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A Primer on the PPACA and Its Impact on Radiology Wes Angel, MD University of Tennessee Health Science Center, Methodist Program.

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Presentation on theme: "A Primer on the PPACA and Its Impact on Radiology Wes Angel, MD University of Tennessee Health Science Center, Methodist Program."— Presentation transcript:

1 A Primer on the PPACA and Its Impact on Radiology Wes Angel, MD University of Tennessee Health Science Center, Methodist Program

2 Outline Background of the PPACA PPACA Provisions PPACAs Potential Impact to Radiology Summary

3 Background: Reasons for PPACA Rising healthcare expenditure 1 Large percentage of uninsured Lack of access to healthcare for insured and uninsured alike Rising drug costs Source: Kaiser Family Foundation http://facts.kff.org/chart.aspx?ch=202

4 Background: PPACA Patient Protection and Affordable Care Act –AKA Affordable Care Act Signed into law on March 23, 2010 Number of pages 2 : 907 Number of major provisions 3 : 92 Source: http://www.libertyhealthconsultants.com/surveyint ro.html

5 PPACA: Major Tasks 4 Create consumer rights and protections –Guaranteed issue –Patients Bills of Rights Expand insurance –Creation of insurance exchanges –Co-op insurance Expand Medicaid Start health insurance exchanges Establish coverage requirements for small business

6 PPACA: Financial Structure to Increase Revenue 3 Start excise taxes on: –Health coverage –Medical devices –Indoor tanning Increases Medicare tax base Imposes annual fees on: –Branded drugs –Health insurance providers Changes tax structure on flexible savings accounts

7 PPACA: Small Sample of Currently Active Provisions 3, 14 Insurance –Provides adult dependent coverage to Age 26 –Creates state option for Medicaid coverage to childless adults with income levels up to 133% of the federal poverty level (Section 1902) –Creation of consumer website to compare coverage options –Prohibits lifetime limits of insurance coverage Cost reduction –Prohibits federal funding to states for certain hospital acquired infections and other provider preventable conditions –Aims to create a Medicare Independent Payment Advisory Board (IPAB) Primary care –Provides 10% bonus payment for primary care services Preventative medicine and public health –Allocates $5 Billion for 2010-2014 –Allocates $2 Billion Dollars each fiscal year after 2014

8 PPACA: Small Sample of Currently Active Provisions 3, 14 Revenue generation –Creates 10% excise tax on indoor tanning services Graduate medical education –Increases GME positions –Funds ambulatory teaching health centers Expansion of Drug Discount Program Changes to Medicare provider rates

9 PPACA: Future Provisions 2012 2,3 Creation of ACOs (Accountable Care Organizations) for MedicareACOs (Accountable Care Organizations) –Group of healthcare providers –Various reimbursement models: capitation and fee-for- service –Ties reimbursement to quality of care Annual pharmaceutical fees Medicare value based purchasing Reduced Medicare payments for hospital readmissions New fraud screening efforts

10 PPACA: Future Provisions 2013 2,3 Closure of Medicare drug coverage gap Increased Medicaid payments for primary care to match Medicare rates for 2013 and 2014 Medicare tax increase –Increased wages tax rate by 0.9% –3.8% tax on unearned high income Medicare bundled payment pilot program 2.3% excise tax on medical devices

11 PPACA: Sample of Future Provisions 2014- 2016 2,3 2014 –Expand Medicaid base –Individual requirement to have insurance –Guaranteed issue –Health insurance company fees –No annual limits on insurance coverage –Reduced reimbursement for certain Medicare hospital acquired infections 2018 –Tax on high cost insurance

12 PPACAs Potential Impact to Radiology Potential expansion of referral base Establishment of ACOs in Medicare –Creates potential for various roles of radiologists within ACOs 8,10 Reimbursements –Increase in utilization rate of equipment from 50 to 90% 5 –Increase in multiple procedure reduction rule from 25 to 50% 5 –Decrease in professional component of 2-3% 6 Establishment of Center for Medicare and Medicaid Innovation –Potential impact on ordering and reimbursement of diagnostic imaging

13 PPACAs Potential Impact to Radiology (continued) New Self Disclosure Requirements 9 –Requires physician to provide written notice to patients that they may obtain services such as CT, MRI, and PET elsewhere if physician has a financial interest (Section 6003) –Requires establishment of self referral disclosure protocol (Section 6409) False claims 9 –Allows federal government to prosecute anti-kickback violations under the False Claims Act (Section 6402) –Mandatory requirement to return Medicare and Medicaid overpayments within 60 days (Section 6402) –Maximum period for submission of Medicare claims to less than 12 months (Section 6404)

14 Summary PPACA will continue to evolve with continuous changes to the law, its provisions, and its implementation Implements multiple changes to Medicare and Medicaid Provides near universal coverage by various means Creates uncertain impact to radiology and the medical field as a whole Interested in learning more?

15 References/Resources 1.Kaiser Family Foundation www.kff.org, Last accessed December 15, 2011.www.kff.org 2.Patient Protection and Affordable Care Act, http://docs.house.gov/energycommerce/ppacacon.pdf, Last accessed October 10, 2011.http://docs.house.gov/energycommerce/ppacacon.pdf 3.Implementation Timeline, http://healthreform.kff.org/Timeline.aspx, Last accessed October 10, 2011.http://healthreform.kff.org/Timeline.aspx 4.U.S. Department of Health and Human Resources, http://www.healthcare.gov/, Last Accessed December 12, 2011.http://www.healthcare.gov/ 5.American College of Radiology, Impact to Radiology as an Result of PPACA, http://www.acr.org/Hidden/Economics/FeaturedCategories/mps/mpfs/2011-Medicare-Physician-Fee- Schedule-FR/Impact-To-Radiology-As-A-Result-of-PPACA.aspx, Last accessed on October 10, 2011. http://www.acr.org/Hidden/Economics/FeaturedCategories/mps/mpfs/2011-Medicare-Physician-Fee- Schedule-FR/Impact-To-Radiology-As-A-Result-of-PPACA.aspx 6.American College of Radiology, Aggregate Estimated Impact of Equipment Usage Assumption Changes for Advanced Diagnostic Imaging Services (Diagnostic CT and MR) on PE RVUs Using 2008 Constant Volume, http://www.acr.org/Hidden/Economics/FeaturedCategories/mps/mpfs/2011-Medicare- Physician-Fee-Schedule-FR/Impact-To-Radiology-As-A-Result-of-PPACA/Usage-Assumption-Results- DxCTMR.aspx, Last accessed on October 10, 2011http://www.acr.org/Hidden/Economics/FeaturedCategories/mps/mpfs/2011-Medicare- Physician-Fee-Schedule-FR/Impact-To-Radiology-As-A-Result-of-PPACA/Usage-Assumption-Results- DxCTMR.aspx 7.Allen, B., Donovan, W. D., McGinty, G., Barr, R. M., Silva, E., Duszak, R., Kim, A. J., et al. (2011). Professional component payment reductions for diagnostic imaging examinations when more than one service is rendered by the same provider in the same session: an analysis of relevant payment policy. Journal of the American College of Radiology: JACR, 8(9), 610-6. doi:10.1016/j.jacr.2011.06.012

16 References/Resources (continued) 8.Allen, B., Levin, D. C., Brant-Zawadzki, M., Lexa, F. J., & Duszak, R. (2011). ACR white paper: Strategies for radiologists in the era of health care reform and accountable care organizations: a report from the ACR Future Trends Committee. Journal of the American College of Radiology: JACR, 8(5), 309-17. Elsevier Inc. doi:10.1016/j.jacr.2011.02.011 9.Bloom, G. E., & Smith, G. R. (2011). Key provisions of the Patient Protection and Affordable Care Act. Journal of the American College of Radiology: JACR, 8(1), 69-70. doi:10.1016/j.jacr.2010.10.001 10.Breslau, J., & Lexa, F. J. (2011). A radiologists primer on accountable care organizations. Journal of the American College of Radiology: JACR, 8(3), 164-8. Elsevier Inc. doi:10.1016/j.jacr.2010.08.005 11.Greaney, T. L. (2011). Accountable care organizations--the fork in the road. The New England journal of medicine, 364(1), e1. doi:10.1056/NEJMp1013404 12.Pentecost, M. J. (2009). Health care reform: what Americans want. Journal of the American College of Radiology: JACR, 6(12), 831. Elsevier Inc. doi:10.1016/j.jacr.2009.09.010 13.Pentecost, M. J. (2011). Health care reform: the first anniversary. Journal of the American College of Radiology: JACR, 8(4), 221. Elsevier Inc. doi:10.1016/j.jacr.2011.01.002 14.Consumers Union, The Affordable Care Act: The First Year, http://www.consumerreports.org/health/resources/pdf/ncqa/health-reform.pdf, last accessed on December 12, 2011. http://www.consumerreports.org/health/resources/pdf/ncqa/health-reform.pdf


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