By Steve Wehn, vice president, Government and Community Relations, AMN Healthcare
In 2012, healthcare reform survived major challenges and starting in 2013 will now enter the 12-months countdown before millions are expected to gain health insurance and the Affordable Care Act will be (almost and finally) fully implemented. 2013 will be a year that the healthcare sector will continue to transform operations and push even harder to gain greater efficiency. This will also be the year of greater pressure on quality initiatives to deliver a return that will control and reduce costs by the nation's hospitals and doctors as they prepare for full implementation of reform.
There are several healthcare reform provisions set to go into effect in 2013. The law will attempt to strengthen America's health care by increasing physician pay and expanding preventive care under Medicaid; bolstering the Children's Health Insurance Program, and launching more streamlined Medicare billing. State insurance exchanges also face federal certification as they prepare for a scheduled opening in 2014.
Medicaid pay raise for primary care doctors
Beginning in January 2013, state Medicaid programs will be required to pay primary care doctors at or above the Medicare rates, with the additional money coming solely from the federal government.
The Affordable Care Act should provide coverage for about 32 million additional patients that weren't covered before with about half of those are eligible for Medicaid. Without efforts of health care reform to strengthen primary care, America could face a shortage of 21,000 primary care physicians by 2015.
Improving Medicaid preventive care
Chronic diseases, such as heart disease, cancer and diabetes, account for 7 out of 10 U.S. deaths and 75 percent of national spending on health care. To bend that costly curve, the Affordable Care Act invests $15 billion over 10 years to catch and manage diseases early.
In 2013, the Affordable Care Act picks up the tab for state Medicaid programs that choose to offer preventive services at little or no cost,
Exploring 'bundled' payments in Medicare
Medicare and health care in general can provide better care at a lower cost if doctors, hospitals and caregivers work together for the well-being of the patient.
In 2013, the Affordable Care Act addresses Medicare's pay-per-service system, in which a simple surgery can result in dozens of separate bills. A new national pilot program will pay a flat rate to cover all care provided during a medical episode.
Chipping in more for CHIP
Established in 1997 and reauthorized by Congress in 2009, the Children's Health Insurance Program, or CHIP, provides affordable health coverage for nearly 8 million kids from low-income families that make too much to qualify for Medicaid but not enough to afford private health insurance. Health care reform extends federal CHIP funding to states through Oct. 1, 2015.
Certifying new state insurance exchanges
New state insurance exchanges, designed to offer consumers and small businesses one-stop online shopping for affordable private health plans, are supposed to launch starting in 2014. They're to be certified by the federal government during 2013.
States face one of three options under the Affordable Care Act: Set up an exchange on their own, partner with the federal government, or simply sit back and let the feds run the exchange for them.
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