HEALTHCARE CHANGES AFFECTING YOUR PRACTICE. Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas

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1 HEALTHCARE CHANGES AFFECTING YOUR PRACTICE Vinay Kumar MD, FACS, ABVM Endovascular options Dallas, Texas

2 HEALTH CARE CHANGES 1 st Major overhaul of health care system since WWII introduction of 3 rd party payment system Medicare introduction 1965 Curb the rising health care cost

3 Fellows Course I raised a question What is the cost of a STEMI procedure to a patient Average Answer : $ Does not include Physician fees

4 Physicians don t even have a clear handle on the changes that will affect them directly like the payment reforms, survey in summer 2013 found that more than 6 out of 10 physicians said they were not at all familiar with issues like what the Obamacare health exchange plans would cover, what the payment rates would be and how the process would work to get their medical claims paid.

they were not at all familiar with issues like what the Obamacare health exchange plans would

5 HOW DID WE GET HERE Pay for service Obama care=aca 2012 Billing for service New health care system Cutting cost measures( ) Payments through insurance companies Lowered payments : Via HMO/PPO (70-80) Increased spending Medicare introduced as part of health scheme for elderly Progress in healthcare such as CABG, dialysis, Endovascular, orthopedic joint replacement

: Via HMO/PPO (70-80) Increased spending Medicare introduced as part of health scheme for

6 What Does ObamaCare Do? The Affordable Care Act does a number of important things including offering Americans a number of new benefits, rights, and protections in regards to their healthcare, and setting up a Health Insurance Marketplace where Americans can purchase federally regulated and subsidized Health Insurance during open enrollment. The law also expands Medicaid, improves Medicare, requires you to have coverage in 2014 and beyond, and contains some new taxes and tax breaks, among other things.

in regards to their healthcare, and setting up a Health Insurance Marketplace where Americans can purchase federally regulated and

7 Medicare pays for 60% of all health care payments Govt Wants to recover 20 billion in Medicare Fraud Medicare had about 51 million beneficiaries Gross spending (excluding administrative costs that are subject to appropriation) for the program was $585 billion. CBO anticipates that Medicare spending will rise rapidly over the next decade, spurred by the retirement of the baby boomers..

that are subject to appropriation) for the program was $585 billion.

8 ESTABLISH THIS BRAND Obamacare or ACA ACO Strict scrutiny Medicare audits RAC audits Medicaid and their audit programs Billing and payments are controlled Data posting on web Payment information Performance data

their audit programs Billing and payments are

9 HEALTHCARE : ACA : OBAMA CARE MOVING AWAY FROM AUTONOMY 1. EMR and EHR 2. Hospital and ACA 3. Sunshine Act Transparency of Physicians Physician payment exposure Physician performance exposure Patient survey results Penalties for failure to comply Non approved procedure? Other financial information disclosure Here

Sunshine Act Transparency of Physicians Physician payment exposure Physician

10 EMR AND EHR : Documentation More then ever : completing Charts in less the 24 hrs Hospital control Medicare can check 49 or more charts per year Failed audit : if you don t meet Medicare criterions Return of payments with 21% penalty Outlier : subject to more audits Drop by Medicare

year Failed audit : if you don t meet Medicare criterions Return of

11 All healthcare changes are based around Cutting cost Outcome based medicine Keeping patients out of hospitals Better results in medical therapy/intervention/surgery Fewer readmissions Holding physician responsible Rewards for Short hospital stays Fewer readmissions Good outcomes Passing health grade surveys by patients Being a team player (Team based patient care) Penalties for Poor outcomes Recurrent admissions Patient non compliance Failing to obtain ancillary services (smoking cessation) Poor documentation Not being a team player Failing patient survey

outcomes Passing health grade surveys by patients Being a team player (Team based patient care) Penalties for Poor outcomes Recurrent

12 WHAT IS IN FOR YOU Transparency Physician Accountability Medicare and RAC audits Team approach to disease Family physician being gate keeper Bundled payments

16 WHAT IS AN ACCOUNTABLE CARE ORGANIZATION? An ACO is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient's care is a primary care physician. In Obamacare, each ACO has to manage the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years. ACOs will need to prove that the overall health care product they're creating does work better and costs less in order to encourage patients and payers to buy it. You have to join ACO : no questions 1.Healthcare reimbursement system paying for quality not volume. 2.Incentives for more integrated care delivery, focus on managing populations of patients. 3.Healthcare organizations today need to prepare for a world that involves more accountability.

At the heart of each patient's care is a primary care physician. In Obamacare, each ACO has to manage the health care needs of a minimum of 5,000 Medicare beneficiaries for at least three years.

17 ACO STRUCTURE Hospital Logistic support Health care organizations Follow ACO requirement Insurance companies Central Core Physician compliance ACO Hospital Employed Physicians Data Sharing Physicians Private practice physicians Data provided to Medicare Hoping for incentive money Walgreen Pharmacy Walmart Private Pharmacies

Employed Physicians Data Sharing Physicians Private practice physicians Data

23 Consulting fees Compensation for services other than consulting, including serving as faculty or as a speaker at an event other than an accredited continuing education program Honoraria Gifts Entertainment Food and beverage Travel and lodging Education Research Charitable contributions Royalty or license Current or prospective ownership or investment interest (including those held by immediate family members) Grants

25 Easy to deal with new healthcare rules

How Health Reform Will Affect Health Care Quality and the Delivery of Services

Fact Sheet AARP Public Policy Institute How Health Reform Will Affect Health Care Quality and the Delivery of Services The recently enacted Affordable Care Act contains provisions to improve health care