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Updated: April 29, 2011

For work around state health reform, click here

 

Member Reform Documents

June 8, 2010 | Federal Reform SWOT Analysis, pdf

 

   Implementation Timeline

Resources from the American Hospital Association 

  • “A Guide to Financing Strategies for Hospitals: With Special Consideration of Smaller Hospitals”
    Reform and market changes are accelerating hospitals’ need for capital to fund physician employment and integration, information technology, facility modernization and expansion, and other initiatives. Successful health care organizations will need to make substantial capital investments in each of these areas. Scale and market essentiality will be factors critical to success. This guide offers seven strategies that can help hospitals achieve the best possible capital access. Key “take aways,” recommended action items and implications for smaller organizations are highlighted. 
  • AHA Urges CMS To Be Flexible When Implementing ACOs
    In its letter to the Centers for Medicare & Medicaid Services, the American Hospital Association offered 15 suggestions for implementing accountable care organizations. AHA agreed with CMS Administrator Don Berwick that with ACOs “no one size will fit all.” AHA urges CMS to allow different configurations of provider organizations to enter the shared savings program to see what does or does not work well.
  • PPACA: Grant Opportunities Of Interest To Hospitals
    The document, prepared for the AHA by Hogan Lovells L.L.P., describes many of the funding opportunities that may be available to hospitals. For each available opportunity, the document includes the name of the program, a description of the program, the section of the PPACA and other statutory references, eligibility criteria, the funding source and amount, and the application process, if specified.
    Additional information on how to apply for the funds or for agency deadlines is available online.

Tax-exempt Hospital Requirements

  • Internal Revenue Service
  • Hall Render Killian Heath Lyman Law Firm 
  • Robert Wood Johnson Foundation
    This issue brief, “Hospital Community Benefits After the ACA: The Emerging Federal Framework,” is the first in a series funded by the Robert Wood Johnson Foundation that will be published throughout three years. It presents the emerging federal framework for hospital community benefits set forth by the Affordable Care Act. This brief provides historical background on federal hospital community benefit policy, outlines the new requirements described in the ACA and identifies new challenges and opportunities for state and federal decision makers as they begin to develop responses to the new federal requirements. 

 Rural Hospitals 

  • Hospitals and Health Networks
    “Health Reform In-Depth: Small and Rural Hospitals” explores the challenges and opportunities for small and rural hospitals under health care reform.
  • Health Care Reform Implementation for Rural Hospitals
    The Rural Policy Research Institute and the Robert Wood Johnson Foundation have published a document that calls attention to elements of the Affordable Care Act that are likely to affect rural health care within the next three years. The document contains a summary of each section of the ACA, along with suggested recommendations for monitoring and implementation.   
  • Quorum Health Resources
    “Federally Qualified Health Centers: Threat or Collaborative Opportunity” discusses the proliferation and rise of federally qualified health centers in the United States and the comprehensiveness of services they provide. Because of the $11 billion in new funding being made available to FQHCs through the health reform package, critical services will be made available to the nation’s poor and underserved, but this also could significantly impact the financial viability and sustainability of rural and critical access hospitals.
  • Trustee
    “Rurals at a Crossroads” discusses what rural organizations need to consider if they want to play a meaningful role in accountable care organizations. The article offers rural hospital leaders ways to assess opportunities and develop strategies that enable their hospitals to remain relevant during and following the redesign of the health care delivery system.

Care Transitions Initiatives

  • Healthcare Leader Action Guide to Reduce Avoidable Readmissions — This new resource outlines approaches to improving quality of care—such as the Care Transitions Intervention. It also addresses issues that lead to costly rehospitalizations, such as lack of appropriate follow-up care, or confusion over medications, which can lead to serious errors and harm.
  • H2H – Hospital to Home —The Hospital to Home (H2H) national quality initiative, cosponsored by the American College of Cardiology and the Institute for Healthcare Improvement, is an effort to improve the transition from inpatient to outpatient status for individuals hospitalized with cardiovascular disease.
  • Project Boost — The BOOSTing (Better Outcomes for Older adults through Safe Transitions) Care Transitions resource room provides a wealth of materials to help you optimize the discharge process at your institution. We developed this through support from the John A. Hartford Foundation.
  • The Care Transitions InterventionSM was designed in response to the need for a patient-centered, interdisciplinary intervention that addresses continuity of care across multiple settings and practitioners. The overriding goal of the intervention is to improve care transitions by providing patients with tools and support that promote knowledge and self-management of their condition as they move from hospital to home. 

Quality Improvement Initiatives
More online: www.oahhs.org/quality

  • The IHI Improvement Map™ is an online tool that distills the best knowledge available on the key process improvements that lead to exceptional patient care.

Health Information Technology and Data Support

  • Health Forum/American Hospital Association
    “Information Technology for Accountable Care Organizations”
    Recent federal legislation is encouraging the formation of accountable care organizations. To be effective, these ACOs must use sophisticated information technology, according to this article in Hospitals & Health Networks.
  • PriceWaterhouseCoopers – “Ready or Not: On the Road to the Meaningful Use of EHRs and Health IT"
    This report discusses the struggle by hospitals to qualify for payments allocated through the American Recovery and Reinvestment Act for hospitals and doctors to purchase equipment to computerize patient medical records. Eight in 10 hospital chief information officers surveyed by PricewaterhouseCoopers LLP said they are concerned or very concerned they will not be able to demonstrate "meaningful use" of EHRs within the federally established deadline of 2015.

Quality Reporting

  • Center for Medicare & Medicaid Services
    Section 3004 of the Affordable Care Act directs the secretary of U.S. Department of Health and Human Services to publish the quality measures that long-term care hospitals, inpatient rehabilitation facilities and hospice programs report to receive their full annual payment update. For fiscal year 2014 and each subsequent year, failure to submit required quality data shall result in a 2 percent reduction in the annual payment update. CMS has created a website to support the quality reporting for LTCHs, IRFs and hospice programs.

    CMS also has published the initial core set of adult health quality measures, as required by section 2701 of the Affordable Care Act, and the final fiscal year 2009 and preliminary FY 2011 disproportionate share hospital (DSH) allotments. 
  • DotMed.com — “Focus on Health Care Reform: Quality Improvement, Workforce Changes”
    This article focuses on quality improvement, but Page 2 includes information on a National Health Care Workforce Commission and special funding for primary care professional training programs.
  • “Healthcare Reform: Quality Outcomes Measurement and Reporting”
    This article in the September/October 2010 issue of American Health & Drug Benefits is based in part on a presentation given at the annual meeting of America’s Health Insurance Plans in May 2010 in Las Vegas. 

Health Disparities and Data

Coverage Provisions 

  • The Commonwealth Fund
    “Realizing Health Reform’s Potential: Young Adults and the Affordable Care Act of 2010”
    This new report estimates that 7.2 million young adults may gain Medicaid coverage, and 4.9 million may gain subsidized private coverage through the reform law's insurance exchanges. In addition, the report notes about 1 million young adults are expected to join their parents' policies beginning in 2010 under a provision allowing them to remain on their parents' insurance until age 26.
  • U.S. Department of Health and Human Services
    In early November, HHS announced that states with federally administered pre-existing condition insurance plans will offer three coverage options beginning Jan. 1. In addition to the standard plan, an extended plan and health savings account option will be available in 23 states. The program is administered through the federal Office of Personnel Management.

Health Insurance

  • Deloitte Consulting
    A white paper from Deloitte Consulting analyzes the modifications that health insurance plans have made in 2010 following the enactment of the health care reform law. The report outlines some of the challenges facing plans and issues that health plans will focus on in the coming years.
  • Health Affairs
    The November issue focuses on designing insurance to improve value in health care. You must be a subscriber to the journal to obtain copies. Print copies of the issue may be purchased online or by contacting customer service at 301/347-3900. Special discounts apply to orders of more than 11 copies. Subscriptions to Health Affairs also are available online. 
  • U.S. Department of Health and Human Services
    This week, HHS issued a proposed rule establishing a process for reviewing "unreasonable" health insurance rate increases in the individual and small group markets. The Affordable Care Act requires health insurers to justify unreasonable increases to the HHS secretary and applicable state before implementing them. According to HHS, 43 states have a rate review process in the individual or small group markets. Beginning in calendar year 2012, HHS would set annual state-specific thresholds for rate increases based on data and cost trends in that state. 

Insurance Exchanges and Enrollment 

  • Center for Studying Health System Change
    A recent study released by the Center for Studying Health System Change shows that almost one-third of uninsured people eligible to receive subsidies to buy health insurance through state-based exchanges report no recent problems with their health, access to health care or paying medical bills. About 40 percent of uninsured people eligible to receive the subsidies beginning in 2014 have chronic conditions or report their health as fair or poor, while 28 percent report good or excellent health but problems getting health care or paying medical bills.  
  • HealthCare.gov
    On July 1, the U.S. Department of Health and Human Services unveiled a new online tool to help connect consumers to new information and resources that will help them access quality, affordable health care coverage. Called for by the Affordable Care Act, the Web site seeks to provide consumers with both public and private health coverage options tailored specifically for their needs.
  • HealthReform.gov — A service of the U.S. Department of Health and Human Services, this site contains good information on the impact of reform in Oregon.
  • Kaiser Family Foundation
    • Medicaid and Children’s Health Insurance Program Provisions in the New Health Reform Law
    • Questions About Health Insurance Exchanges
    • Medicaid Primer
      This primer provides an overview of the basic components of Medicaid. The primer examines how the program is structured, who it covers, what services it provides and how much it costs. It also provides an overview of how Medicaid will change and significantly expand as it plays a key role in the new health reform law, serving as the mechanism to provide coverage to millions of previously uninsured low-income adults and children. Also available is an updated two-page fact sheet about the Medicaid program.
    • Kaiser Health News — The new regulations on which insurance plans would be considered “grandfathered” under the new health law has prompted diverse responses from bloggers.
  • Milliman Inc. 
    • “What Kind of Risk Adjustment Systems are Necessary for Health Insurance Exchanges?”
      This article examines the adequacy of current risk adjustment systems when applied to a wholly new type of enrollment — the “all-population risk pool” — and offers considerations and options for exchange designers. 
    • “Operation of a Health Exchange Within the PPACA”
      The Patient Protection and Affordable Care Act mandates that each state has a health exchange in place by Jan. 1, 2014. These exchanges will be either of the state's invention or under the aegis of the U.S. Department of Health and Human Services. This paper, the latest in a series of papers on exchanges, addresses the functions of an exchange and examines various operational considerations.
    • “Should Your State Establish a Health Insurance Exchange?”
      The state healthcare exchanges that will be created as part of the Patient Protection and Affordable Care Act are intended to bring buyers and sellers together in a single marketplace for qualified healthcare insurance. Although the idea of a single marketplace is relatively straightforward, there are numerous underlying complexities, including plan cost, affordability, access, group size, participant age, marketing, education, eligibility, plan qualification and risk adjustment. States that plan to establish exchanges should be aware of these issues and should determine the best course of action depending on their specific circumstances.
  • National Association of Insurance Commissioners
    A Health Insurance Exchanges webinar is now available on demand to the public through the National Association of Insurance Commissioners. The webinar will introduce the exchanges, their requirements, how they are intended to work and how the NAIC will support them.
     
  • Robert Wood Johnson State Coverage Initiatives
    “Health Insurance Exchanges: Key Issues for State Implementation”
    This issue brief delves into some of the details of the health insurance Exchange, as defined by the Patient Protection and Affordable Care Act, and highlights a number of key issues for states to consider.
  • The Commonwealth Fund
    • “Health Insurance Exchanges and the Affordable Care Act: Eight Difficult Issues”
      This report focuses on eight of the most difficult issues that the states and the federal government face in implementing the exchanges.
      • governance
      • avoidance of adverse selection
      • making self-funded plans compatible
      • making exchanges attractive to employers
      • exchanges' use of their regulatory authority
      • information that exchanges must make available to consumers and employers
      • exchanges' role in making eligibility determinations for premium tax credits and cost-sharing reduction payments and their relationship with public insurance programs
      • reducing administrative costs
    • “Health Insurance Exchanges: Overcoming Implementation Barriers”
      To ensure that the exchanges work as intended, federal and state governments will have to tackle a number of thorny issues throughout the implementation process. This blog explores the issues and offers recommendations for addressing them.
  • U.S. Department of Health and Human Services
    The U.S. Department of Health and Human Services will issue regulations governing health insurance exchanges but has already provided some guidance to assist states with overall planning, including legislative plans for 2011. This guidance focuses on four main categories.
    • principles and priorities
    • outline of statutory requirements
    • clarifications and policy guidance
    • federal support for the establishment of state-based exchanges 

Effects on Medicare and Medicaid 

  • Centers for Medicare & Medicaid Services
    • Claims from rural health clinics and federally qualified health centers, and  home health agencies with dates of service on or after Jan.1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare, as a result of the Affordable Care Act.
    • CMS launched its Center for Medicare and Medicaid Innovation, created by the Patient Protection and Affordable Care Act, to study better ways of delivering health care and paying providers. As part of the launch, the center announced two new projects to test the effectiveness of primary care medical homes. The Medicaid Health Home State Plan Option, authorized by the ACA, will allow Medicaid patients with at least two chronic conditions to designate a "health home" provider to coordinate treatments. The Federally Qualified Health Center Advanced Primary Care Practice Demonstration, requested by the president last December, will test the medical home model at up to 500 community health centers serving low-income Medicare patients.

New Care Delivery Models

  • New (added 2/23)
    • American Enterprise Institute for Public Policy Research
      This report, “ACOs Will Stifle Medical Innovations,” contends that plans to encourage the development of accountable care organizations under the federal health reform law will discourage medical innovation by pushing for-profit businesses out of the market.
  • American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and American Osteopathic Association
    Beginning in January 2012, the Patient Protection and Affordable Care Act will allow qualifying health care provider groups, including hospitals and physicians, to form accountable care organizations to improve care coordination and quality for patients while sharing in cost savings they achieve for the Medicare program. On Nov. 26, several physician groups recommended 21 principles for structuring ACOs and their payment. 
  • American Hospital Association
    • AHA Urges CMS To Be Flexible When Implementing ACOs
      In its letter to the Centers for Medicare & Medicaid Services, the American Hospital Association offered 15 suggestions for implementing accountable care organizations. AHA agreed with CMS Administrator Don Berwick that with ACOs “no one size will fit all.” AHA urges CMS to allow different configurations of provider organizations to enter the shared savings program to see what does or does not work well.
       
    • In its report, AHA synthesizes the research literature on ACOs, including their potential impact, required organizational competencies and key questions to consider as the federal and private sectors prepare for widespread implementation of the model.
  • American Medical Association  
    • AMA had released 13 guiding principles for the development and operation of accountable care organizations. These principles call for ACOs to place patients' interests first, ensure voluntary physician and patient participation and enable independent physicians to participate, among other provisions.
  • Center for the Health Professions
    “ACOs: The Clinical and Business Case to Peel Back Disparities” — This guest blog on Advancing Health Equity is by Wells Shoemaker, M.D., medical director for the California Association of Physician Groups. shares his perspective on the ACO concept and this model's potential to create the clinical imperative and an aligned business case to confront health disparities.
  • Center for Healthcare Quality and Payment Reform — “How to Create Accountable Care Organizations”
  • Centers for Medicare & Medicaid Services
  • Health Affairs/Robert Wood Johnson Foundation Health Policy Brief Series
    • Accountable Care Organizations
      Under the health reform law, Medicare will be able to contract with ACOs to provide care to enrollees. What are ACOs and how will they work?
  • Health Forum/American Hospital Association
    “Information Technology for Accountable Care Organizations”
    Recent federal legislation is encouraging the formation of accountable care organizations. To be effective, these ACOs must use sophisticated information technology, according to this article in Hospitals & Health Networks. 
  • Hospitals and Health Networks
    • “ACOs and Health Information Exchange” discusses the need for accountable care organizations to have well-integrated networks for exchanging patient data and performance metrics.
    • The article titled “ACOs and Integrative Health Care” discusses the need for providers to invest in care that improves healing, promotes self-care and ultimately prevents admissions under accountable care organizations.
    • “ACOs Forging the Links” discusses the importance of building strong relationships with physicians and better managing patient care as hospital executives look to develop accountable care organizations.
    • “Chasing Unicorns: The Future of ACOs” — This article by Ian Morrison discusses how ACOs hold tremendous promise as a driver of health care delivery transformation but also pose major risks to participating providers. By following the 10 laws of accountable care, would-be ACOs can reap the benefits of clinical integration while avoiding the pitfalls.
  • Federation of American Hospitals
    In response to draft qualifying and monitoring standards developed by the National Committee for Quality Assurance for accountable care organizations, FAH responded saying there is no need to have an additional, very expansive layer of accreditation-type processes and scoring mechanisms for licensed and certified health care providers seeking to operate in an ACO shared savings program.
     
  • Integrated Healthcare Association
    A report prepared by Integrated Healthcare Association summarizes the accountable care organization experience in California and its implications for the national debate over how to encourage organizational structures and payment methods that promote quality and efficiency in health care.
     
  • Integrated Healthcare Strategies
    • “Accountable Care Organizations and Their Impact on Physician Affiliation and Reimbursement”
    • "Accountable Care Organizations vs. Health Maintenance Organizations"
      New health care legislation includes provisions that will provide incentives to accountable care organizations for reducing costs of treating Medicare patients. These ACOs are very similar to the health maintenance organizations that resulted from legislation passed in the late 1960s. This article explores how ACOs differ and what we can learn from the early years of the HMOs to serve patients better now.
    • “Motivating Employees Under an ACO”
      Both the legislation and subsequent commentary mention how accountable care organizations will affect relationships between physicians and hospitals, but there is no mention of the fundamental impact between the hospital and its employees. In an industry already riddled with high levels of job insecurity and wage issues, further strain on hospital and employee relations is a cause for great concern. To call for even higher accountabilities for quality and customer service, hospital leaders will need to take employee motivation to the next level.
    • “Physician Alignment and Leadership Academies: Essential for ACO Success”
      As hospital boards and CEOs navigate the uncharted waters of accountable care organizations, their initiatives will fall flat unless they have secured a new generation of competent and successful physician leaders. Hospital organizations will need to accelerate and enhance their development of "physician leadership academies" that will produce physician leaders that can engage in ACO strategic planning, budgeting and operational process improvements during the next three to five years.
  • Kaiser Family Foundation
    A new report from the Center for American Progress surveys the development of accountable care organizations, and whether this type of care model will serve the goals intended by policymakers – improving and coordinating care and saving money. The report argues that "the accountable care organization regulation, alongside related efforts in the Center for Medicare and Medicaid Innovation, is key to making Medicare the engine for system-wide reform.”     

Implications for Safety-Net Providers

  • National Health Policy Forum
    A new background paper examines the roles that safety-net providers play in serving the low-income and the uninsured and how those roles may change as a result of health care reform.

Long-Term Care Implications

  • “Perspectives on the Community Living Assistance Services and Support Act”
    The Community Living Assistance Services and Support Act, which is included in Title VIII of the Patient Protection and Affordable Care Act, has key implications for the future of long-term care in the United States. This series of four articles provides an overview of the CLASS Act and details various implications for individuals, the federal government, employers, insurers and agents, and healthcare providers.

Physician Implications

  • Becker’s Hospital Review
    “Hospital Strategies and Transactions: Healthcare Reform and Market Evolution” 
    The advent of major health care reform in the context of the recently passed Patient Protection and Affordable Care Act will continue to drive dramatic change in health care over the next two decades. Notwithstanding the impact to consumers, the effect of reform will drive strategy and transactions that impact hospital structures, physician practices, ancillary services and the relationships between physicians and hospitals.
  • Guidance Outlines Incentive Program For Surgeons In Health Shortage Areas
    A provision in the Affordable Care Act authorizes an incentive payment program for major surgical services furnished by general surgeons in health professional shortage areas. The section indicates that there also shall be paid (on a monthly or quarterly basis) an amount equal to 10 percent of the payment for physicians’ professional services under Part B. These changes will be implemented during two releases. The Jan. 3 release will implement the claim identification of the incentive and the April 4 release will provide full implementation of the instructions.
  • Robert Wood Johnson Foundation — “How Will Physicians Be Affected by Health Care Reform?”
    This brief report explores the effects that health reform will have on physicians. The authors conclude that under reform, physicians will likely benefit financially as coverage expands. At worst, they will be unaffected financially. 

Regulatory Changes

  • “Coming to Grips with Reform and Its Impact on Prescription Drug Coverage”
    Health care reform legislation will have a significant impact on prescription drug coverage. The new regulations, to be phased in between now and 2020, will affect insurers, physicians, patients and plan sponsors alike. This article provides an overview of both near-term and long-term health care reform developments as they apply to pharmacy benefits.
  • Congressional Research Services
    The report, "Initial Final Rules Implementing the Patient Protection and Affordable Care Act," describes the final rules implementing the ACA that had been published in the Federal Register during the first eight-and-a-half months of implementation. More than 40 provisions in the act specifically require or permit federal agencies to issue regulations to implement the act’s requirements.

Access Issues 

  • Health Forum/American Hospital Association
    “Access”
    An additional 30 million insured Americans during the next decade and expanded federal support for Medicaid could lead to a sharp reduction in uncompensated care and bring billions more dollars through the door. This article in Hospitals & Health Networks looks at a landscape that is dramatically more complicated. 

Behavioral Health Resources

Evidence-based Medicine

  • Health Affairs
    The October issue of Health Affairs looks at comparative effectiveness research in the era of health care reform. The journal, along with the Robert Wood Johnson Foundation, also published a policy brief on comparative effectiveness research.

Health Services Research

Medical Homes 

Prevention and Wellness

Readmissions Reduction and Care Transitions

  • Health Dimensions Group — “The Impact of Health Reform on the High-Risk Geriatric Population”
    The Patient Protection and Affordable Care Act will require healthcare providers to seriously change their thinking. One of the biggest thought changes will involve the use of nonskilled services. In fact, nonskilled services, which are currently underused, will play a central role under health reform. Regardless of whether your organization is a large hospital system, physician practice group or small independent provider, you need to understand how comprehensive nonskilled services will become a vital part of your continuum.

Bundled Payments 

  • Health Research and Educational Trust
    This AHA Research Synthesis Report presents an overview of bundled payment, including evidence of its effects in the public and private sector, as well as questions that must be considered as the concept is carried forward by both policymakers and delivery organizations.
  • Marketbasket Adjustment Graph

Effects on Medicare and Medicaid 

  • Centers for Medicare & Medicaid Services
    • Claims from rural health clinics and federally qualified health centers, and  home health agencies with dates of service on or after Jan.1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare, as a result of the Affordable Care Act.
    • CMS launched its Center for Medicare and Medicaid Innovation, created by the Patient Protection and Affordable Care Act, to study better ways of delivering health care and paying providers. As part of the launch, the center announced two new projects to test the effectiveness of primary care medical homes. The Medicaid Health Home State Plan Option, authorized by the ACA, will allow Medicaid patients with at least two chronic conditions to designate a "health home" provider to coordinate treatments. The Federally Qualified Health Center Advanced Primary Care Practice Demonstration, requested by the president last December, will test the medical home model at up to 500 community health centers serving low-income Medicare patients.

Financial Implications

  • HHS Issues New Medical Loss Ratio Regulations
    New medical loss ratio regulations require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality, beginning in 2011. Under the rules from the U.S. Department of Health and Human Services, any insurer spending less than these percentages must provide a rebate to their customers, starting in 2012.
  • Milliman
    “Health Insurers Need to Quickly Assess Operational Costs for Medical Services Under Health Care Reform”
    The Patient Protection and Affordable Care Act requires health insurance carriers to meet medical loss ratio requirements on a state-by-state basis starting in 2011. This leaves insurers with a fairly short time frame in which to learn the intricacies of MLR calculations. Because specifications and interpretations also are likely to evolve over time, health plans will need to keep abreast of any regulatory changes and should consider performing annual operational audits that document their compliance efforts.
  • A report published in the October issue of Health Affairs presents updated national health spending projections for 2009–2019 that take into account recent comprehensive health reform legislation and other relevant changes in law and regulations. The Centers for Medicare & Medicaid Services said health spending will climb to $4.6 trillion by 2019 and account for 19.6 percent of the nation’s economy. This is an increase from a February pre-reform prediction of $4.3 trillion - 19.3 percent of the economy. 
  • Center for Health Care Strategies and AcademyHealth
    The role of the charity care programs likely will shift and new financial challenges will exist, according to a new report by the Center for Health Care Strategies and AcademyHealth. The study, funded by the Kaiser Permanente Institute for Health Policy, suggests charity care programs will remain an essential part of the health care system, even as millions gain coverage under the health reform law. However, the programs will likely have to adapt to new patient populations and financial difficulties. A corresponding report provides in-depth analysis of study findings, the Affordable Care Act’s potential impact on charity care programs and the uninsured population, and case studies of charity care programs included in the study.

Fraud Prevention 

  • Centers for Medicare & Medicaid Services
    One of the goals of the health reform law is to improve and expand consumer protections, and to strengthen and reduce health care costs. One important way it achieves these goals is by improving government-wide efforts to fight fraud and waste. The new law contains some critical new tools to improve and enhance efforts to prevent, detect and take strong enforcement action against fraud in Medicare, Medicaid and the Children’s Health Insurance Program, as well as private insurance.

Value-based Purchasing 

  • Centers for Medicare & Medicaid Services
    A proposed rule to implement the value-based purchasing program as required by the Affordable Care Act is being prepared by CMS. A comment letter from the American Hospital Association, the Association of Medical Colleges, the Catholic Health Association, the Federation of American Hospitals, the National Association of Public Hospitals and Health Systems, and the Premier health care alliance offered suggestions in several areas.   
  • Kaiser Family Foundation
  • Lewin Group Health Benefits Simulation Model HBSM — A micro-simulation model of the U.S. health care system designed to model the effect of policies designed to increase public and private health insurance coverage. It should be thought of as a platform for analyzing the impact of health reform proposals.
  • Market Basket Adjusment Chart
  • Medicare Payment Reductions
  • Milliman Inc.
    • "Risk Adjustment: Health Calculus for the Reform Environment"
      Risk adjustment, a method for adjusting healthcare costs to reflect the health status of a given population, will take on new significance under healthcare reform. To harness the true potential of such a powerful tool, critical stakeholders like government agencies, health plans, provider organizations and employer groups must understand how to properly select, implement and evaluate risk-adjustment models. Using the appropriate risk-adjustment methodologies in the correct context will contribute to more accurate healthcare pricing, more efficient utilization and improved quality of care.

Risk Sharing 

  • Milliman Inc. — “Controlling Costs the Old New Way” 
    Has the time finally come for provider risk sharing? In the past, the concept has attracted substantial attention as a means of controlling healthcare costs. But, efforts to implement provider risk-sharing strategies have often not lived up to their promise.  

Health Care Costs

  • Brookings Institution
    In a report, “Bending The Curve Through Health Reform Implementation,” a panel of 12 health care experts at the Brookings Institution’s Engelberg Center for Health Care Reform recommends three goals that can be accomplished within the next five years to lower health care costs and improve quality.

Grant Opportunities

  • A report prepared by Congressional Research Services summarizes all the discretionary provisions grant programs and activities for which appropriations are authorized. Funding for all of these programs and activities is subject to action by congressional appropriators. A companion report summarizes all the mandated appropriations and Medicare trust fund transfers in the new law.
  • U.S. Department of Health and Human Services
    HHS Secretary Kathleen Sebelius has announced grant awards of $46 million to 45 States and the District of Columbia. These Affordable Care Act grants will be used to help improve the oversight of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes and ensure consumers receive value for their premium dollars. A chart summarizing how each State will use the new resources can be found online.

Impact On Employers

  • The Commonwealth Fund
    “Realizing Health Reform's Potential: Small Businesses and the Affordable Care Act of 2010”
    This report outlines several short- and long-term provisions included in the Affordable Care Act that are designed to help small businesses pay for and maintain health insurance for their workers and to allow workers without employer coverage to gain access to affordable, comprehensive health insurance. Provisions include a small business tax credit to offset premium costs for firms that offer coverage starting this taxable year, establishment of state-based insurance exchanges that promise to lower administrative costs and pool risk more broadly, and creation of new market rules and an essential benefit standard to protect small firms and their workers.
     
  • “Employer's Guide to Healthcare Reform Law”
    There is a confusing array of information about the health care reform law. Employers are having difficulty finding good information about how to prepare and answer their employees’ questions. This article provides practical information about what employers should already be doing and how to prepare for future requirements.
  • Internal Revenue Service
    “Employer-Provided Health Coverage — Not Taxable”
    Starting in tax year 2011, the Affordable Care Act requires employers to report the value of the health insurance coverage they provide employees on each employee's annual Form W-2. This reporting is for informational purposes only, to show employees the value of their health care benefits so they can be more informed consumers. The amount reported does not affect tax liability, as the value of the employer contribution to health coverage continues to be excludible from an employee's income and it is not taxable.

Resources include a health care reform resource page, Webcasts, articles and the latest news. The site contains both “free” and “members only” information. Basic news and articles are occasionally free but most likely are password-protected. In many MHA-member facilities, one or more human resource staff members are SHRM members and, as such, would be able to access all the information. Some SHRM Webcasts are free to members. Others do have associated costs but are available to both SHRM members and nonmembers, with the price being higher for non-members.

Resources include Webinars, publications and downloads. Some articles are available to the public, while many articles, downloads and other information require an account to be established and are password-protected. Typically, downloads and Webinars have associated costs.

Available resources include Webcasts and publications. Articles and downloads are free and open to the public.

This site Includes a health care reform page. All information and links are open to the public.

Available resources include videos, Webcasts, links, news, Q&A’s and a blog. General information and links are open to the public. An e-mail address must be submitted to automatically receive health reform updates from the U.S. Department of Health and Human Services.

Available resources include a special section devoted to the PPACA, general resources, links and Q&A’s. General information in the "Special Section: Health Care Reform" is open to the public.

Resources include a health reform toolkit, Webinars and links. The toolkit is available to ASHHRA members only. As is the case with SHRM, one or more human resource staff members possibly belong to ASHHRA and, as such, would be able to access the information. However, ASHHRA membership is not as prevalent as SHRM membership within the HR community. Webinars are open only to ASHHRA members.

Workforce Implications

  • Center for the Health Professions at the University of California San Francisco
  • DotMed.com — “Focus on Health Care Reform: Quality Improvement, Workforce Changes” This article focuses on quality improvement, but Page 2 includes information on a National Health Care Workforce Commission and special funding for primary care professional training programs.
  • The Emerging Nurse Leaders Train-the-Trainer program is a train-the-trainer approach to nursing leadership development. It is designed to equip nursing schools, hospitals and public health agencies with the tools to provide leadership development opportunities for emerging nurse leaders in a cost-effective and flexible manner. The goal of the program is to assist nurse leaders in developing the leadership skills needed to successfully bring change to their organizations to make them more responsive to the demands and opportunities of the emerging health care system. The first session is being held this fall.  
  • Internal Revenue Service
    Under the Patient Protection and Affordable Care Act, health care professionals may qualify for a 2009 federal income tax refund and annual tax cut going forward if they receive student loan relief from their state for working in underserved communities. The PPACA expanded eligibility for the federal tax exclusion to health professionals in any state program that repays or forgives loans to increase health care services in underserved areas.
  • National Health Services Corps
    As a part of health care reform, the NHSC is expanding and reaching out to better serve communities in need around the country. The NHSC supports primary care professionals by offering loan repayment awards in return for service in an underserved community. They are currently recruiting 4,000 new Corps members to receive loan repayment awards. Primary care professionals who have completed their training are eligible to receive up to $145,000 in loan repayment for completing a five-year service commitment, with an initial award of $50,000 for two years of service.
  • PricewaterhouseCoopers’ Health Research Institute — “Health Reform: Prospering in a Post-reform World” This comprehensive report discusses how providers will need to reassess their current strategies and develop ways to work together. Pages 38 and 39 offer a time line graph detailing the legislation’s effective dates for payers, providers, employers and pharmaceuticals.

Consumer Resources

  • Centers for Medicare & Medicaid Services
    As required by the Affordable Care Act, CMS has enhanced the Physician Directory tool at www.medicare.gov with a new feature. Physician Compare expands and updates CMS’ health care provider directory and the suite of informational tools for Medicare beneficiaries and other consumers with additional doctor-specific information.
  • Kaiser Health News
    “A Consumer's Guide To The Health Law, Six Months In”
    On the six-month anniversary of the Patient Protection and Affordable Care Act, this article examines how the law affects people who get their health care coverage at work, buy their own health insurance or are enrolled in Medicare. 

General Resources

  • New (added 2/17)
    • Trustee
      “Leadership in the Era of Reform” discusses the practical steps leaders can take to address the scope of the looming changes under health care reform. Organizations may need to bring new skill sets into the executive suite while sharpening existing ones. It also presents “10 Tactics for Hospitals,” a set of key actions that hospitals should undertake to help organize those efforts.
       
  • All Fee-for-Service Providers
  • American Hospital Association and Polsinelli Shughart, PC
    "Compendium of Federal and State Health Insurance Reform Actions Required by the Affordable Care Act"
  • Center for the Health Professions at the University of California, San Francisco
    A recent essay by Ed O’Neil discusses the concept of American exceptionalism — the notion that a distinctive set of values and practices have served the nation well for more than 200 years. The values embedded in American exceptionalism also are essential to making health care reform come to meaningful life during the next decade.
  • Centers for Medicare & Medicaid Services' Health Reform Center 
    • Reports Differ About Medicare’s Future
      According to a report from the Medicare Board of Trustees Medicare savings generated by the healthcare reform law would improve the program’s financial outlook and help extend the solvency of the Medicare hospital trust fund from 2017 to 2029. The Centers for Medicare & Medicaid Services Chief Actuary Richard Foster recently told a forum sponsored by the American Enterprise Institute that none of the experts with whom he has consulted think that the modest yearly payment increases the law provides for hospitals and other providers are realistic. An analysis from CMS' Office of the Actuary notes that the trustees’ report does not represent the best estimate of actual future Medicare expenditures because of the unrealistic assumptions about productivity increases and physician payment cuts.
    • CMS released a new report saying that reforms in the Affordable Care Act will generate billions of dollars in savings for Medicare and strengthen the care Medicare beneficiaries receive.
  • Congressional Research Services
    A memorandum from CRS summarizes statutorily imposed deadlines in the Patient Protection and Affordable Care Act as amended. It focuses on the provisions that require a specific action to be taken by a federal entity by a specific date. These dates range between March 23, 2010, and March 23, 2011.
  • Health Affairs 
    • The June edition of “Moving Forward on Health Reform” covers the history and politics of reform, bending the cost curve, coverage and insurance reforms, Medicaid expansion and state roles, delivery and payment reforms, large employers, individual mandates and updates on Massachusetts.
  • Healthcare Financial Management Association
  • Healthcare Reform Guide for Nursing Related Initiatives
  • Hospital Center
  •  Hospitals and Health Networks and McKesson
    • “Expert Panel Discussion: Health Care Reform: How Community Hospitals Thrive in an Environment of Rapid Change”
      The U.S. health care delivery system is on the verge of reform. Reimbursement and care delivery models are poised for significant overhaul, with the goal of improving the quality, safety and efficiency of care. This online executive dialogue explores how organizations are preparing for changes under health care reform, meaningful use requirements and ICD-10, among other things. Expert chief information officers share their strategies for thriving in an environment of rapid change.
  • Hospitals and Health Networks 
    The article, "Status Quo: Not an Option," focuses on the tremendous pressure hospital leaders are facing to prepare for reform implementation and improve their current operations.
  • Kaiser Family Foundation
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503-636-2204 | Fax: 503-636-8310
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