ACP updates health reform guide for PCPs, internists

The American College of Physicians (ACP) has come forward with a revised edition of An Internist's Practical Guide to Understanding Health System Reform, complete with the most recent timeline regarding how the Affordable Care Act is expected to unravel during the upcoming years.

"We've published this since 2010, and the guide reallyhelps define the provisions of the law being implemented," said David L. Bronson, MD, FACP, ACP's president, in a news release. "This is a great source and it is written with the internist customer in mind: How does thisaffect you?"

The ACP listed the latest revisions as follows:

  • Medicaid expansion. The original law relied on a federally funded expansion of Medicaid in 2014 to extend health coverage tomillions of Americans, with the threatened loss of existing Medicare funding if states refused to expand the program. "The Supreme Court's ruling gave states the option to not expand without the threat of losing Medicaid funding," Bronson said. "That was a significant shift and change, and the guide was updated to reflect that decision. States across the country are in the process of deciding whether they will expand their Medicaid programs, and we are keeping a close eye on that."
  • Health insurance exchanges. The law also requires states to set up health insurance exchanges by 2014, which would serve as open marketplaces for individuals and groups looking for health coverage. If a state balks at setting up its own exchange, the federal government will step in and set up one on the state's behalf. "In December, states were required to declare whether their exchanges would be state or federally operated," Dr. Bronson said. Of all states and the District of Columbia, 24 have refused to set up an exchange and will have theirs implemented by the federal government, 19 have elected to run their own exchanges and six will partner with the federal government. Two states remain undecided.
  • Cost of implementation. The Supreme Court decision to make the Medicaid expansion optional has reduced the cost of implementing the Affordable Care Act, and that reduced cost is included in the report. According to the Congressional Budget Office, the expansion of coverage as a result of the health law is estimated to cost roughly $1.2 trillion over the next decade, down $84 billion from the CBO's last estimate in March 2012.
  • Value-based payment modifier. The guide gives an updated description of the Centers for Medicare and Medicaid Services value-based payment modifier, which provides the opportunity for financial incentives for physicians in practices of 100 or more eligible professionals who participate in the Physician Quality Reporting System. "Practices that participate in PQRS, when they meet certain criteria, will have the opportunity to receive a positive (or negative) adjustment in their Medicare payments," Bronson said. "It's telling folks that if you participate and you do well, you're going to get a bump up in your payments."

The guide remains organized chronologically by the year in which a legislation of interest was passed and includes “frequently-asked-questions” within each policy tab.

Bronson noted that physicians who consult the guide could have a more extensive understanding of how ACA will affect their given practice, pushing them out ahead of the provider pack and leaving few surprises further down the path.

"We wanted to give physicians one place to look for information so they can be ahead of the game," he remarked.

Find the revised report in its entirety here.