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Updated: August 26, 2010

General Resources 

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• Added August 11, 2010:
• 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.
• The Commonwealth Fund —  New Study:Realizing Health Reform's Potential: Women and the Affordable Care Act of 2010
  Thirty million women will benefit from the new health reform law through the next decade, either through new or strengthened insurance coverage, according to the Commonwealth Fund study.
• Centers for Medicare & Medicaid Services — 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.
• Kaiser Family Foundation — Seniors and Health Reform, The Latest "Pulling It Together, From Drew Altman"
  In his latest column, the Kaiser Family Foundation's President and CEO takes a closer look at seniors' views about the health reform law.
• Robert Wood Johnson Foundation — "How Will Hospitals Be Affected by Health Care Reform?"
  This brief report explores the effects that health reform will have on hospitals, including community, teaching and safety net hospitals. The authors conclude that under reform, hospitals will likely be able to improve the quality of their care without seeing much difference in their revenues and expenditures.
• The Commonwealth Fund — "A New Era in American Health Care: Realizing the Potential of Reform"
  In this report, Commonwealth Fund President Karen Davis outlines the key features of the new reform law, discusses who will be most helped and how, and describes the ways in which the health care system will begin to provide more patient-centered, accessible and coordinated care to all Americans. 
• Kaiser Family Foundation
• U.S. Senate Democratic Policy Committee
• 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.
• Health Reform GPS — a joint project of the Robert Wood Johnson Foundation and the Hirsh Health Law and Policy Program of the George Washington University School of Public Health and Health Services
• Proskauer Law Firm
• The Lewin Group
• Healthcare Reform Guide for Nursing Related Initiatives
• The White House — State by State Fact Sheets
  provides information about the immediate benefits of the Affordable Care Act
• Centers for Medicare & Medicaid Services' Health Reform Center
• Hospital Center
• All Fee-for-Service Providers
• Healthcare Financial Management Association

Resources from the American Hospital Association 

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• 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.
• Summary of 2010 Health Care Reform Legislation: The Patient Protection and Affordable Care Act (H.R. 3590) and Health Care and Education Reconciliation Act (H.R. 4872)
• Financial Modeling — To access this tool, a password to AHA's site is required.

Implementation Time Line

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• Health Care Reform Implementation Time Line
• Kaiser Family Foundation
• Commonwealth Fund

Payment Provisions 

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• 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.
• Centers for Medicare & Medicaid Services — "Systems Changes Necessary to Implement the Patient Protection and Affordable Care Act (PPACA) Section 6404"
  As a result of the ACA, claims with dates of serviced on or after Jan. 1, 2010, received later than one calendar year beyond the date of service will be denied by Medicare. Details are available online.
• 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.
• Geographic Variation

Bundled Payments 

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• 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

Financial Implications

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• Added August 26, 2010
• 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.

Readmissions Reduction and Care Transitions Initiatives

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• 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.
• 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.

• AHRQ Project RED —The ReEngineered Discharge

• 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.

Hospital-Acquired Conditions Initiatives

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• National Guideline Clearinghouse - Evidence-based guideline resources to assist users in the prevention of the ten CMS-identified hospital-acquired conditions.

• 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.

• On the Cusp Stop BSI Initiative — A national and state implementation of the Comprehensive Unit-Based Safety (CUSP) program to eliminate healthcare acquired conditions.

• TeamSTEPPS is an evidence-based teamwork system designed to improve patient safety by teaching communication and teamwork skills to health care professionals.
• Oregon's first HAI statewide report

Coverage Provisions 

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• Kaiser Family Foundation 

New Care Delivery Models

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• Added August 11, 2010
• Rand Corporation
  “Analyzing the Operation of Performance-Based Accountability Systems for Public Services”
  This technical report presents an analytic framework for describing how a performance-based accountability system works and uses the framework to identify appropriate questions to ask when studying the operation and impact of PBASs. This document, which introduces a common language that can be used to discuss PBASs and compare research across sectors, should be of interest to researchers and analysts studying performance measurement and accountability.
• Milliman Inc. — Briefing Paper: The Nuts and Bolts of ACO Financial and Operational Success: Calculating and Managing to Actuarial Utilization Targets
  The Patient Protection and Affordable Care Act calls for the creation of accountable care organizations as a more cost-effective way of paying for healthcare. In order to succeed, ACOs will have to establish actuarial cost and utilization targets and use medical management to achieve those targets. This process of benchmarking and managing toward targets requires a delicate balance of actuarial and clinical know-how.  This briefing paper offers a practical guide for approaching this analytic and management imperative. In addition to identifying the steps required, it identifies the medical management priorities for an effective ACO and highlights some of the risks involved.
• The Commonwealth Fund — Health Care Opinion Leaders Weigh in on Barriers to Integrated and Accountable Care
  Nearly nine of 10 leaders in healthcare and healthcare policy believe that a lack of incentives and the current financial interests of providers and other stakeholders are holding back progress in achieving greater integration and accountability in healthcare delivery, according to a Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey. The survey's findings are discussed in a data brief, and the need for accountable care is addressed by U.S. Department of Health and Human Services Secretary Kathleeen Sebelius and former U.S. Sen. David Durenberger.  
• 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 they and how will they work? 
• American Hospital Association — 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.
• Center for Medicare & Medicaid Services — CMS has prepared a document with preliminary questions and answers about accountable care organizations.
• Milliman Insight Magazine — "Accountable Care Organizations: The New Provider Model?"
• Integrated Healthcare Strategies — "Accountable Care Organizations and Their Impact on Physician Affiliation and Reimbursement"
• American Academy of Family Physicians — "MedPAC Considers Accountable Care Organizations as Possible Path to Health Care Reform"
• The Commonwealth Fund — "MEDPAC Probes Effectiveness of Accountable Care Organizations"
• The Urban Institute — "Can Accountable Care Organizations Improve the Value of Health Care by Solving the Cost and Quality Quandaries?"
• The Brookings Institution — "A National Strategy to Put Accountable Care into Practice"
• "CMS Reform Demonstration Programs"
• Center for Healthcare Quality and Payment Reform — "How to Create Accountable Care Organizations"

Insurance Exchanges and Enrollment 

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• Milliman Inc. — "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 and 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.
• Oregon Department of Human Services -- On July 14, Oregon launched a new insurance program for preexisting medical conditions
• 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.  
• 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.
• 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.

• U.S. Department of Health & Human Services
• HealthReform.gov — A service of the U.S. Department of Health and Human Services, this site contains good information on the impact of reform

Risk Sharing 

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• 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 Information Technology and Data Support

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• 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.
   
• Centers for Medicare & Medicaid Services
  • CMS issued three new fact sheets about the Medicare and Medicaid EHR incentive programs. These fact sheets summarize provisions in the final rule announced July 13, 2010.
    • Meaningful Use Fact Sheet
    • Medicare EHR Fact Sheet
    • Medicaid EHR Fact Sheet
  • Additional information on the Medicare and Medicaid EHR incentive programs, including a link to the text of the final rule, are available online. 

• U.S. Department of Health and Human Services – "Secretary Sebelius Announces Final Rules To Support 'Meaningful Use' of Electronic Health Records"
• Centers for Medicare & Medicaid Services – "CMS and ONC Final Regulations Define Meaningful Use and Set Standards for Electronic Health Record Incentive Program"
• Centers for Medicare & Medicare Services — CMS has launched the official Web site for the Medicare & Medicaid EHR Incentive Programs. This site provides the most up-to-date, detailed information about the EHR incentive programs.
• Agency for Healthcare Research and Quality
• Healthcare Information and Management Systems Society (HIMSS)

Physician Implications

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• 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.
• "Health Care Reform and the Community Cardiologist: 2010 and Beyond"
  This article in Cardiology Today discusses cardiologists moving to employment in hospital settings and how the shift will likely increase as healthcare reform implementation occurs.

Hospitals as Employers

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• Added August 11, 2010
• 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.
• Society for Human Resource Management (SHRM) 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.
• Business and Legal Resources (BLR): 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.
• Hewitt Associates Available resources include Webcasts and publications. Articles and downloads are free and open to the public.
• U.S. Small Business Administration This site Includes a health care reform page. All information and links are open to the public.
• HealthReform.gov 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.
• National Association of Insurance Commissioners 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.
• American Society for Healthcare Human Resources Administration (ASHHRA)  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

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• Center for the Health Professions at the University of California San Francisco
• 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.
• Center for the Health Professions at the University of California – San Francisco — "Workforce Challenges in a Remade Approach to Care"
• 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.
• 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.

Tax-exempt Hospital Requirements

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• Internal Revenue Service
• Hall Render Killian Heath Lyman Law Firm 

Medical Homes 

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• The Commonwealth Fund — "How Physician Practices Could Share Personnel and Resources to Support Medical Homes" 

Quality Reporting

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• 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. 

Health Disparities and Data

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• U.S. Department of Health and Human Services
• Health Reform GPS

Prevention and Wellness

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• Health Reform GPS
  • Prevention and Public Health Fund
  • Racial and Ethnic Disparities in Health and Health Care

Behavioral Health Resources 

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• U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration — provides information on how behavioral health should be incorporated into general health under the Affordable Care Act  

Health Services Research

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• Academy Health

From Chaos comes Opportunity: Member Webcast Series

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• Save the date: Beginning September 16, OAHHS, in partnership with the American Hospital Association’s Health Research and Educational Trust (HRET), will launch an educational webcast series exclusively for OAHHS members: Healthcare Reform – From Chaos Rises Opportunity. Registration information and further details for each webcast will be sent to the membership early next week.

  • September 16: Reducing Readmissions
  • October 12: Bundled Payments and ACOs
  • October 26: Governance, Leadership, and Workforce
    
  This 3-part series will provide our members access to national research and best practices around three key components of state and federal reform:  Effectively managing readmissions; considering bundled payments and the formation of Accountable Care Organizations (ACOs).  This series will also assist with understanding how your governance and workforce practices can drive the implementation of health reform.
  
• April 8, 2010:  OAHHS webcast around reform impacts