Savings Program aimed at coordinating care, distributing bonuses, and reporting on quality and care measures. But there are several still-unanswered questions about how this program will work, Gilberg explained. Similarly, CMS is piloting a payment bundling model, which under the law could be expanded by 2016. "This could be a fundamental building block to a reformed system," he said.

Physicians are facing a 23.6 percent Medicare payment cut on Dec. 1, and an additional 6.5 percent cut on Jan. 1, 2011, unless Congress must act to repeal the cuts. "It's a system that doesn’t work, and it's not going to work," Smith said of the sustainable growth rate (SGR) formula on which the payments are based.

Smith was also skeptical that lawmakers would act in time, because the election will be followed by a lame-duck session in Congress. But the size of these cuts is unprecedented, and MGMA's surveys show they could have devastating repercussions on patient care.

For example, MGMA's June 2010 survey, following a cut that was later repealed, showed that 37 percent of practices delayed purchases of EHRs and 30 percent cut the number of appointments to new Medicare patients.

In a survey released Monday, nearly half of practices anticipate they will stop seeing new Medicare patients, and about 28 percent said they will cease treating all Medicare patients.
MGMA is asking for a moratorium on the cuts for about a year, which would give time to develop an alternative to the SGR payment formula, Smith said. The group is also calling on members to communicate with their lawmakers and urge them to stop the cuts.

Sara Michael is senior editor at Physicians Practice. She can be reached atsara.michael@ubm.com.