1. AFFORDABLE CARE ACT: OVERVIEW, STUDY OF THE GENERAL EFFECTS ON RADIOLOGY, HOW FAR HAVE WE COME AND THE FUTURE Bhavya Rehani, MD, Lindsay P. Busby, MD, MPH, William P. Dillon, MD

2. Reason: She cannot afford care. Case Example Christine comes to ED. She is a 36 y/o F with 3 children, works as a nanny and has no health insurance. She gets admitted to the hospital with severe arrhythmias. She leaves the hospital after getting multiple tests in a single day of hospitalization.

3. Patient Protection and Affordable Care Act (PPACA) Signed into law on March 23, 2010 by President Obama

4. Purpose  To understand the basics of health care reform  Mechanisms by which the PPACA expands health care coverage  To outline in comprehensible terms the PPACA’s effect on consumers, on neuroradiologists and on the specialty of radiology at large  Understand, what is the future?

5. Methods and Materials  ACA legislation, a 1,000 page document, was studied extensively  Potential to impact radiologists was analyzed Methods Materials

6. Methods and Materials  Impact on health insurance  Health insurance is a major part of Obama-care with new terminologies and multiple new changes on the horizon  Impact on radiology

7. Overview  PPACA expands coverage to nearly all US Citizens and legal residents through two principle mechanisms:  An expansion of Medicaid  A mandate to require most U.S. citizens and legal residents to purchase health insurance  Each of these mechanisms accounts for approximately half of the 30 million people who will be newly insured due to the Act.

8. Expansion of Coverage  PPACA expands coverage through:  Medicaid Expansion Mandate

10. Expansion of Coverage  A mandate to requiring purchase of health insurance:  The insurance products are made available on a state by state basis through insurance exchanges and the mandate is enforced through the tax code.  Individuals who do not meet the expanded criteria for Medicaid and who meet other income eligibility criteria (from 133%-400% of the federal poverty level) will be given subsidies for purchase of insurance on the exchange.

11. Health Insurance Exchanges Each state will establish an Exchange to help individuals and small employers obtain coverage

12. Health Insurance: Mandate  What if I can’t afford insurance?  Give tax credit so people can afford insurance  What if I don’t want to buy insurance?  Fine people who are not compliant ($695/year)  What if I have a pre-existing condition  Guaranteed issuance an of insurance

13. Overview  Other important components of PPACA include:  Cost controls  Incentives to form Accountable Care Organizations and health plan regulation  Specific to radiology is legislation that includes:  Utilization rate  Self-referral  Appropriateness criteria  A 2.3% excise tax on medical devices

14. Results: Radiology Utilization rate Multiple Payment Procedure Reduction  2.3% excise tax on medical devices  Self referral  Appropriateness criteria  Accountable care organization

15. Results: Radiology  2.3% Excise tax on almost all medical devices.  Devices that individuals buy for their own use are mostly exempted.

16. Results: Radiology  Section 6003 of ACA  The provider must provide the patient with a written list of suppliers who furnish services in the area in which such patient resides.

17. Results: Radiology. The U.S. Centers for Medicare and Medicaid Services (CMS) will establish a demonstration project that will offer incentives to referring physicians to use appropriateness criteria when ordering advanced imaging tests.

18. Courtesy: rewardhealth.com Results: Radiology

19. Utilization rate: from 50% to 75% Multiple Payment Procedure Reduction 2.3% excise tax on medical devices Self referral Appropriateness criteria Accountable care organization

20. Taxes  Tax rate increase 0.9% on employee wages & increase in Medicare tax on individuals $200,000. Insurance  Annual fee  40% excise tax on Cadillac Insurance policies Pharmaceutical companies  Annual fee Funding for Tax Credits

21. Health Insurance: Tax credits What do tax credits mean?  Federal poverty line: $11,170  Imagine you are sole income earner - family of 4 and make: $69,500  Average cost for health insurance is: $15,745  You make 300% of the FPL and would be responsible for 9.5% of your income: $6,602 Reference: Kaiser Family Foundation

22. Future

23. Now she can benefit from Medicaid expansion and subsidies. Future Christine comes to ED. She is a 36 y/o F with 3 children, works as a nanny and has no health insurance. She gets admitted to the hospital with severe arrhythmias. She leaves the hospital after getting multiple tests in a single day of hospitalization. Reason: She cannot afford it.

24. New changes on the horizon in ACA Awareness helps ensure we are prepared to create a better future of radiology