Healthcare Reform: A Map to the Changing Landscape
In the last decade, debate over the nation’s healthcare system has moved to the forefront of our political arena. On March 23, 2010 talk turned to action as President Obama signed into law the biggest expansion of healthcare guarantees in more than forty years, the Patient Protection and Affordability Act of 2010. This sweeping legislation will send ripples through the industry, affecting everyone from doctors and dialysis facilities, to business owners and patients.
This reform had a modest impact on the renal community with only one provision relating directly to dialysis care. This provision states that the General Accounting Office, “GAO”, commit to analyzing the impact of including oral drugs in the new dialysis bundling regulations. This report is due one year from the bill’s passage (3.23.11). Another provision that relates indirectly to the dialysis industry is an opportunity for increased savings. Doctors and facilities can now band together to form Accountable Care Organizations (ACO). The Department of Health and Human Services has been authorized to begin reimbursing providers and doctors who join together to care for large groups of patients. While structure and compensation for these ACOs have yet to be defined the possibility of saving cost while increasing patient quality of care exists.
While reform does not have drastic effects on dialysis care, many providers and most small businesses will feel the winds of change. One of the biggest changes will be that employers with more than 50 full-time employees (or equivalents in hours worked) will be considered large employers. Large employers will have to make available to all employees a minimum level of medical coverage or pay a per-employee penalty (the “pay or play” fee) effective January 1, 2014. An immediate shift felt by owners will be that small businesses with fewer than 25 employees and less than $50,000 in average wages who pay for employee health insurance premiums may be eligible for credits on their 2010 tax return. Small businesses will also benefit from Small Business Health Options Programs, or “SHOP Exchanges,” where they will be able to pool together to buy insurance. These exchanges must be established by the states no later than 2014.
The main focus of this health care package is to increase patient access to affordable health insurance. Many of the provisions take effect in 2010 with others phased in over time as the system adjusts to changes. Beginning in 2010 young adults can stay on their parents’ private insurance until the age of 26 and private insurers can no longer drop individuals from their plans if they get sick. In addition health insurers cannot impose lifetime limits on benefits, meaning patient benefits can no longer run out due to long or expensive illnesses. Another important provision beginning in 2010 is children 18 years and younger can no longer be denied coverage because of a preexisting condition. The same provision takes effect for adults beginning in 2014. With increased access to health insurance the government hopes that patients, including those with chronic kidney disease, will receive more preventative care. By detecting symptoms earlier doctors can now deter the onset of CKD in patients, or slow the rate of progression, by identifying and treating the disease in its early stages.
While the debate over healthcare is far from over, a policy shift is taking hold. Healthcare providers large and small must adjust and comply with the changes implemented by the new bill. GAIA Healthcare Systems is committed to helping facilities adapt to the changing atmosphere. We’re focused on eliminating obstacles so caregivers can focus on what they do best, providing quality care.
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