The Affordable Care Act
2014 What a Year!
Kansas Association of Osteopathic Medicine (KAOM)
Annual CME Convention
April 2014
Presented by:
Cynthia Penkala CMM, CMPE, CMOM
American Osteopathic Association
Disclaimer
The lectures and presentations are intended for educational purposes
only. Speakers and presenters provide their viewpoint and opinion
and have not consulted with the Kansas Association of Osteopathic
Medicine in developing the presentation. Their presentations are not
targeted at the audience as a whole and not to the specific
circumstances of individuals attending the program. The
presentations do not replace independent professional judgment and
study of the specific details an attendee may be confronting.
Statements of fact and opinions expressed are those of the individual
presenters and, unless expressly stated to the contrary, are not the
opinions or position of the Kansas Association of Osteopathic
Medicine its cosponsors, or its committees. The Kansas Association of
Osteopathic Medicine does not endorse or approve, and assumes no
responsibility for, the content, accuracy or completeness of the
information presented.
Developed by the Division of Socioeconomic Affairs, in conjunction with the General Counsels’ office in September 2010.
Plan
 ACA
 The Marketplace
 Payment Reform
 Meaningful Use
 Medical Home
 HIPAA
 ICD-10
 AOA Resources
 Question & Answer Session
The Affordable Care Act
2014
What a Year!
2014
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Year of the Horse
3D printing
3D TVs
Google Glass
Winter Olympics
Robots that sing
2014 & Health Care
• ACA
• PPACA
• Obamacare
• HIE
• ICD-10
• HIPAA
ACA –Accountable Care Act
Where it all started
Patient Protection & Affordable Care Act
(PPACA) (P.L. 111-148)
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Increasing access to affordable care
Improving quality and lowering cost
New consumer protections
Holding insurance companies accountable
New to 2014
• Young adults under the age of 26
• Newly insured
• Higher out-of-pocket expenses for patients
• Health Care consumerism
• Physician Compare
A Congress Divided
ACA vs. Obamacare
State Marketplace and
Medicaid Expansion
STATE INSURANCE
MARKETPLACE
Source: Kaiser Family Foundation State Health Facts
State Marketplace
Statistics
• Total number of individuals determined
eligible to enroll in a marketplace plan:
– 8,751,907
• Number of individuals eligible to enroll in a
marketplace plan with financial assistance:
– 5,246,641
Source: Kaiser Family Foundation State Health Facts data as of 3/1/2014
State Marketplace
Statistics
• Total determined or assessed eligible for
Medicaid/CHIP by the marketplace:
– 4,377,932
• Total number of individuals who have
selected a marketplace plan:
– 4,242,325
Source: Kaiser Family Foundation State Health Facts data as of 3/1/2014
Kansas Statistics
• Kansas has a federally facilitated
marketplace.
– 29,305 individuals in Kansas have selected a
marketplace plan as of March, 2014.
– This is out of the 65,057 that have been
determined eligible to enroll in a marketplace
plan.
Source: Kaiser Family Foundation State Health Facts data as of 3/1/2014
Kansas Statistics
• An additional 10,344 individuals in Kansas
have been determined or assessed as
eligible for Medicaid or CHIP by the
marketplace.
Source: Kaiser Family Foundation State Health Facts data as of 3/1/2014
Medicaid Expansion
Across the Country
Kansas Medicaid
Expansion
• Kansas expanding Medicaid is currently
unlikely.
• Governor Sam Brownback issued a
statement on January 13, 2014: “at this
time I am not recommending the
Legislature go ahead with the optional
expansion of Medicaid.”
Kansas Medicaid
Expansion
• However, Governor Brownback has not
completely disavowed the idea of
expansion.
• His January 13 statement also said: “I will
continue to monitor the implementation of
Obamacare and I remain open-minded if
improvements are made to address my
concerns.”
Challenges
Patient
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Enrollment via marketplaces
Individual mandate penalties
Access to physician services
Rates
Confusion
Old plans v. New plans
Physician
• Payment rates in marketplace
plans
• Influx of new patients
• Provider networks
• Practice environment changes
• Regulatory & administrative
burden
Practice Impact
 Check participation with new ACA exchange products offered by
your current plans
 Determine your practice’s ability to handle new patients
 Review your payer mix – increase of Medicaid impact
 Staff training
 Check patient eligibility, coinsurance, deductibles and copays
 Be prepared to discuss cost-sharing, out-of-pocket, in-network vs.
out-of-network
 90-day grace period
Payment Reform
• Moving away from current episodic-based
system
• Fee-for-service to ?
Meaningful Use
• Attest to meaningful use of EHRs
1st
Year
2011
2012
2013
2014
2015
2016
2017
Stage of Meaningful Use
2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021
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3
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3
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2
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TBD
TBD
TBD
3
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2
TBD
TBD
TBD
TBD
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3
TBD
TBD
TBD
TBD
TBD
3
1
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Medical Home
• Triple Aim
– Better Care
– Better Health
– Lower Costs
• Accreditation
DOs in NCQA
Accredited Homes
• Nationwide – over 2000
• Kansas - 25
Additional Concerns
• ICD-10
• HIPAA
ICD-10
• 2014 to 2015
• ICD-10 or ICD-11?
• 5 positions (first one alphanumeric, others
numeric) to 7 positions, all alphanumeric
• 13,000 codes to 68,000 codes
• General to specific
What Now?
• Don’t stop
• Know your practice's diagnosis patterns
• Learn ICD-10 codes, documentation
requirements
• Check with your vendors
• Check with your health plans
• PREPARE
HIPAA
The Privacy Rule
• Identifies what is to be protected
• Regulates what entities subject to HIPAA
must do to safeguard information
• Outlines individual’s rights regarding their
PHI
• Restricts uses and disclosures
The Security Rule
• Requires the placement of safeguards,
both physical and electronic, to ensure the
secure passage, maintenance and
reception of protected health information
(PHI).
The Breach Notification Rule
• Notify affected individuals, the
Secretary of HHS and, in some cases,
the media
2014 HIPAA
• Physician imopact
–Revise privacy, security and breach
notification policies and procedures
–Update Notice of Privacy Practices
–Update BA agreements
–Requests for Copies of PHI and ePHI
timelines and charges
Disclosures to health plans
• Physician’s must abide by a patient’s request
not to disclose information about care the
patient has paid for out-of-pocket to health
plans, unless for treatment purposes or in the
rare event the disclosure is required by law.
Where do we go from here?
Prediction #1
• MORE CASH PRACTICES
PREDICTION #2
• GROUP VISITS MAKE $EN$E
PREDICTION #3
• Employed physicians and independent
physicians will continue to exist
PREDICTION #4
• TOS PAYMENTS ARE CRITICAL
PREDICTION #5
• THE YEAR OF THE GOVERNMENT
MANDATE
PREDICTION #6
• SOCIAL MEDIA MAKES SENSE
Mixed Feelings
• Decrease number of uninsured
• Decrease the cost of health care for
Americans
• Decrease in reimbursement to physicians
• Increase of Patients that need to be seen
From Act to Action
www.osteopathic.org/ActToAction
AOA ACA TOOLs
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The AOA’s statement on the ACA
The AOA’s analysis on the Supreme Court Ruling
State ACA Implementation Toolkit
State Health Insurance and Medicaid Expansion
Updates
A full summary/timeline of the provisions
Policy summaries of different aspects of the ACA
Town Hall Webinars that answer questions posed by
physicians and students
Links to informational websites
Quarterly newsletter
AOA
ICD-10 Tools
• ICD-10 Webinars at
www.osteopathic.org/pmwebinars
• ICD-10 Web page at
www.osteopathic.org/icd-10
• ICD-10 Coding help at
www.osteopathic.org/practicemanagement
AOA
Meaningful Use Tools
• Meaningful Use Webinars at
www.osteopathic.org/pmwebinars
• Meaningful Use Web page at
www.osteopathic.org/meaningfuluse
AOA
HIPAA TOOLs
• HIPAA webinars
www.osteopathic.org/pmwebinars
• HIPAA Update www.osteopathic.org/hipaa
• HIPAA manuals
• Template NPP and BA
Practice Management Webinars
www.osteopathic.org/pmwebinars
Movie
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HIPAA
Meaningful Use
ERISA
ICD-10
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Coding
Value Based Modifiers
Healthcare Literacy
Building Blocks of Medicine
Practice Management Communications
• Free, timely and relevant practice management email communications from the AOA.
• Physicians, practice staff, consultants and other health
care partners are invited to sign up.
Sign up by sending a subscribe message to
[email protected]
Department of
Practice Management and Delivery Innovations
Staff
vb
Monica E. Horton, MPP
Department Director
Division of Compliance & Payment Advocacy
Yolanda Doss, MJ, RHIA, CHPS
Public & Private Payment Advocacy
Kavin Williams, CPC
Division of Practice Transformation & Member Education
Cindy Penkala, CMM, CMPE, CMOM
American Osteopathic Association
• Serves as the professional family for more than
104,000 osteopathic physicians (DOs) and
osteopathic medical students
• Promotes public health and encourages
scientific research
• Serves as the primary certifying body for DOs
• Serves as the accrediting agency for all
osteopathic medical schools
• Has federal authority to accredit hospitals
and other health care facilities.
Please support our work through
your AOA membership.
Join today.
To become a member call the AOA toll free at (800) 621-1773, press 1
or join online
www.osteopathic/membership
Questions & Discussion