The Health Reform Law in 2012: Changes Keep Coming

Both proponents and opponents of the federal health care reform law are awaiting the outcome of the U.S. Supreme Court’s ruling on the constitutionality of the law’s individual mandate. But as we wait for a ruling on the most public aspect of the Affordable Care Act (ACA), many provisions of the law continue to go into effect.

Since Congress passed the Affordable Care Act (ACA) in March 2010, four dozen provisions have been enacted or are in progress, according to the Kaiser Health Foundation’s tally. Some have expanded care to new groups of Americans, such as dependents up to age 26 and childless adults. A number are aimed at improving the quality and lowering the cost of health care, such as incentives for Medicare and private providers to meet higher standards. Even if the court finds the individual mandate to be unconstitutional, it is likely that many of the Medicaid and Medicare provisions will continue to be implemented.

The pace of implementation slows in 2012, but some provisions are already underway. Most focus on cutting costs and improving the quality of Medicare. Here are some of the reforms on tap.

• Medicare providers organized as accountable care organizations (ACOs) can share in cost savings if they lower costs while meeting certain quality standards. (An ACO is a group of doctors, other health care providers, hospitals and labs that work as a team to provide care.)
• Privately offered Medicare Advantage Plans can receive bonuses if they provide seniors with high-quality care, including preventive medicine and chronic care management. Some plans could see reduced payments to bring them closer to the cost of a patient in their county’s traditional Medicare program.
• Hospitals will be eligible for higher Medicare payments if they demonstrate quality performance in publicly reported measures, including indicators relating to heart attacks, health care-related infections and patient satisfaction.
• Medicare, as well as Medicaid and Child Health Insurance Plan, providers will be subject to greater screening, oversight and penalties for waste, fraud and abuse.
• Medicare payments will be reduced in cases of preventable hospital readmissions.
• A new pilot project, Medicare Independence at Home, will examine whether caring for Medicare patients at home improves outcomes and reduces costs.

Medicaid demonstration projects also scheduled for implementation will determine how well bundled payments work for episodes of acute care involving a hospitalization, and institute new standards to improve the collection and reporting of health care information.

Regardless of how the Supreme Court rules next year, efforts to reduce costs and improve quality will move forward.