Affordable Care Act: Title III

The third title within the Affordable Care Act – Improving the Quality and Efficiency of Health Care – focuses heavily on Medicare. This title has 7 subtitles, 6 parts, and 97 sections within 502 pages!

The title begins with explaining how payment for Medicare to hospitals and physicians will be linked to quality outcomes. The quality program is to begin October 1, 2012 with hospital reimbursement. Individual hospitals will need to identify quality measures to address:

• Acute myocardial infarction
• Heart failure
• Pneumonia
• Surgery
• Healthcare-associated infections
• Hospital Consumer Assessment of Healthcare Providers & Systems Surveys (HCAHPS)

If quality measures are met by individual hospitals, the reimbursements made according to diagnostic-related groupings (DRGs) could increase by 1% in 2013. If quality measures continue to be met over subsequent years, the reimbursement rates increase up to 2% by 2017. For each year after 2017 the reimbursement rate will be 2% annually. However, payment for hospital-acquired conditions will be reimbursed at a 99% rate or a 1% loss of income according to specific DRGs.

This part of the Act also includes special rules about reimbursement rates for:

• Community hospitals
• Cancer centers
• Long-term care and skilled nursing facilities
• Home care

Medicare payment adjustments will also occur for physicians who show meaningful use of electronic health records and the Medicare quality indicators.

Another large part of the text in Title III is focused on national strategies to improve health care quality. There are plans to create a website to post national strategies to improve health care and coordinate a working group to address progress on the national quality standards.

The national quality measures will address:

• Health outcomes and functional status of patients
• Management and coordination of health care
• Use of information for treatment options
• Use of health information technology
• Timeliness of care
• Efficiency of care
• Equity of care
• Patient satisfaction

This part of the Act focuses on Medicare Part D and the Medicare Advantage program. The amount of money for each subscriber in a Medicare Part D prescription drug program will increase $500 per year. And payments to plans who offer Medicare Advantage programs can see bonus payments for increasing enrollments and meeting the identified quality performance indicators.

The cost to participate in Medicare may increase for high-income recipients. These payments can increase up to 25.5%. However this part of the Act ended with the sentence, “No cuts in guaranteed benefits will occur through Medicare Advantage programs.”

Other information within Title III of the Act included:

• Establishing community health teams to provide care to patients at home with chronic illnesses
• Creating medication management services for the treatment of chronic diseases
• Designing and implementing regionalized systems for emergency care
• Providing grants to health care related schools to integrate quality improvement and patient safety training into clinical education of health care professionals

Next week I’ll provide a review on Title IV of the Act or Prevention of Chronic Disease and Improving Public Health. See you then!