Embed Size (px)
Citation preview
Health Care Reform Health Care Reform Update – The 28% FactorUpdate – The 28% FactorW. Stephen LovePresident and Chief Executive OfficerDallas-Fort Worth Hospital CouncilNovember 14, 2013
Patient Protection & Patient Protection & Affordable Care ActAffordable Care Act
History
Modifications
Legislation Became Law – March 23, 2010
Supreme Court – June 28, 2012
Implementation – Especially 20142
Current and Future Trends in Current and Future Trends in Healthcare DeliveryHealthcare Delivery
Fee for Service
Coordinate Payment
Prevention
Wellness
3
Current and Future Trends in Current and Future Trends in Healthcare DeliveryHealthcare Delivery
Medical Homes
Accountable Care Organizations
Primary Care Networks
Physicians – Retain
Physician Payment
4
Coverage - AccessCoverage - Access
Emergency Room
Proper Primary Setting
Piggly Wiggly Effect
Primary Care Providers
5
Fiscal CliffsFiscal CliffsDebt Ceiling – February 7, 2014
Appropriations Budget – December 13, 2013
Funding Government – through January 15, 2014
Physician Payment Fix – December 31, 2013
6
Reimbursement - FederalReimbursement - Federal
Budget Policy = Health Policy
Provider Cuts = Beneficiary Impact
$250 Billion = 10 Year Reduction
7
Reimbursement - StateReimbursement - State
No Medicaid Expansion◦$85 Billion◦1.4 Million People◦Reasons Against
Medicaid 1115 Waiver
8
State of TexasState of Texas
28 Percent Uninsured6 Million People1.2 Million Children40 Percent of Women –
Inappropriate pre-natal careWorking Uninsured
9
Enroll in Health CoverageEnroll in Health Coverage
Navigators
Non-Navigators
Certified Application Counselors
Agents and Brokers
10
EmployersEmployers2015 Employer Shared
Responsibility PaymentGreater than 50 FTE’s50 or less FTE’sLess than 25 FTE’s
11
EmployersEmployers2014 and 2015 – Shop for 50 or
less FTE’s2016 – Shop less than 100 FTE’sSmall Business Health Options
Program
12
IndividualsIndividualsAdult Penalties
◦2014$ 95◦2015$325◦2016$695◦2017 and beyond – Increased based
on cost-of-living adjustment
13
Questions
Health Care Reform Health Care Reform Update – The 28% FactorUpdate – The 28% FactorW. Stephen LovePresident and Chief Executive OfficerDallas-Fort Worth Hospital CouncilNovember 14, 2013
