Top Banner
1 11 Health Reform: Key Issues for Safety Net Health Systems Claudine Swartz National Association of Public Hospitals & Health Systems Assistant Vice President for Policy July 2010
24
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: NAPH presentation chicago

1111111

Health Reform: Key Issues for Safety Net Health Systems

Claudine SwartzNational Association of Public Hospitals &

Health Systems Assistant Vice President for Policy

July 2010

Page 2: NAPH presentation chicago

22

Overview:

� A little politics

� A little detail

� A lot of discussion

2

Page 3: NAPH presentation chicago

33

Who is the National Association of Public Hospitals and Health Systems (NAPH)?

� For 27 years has advocated for safety net hospitals and

health systems

� NAPH…..

� Represents 140 hospitals with shared mission – access to all

� Effectively advocates at the federal level on issues of concern to

safety net hospital systems

� Helps members effectively advocate

� Conducts research and shares innovations on health system

change at member hospitals

� Communicates value of safety net hospital systems to

policymakers and the public

2

Page 4: NAPH presentation chicago

443

Care for the Uninsured

Source: NAPH Hospital Characteristics Survey, FY 2007

NAPH hospitals represent only 2 percent of the acute care hospitals in the nation, but provide 20% of the uncompensated hospital care.

33

Page 5: NAPH presentation chicago

55Source: NAPH Hospital Characteristics Survey, 2008

Gross Revenues by Payer:

NAPH Members

* Uninsured Revenues are attributed to patients that are considered Self Pay, Charity Care, or covered by a State or Local Indigent Care Program.

Page 6: NAPH presentation chicago

66

The Politics of Health Reform

Page 7: NAPH presentation chicago

77

Landmark Statute

� Two different bills combine to form new health reform law:� Patient Protection and Affordable Care Act, H.R. 3590. Enacted March

23

� Health Care and Education Act, H.R. 4872. Enacted March 30

� Total cost: $930 billion

� Reduces the federal deficit by $143 billion

� Provides coverage to 94% of legal US residents – about 32 million individuals

� Referred to as “health insurance reform” but 7 out of 10titles focus on delivery system changes

Page 8: NAPH presentation chicago

87

Now the Work Begins....Implementation

� “The Secretary Shall”....over 1,000 times

� Health & Human Services and IRS must implement

� Implementation cost estimate: $10-20 billion

� 40 significant regulations....many others likely. Additionally:� Guidance

� Request for proposals

� Creation of commissions, panels, boards

� And, that’s just the feds...don’t forget about:� States

� Healthcare providers

Page 9: NAPH presentation chicago

98

Coverage Expansion

Immediate changes:

� Creates temporary national high-risk pool for those with pre-existing conditions: the Pre-existing Condition Health Plan

� Immediately offers states the Medicaid option to cover childless adults up to 133% FPL (at current FMAP)

� Insurance reforms

� Dependents 26 & under may stay on parent’s plan

� No lifetime limits on coverage

� No pre-existing condition exclusions for children

� Reinsurance fund for 55-64 year old retiree health benefits

� No rescissions except in case of fraud

� Rate review where necessary

EARLY WINS =

POINTS for ADMINISTRATION & DEMOCRATIC CONGRESS

Page 10: NAPH presentation chicago

108

Coverage Expansion

Beyond 2010:

� Guarantee issue (2014)

� Medicaid expansion to non-elderly population with incomes at or below 133% FPL with enhanced FMAP (2014)

✦ 10 million in 2014; 16 million by 2019

✦ Helps states pay for new Medicaid costs. Increases FMAP for newly-eligible Medicaid patients.

� Premium credits and cost sharing subsides for those between 133-400% FPL (2014)

� All legal residents must have coverage or face penalty (2014)

� Undocumented immigrants not covered

■ Basic health plan option for states: create a standard plan in lieu of premium and cost sharing subsidies for those 133-200% FPL

■ Reauthorizes CHIP until 2015

Page 11: NAPH presentation chicago

10

Exchanges■ Requires state-based, or regional, exchanges

■ Each state required to have an American Health Benefit Exchange and SHOP Exchange (can be operated as one)

Initially for individuals and small employers (under 100)

In 2017, open to other businesses

■ Exchanges must offer:

Private “qualified health plans”: federal criteria, state certified

Co-op plans

At least 2 multi-state plans negotiated by the federal gov’t; one must be non-profit.

■ Plans must:

Contract with “essential community providers”

Provide an essential benefit package (defined by feds)

Of the defined benefit categories (bronze, silver, gold, platinum), must offer silver & gold in individual & small group mkts and exchanges.

Page 12: NAPH presentation chicago

Coverage Expansion

Key Questions to Consider for Safety Net Health Systems:

�How much will Medicaid expand? 797,000 estimated statewide

�Will Illinois expand Medicaid early? Unlikely? Connecticut only at this point

�How many patients will gain coverage via Exchange?

1 million Illinois residents will receive premium assistance

�What does the $196 million in state high risk pool funding mean for Illinois?

�How will the safety net facilitate enrollment?

�Increase or decrease in patients? MA safety net patients increased

Page 13: NAPH presentation chicago

1310

Provider payment changes� Reduces Medicaid and Medicare DSH payments by $14 billion and $22

billion, respectively (2014-2019); allows targeted payments

� Reduces the annual market basket increase for Medicare inpatient and outpatient hospital services beginning in 2014

■ Establishes the Independent Payment Advisory Board (IPAB) to reduce Medicare cost growth, improve care. Institute of Medicine study on geographic variation.

� Increases Medicaid payments for primary care physicians to Medicare levels (2013 and 2014).

� Increase Medicare payments to physicians and other providers for primary care and general surgery services (10% 2011-2015).

� Quality + Cost Containment = Value

� Implements budget neutral value-based purchasing program

� Reduces hospital payments to account for preventable readmissions for certain conditions

� Adjusts hospital payments for certain hospital-acquired conditions

� No major Medicaid Reform. Stay tuned with “MACPAC.”

Page 14: NAPH presentation chicago

Provider payment changes

Key Questions to Consider for Safety Net Health Systems:

�Financing implications:

Uninsured reduction

Medicaid expansion

Exchange enrollees

Medicaid payments

Gradual reduction in DSH

Lingering uninsured and/or undocumented patients?

�How will Medicaid and Medicare DSH be reduced?

Are funds well targeted in your state?

What is the likely redistribution of need and dollars going to be?

�Physicians eligible for primary care increases?

�Value based rewards or penalties?

�GME implications?

Page 15: NAPH presentation chicago

Innovation & Funding Opportunities� Well over 20 titles establish demonstrations and/or pilots

� Funding is wildcard -- $105 billion worth of programs require Congressional appropriations

Key opportunities include (but not limited to):

� Community-Based Collaborative Care Networks

� CMS Center for Medicare & Medicaid Innovation

� Medicaid Global Payment System demonstration

� Demonstration to enhance uninsured access

� Medicare & Medicaid payment bundling

� Grants to states for community health teams

� Medicare & Medicaid Pediatric ACOs

� New Medicaid state plan option to designate health homes for Medicaid patients with chronic conditions

� Funding for primary care residency programs

� Trauma funding

Page 16: NAPH presentation chicago

Innovation & Funding Opportunities

Key Questions to Consider for Safety Net Health Systems: Which delivery system reforms and/or funding opps make the

most sense in your community?

First, reflect internally on strengths and weaknesses

Which opportunities complement one another and/or fit into overall community strategy?

Are the opportunities funded?

What is the opportunity cost -- staffing, resources?

Collaboration with the state

“Bridge to coverage” initiatives?

Page 17: NAPH presentation chicago

Administration Activity� Staffing up, Staffing Changes

� Most implementation requires HHS guidance

� Driven by timeline

� Routinely check: www.healthcare.gov

Page 18: NAPH presentation chicago

Department of Health & Human Services Organization

� Established Office of Consumer Information & Insurance Oversight

� Jay Angoff, Director

� Includes:�Office of Oversight

�Office of Insurance Programs

�Office of Consumer Support

�Office of Health Insurance Exchanges

Page 19: NAPH presentation chicago

CMS Reorganization

Center for Medicare and Medicaid Services

Principal Deputy Administrator

Marilyn Tavenner

Center for Medicare

Jonathan Blum

Center for Program Integrity

Peter Budetti

Center for Medicaid, CHIP, and Survey &

Certification

Cynthia Mann

Center for Strategic Planning

(Innovation Center)

Anthony Rodgers

“…in order for CMS to most effectively meet today’s requirements

and strategically position itself for the

future…”

Donald Berwick, MDRecess Appointment

Page 20: NAPH presentation chicago

20

� The sheer magnitude of the task: Commissions, regulations,

state collaboration, payment changes, innovations, etc!

� November elections

� Ongoing Congressional appropriations

� Lawsuits

� Competing Priorities

� Public Understanding

� Unresolved Issues:

FMAP, Doc Fix, 340B

17

Administration: Implementation Challenges

Page 21: NAPH presentation chicago

2119

� Additional insured patients� Innovation and funding opportunities

� MACPAC – longer term opportunity to address Medicaid underpayments

� Community health center funding

� Leveraging:� integrated delivery systems

� safety net health plans (if available)

� community clinics, FQHCs, and community based care

� ability to provide specialized care to unique populations

Safety Net Health Systems: Implementation opportunities

Page 22: NAPH presentation chicago

2218

Safety Net Health Systems: Implementation challenges � Medicaid rates

� FMAP ($750 million immediately at risk in IL)

� Long-term rates

� Unknown Exchange Plan rates

� Will safety net providers be ready for 16 million new Medicaid patients?� Capacity

� Ongoing Medicaid underpayments

� Reduced DSH payments

� Impact of state budgets

� Caring for 23 million remaining uninsured including undocumented immigrants

� Staying ahead of delivery system reforms when Medicare, not Medicaid, is focus

Page 23: NAPH presentation chicago

232017

Safety Net Health Systems: Preparing for Reform

�Customer service & patient satisfaction

�Continue to engage in quality improvement activities

�Partnerships: Develop coordinated and integrated multi-provider networks

�Continue to develop and emphasize chronic disease management programs, “wrap-around” services, cultural competency

�Focus on coordinated care in order to prepare for new payment models based on medical home, bundling, and ACOs

17

Page 24: NAPH presentation chicago

Resources

� NAPH Weekly Podcast:

“This Week in Health Reform”

� www.naph.org: Health Reform Implementation Section

The latest Administration activity

Summary of Key Issues

Implementation Timeline

Funding Opportunity Chart

� NAPH’s Newsline – weekly e-newsletter

� ALL NAPH staff, including:

Claudine Swartz: [email protected] & 202-585-0103