2012 is shaping up to be critical for the effort to implement the provisions of the Patient Protection and Affordable Care Act (“PPACA”) that are designed to reform the nation’s healthcare delivery and reimbursement systems through the development of ACOs and other innovative programs.
The 32 Pioneer ACOs (ACOs approved in December for mature groups ready to take risk) begin operations. One of the Pioneer ACOs, JSA Medical Group, will be operating in the Orlando, Tampa and south Florida markets.
The United States Supreme Court will hear oral arguments on one of the most controversial provisions of PPACA, the so-called “individual mandate.” Most observers expect that by the time the Supreme Court’s current term ends, in June, the Court will issue its decision regarding this keystone provision. However, whether the Court upholds or strikes down the mandate, PPACA already has set in motion forces that likely will significantly alter the business, if not the practice, of healthcare.
Notwithstanding the development of ACOs, the Medicare program will begin using value-based reimbursement criteria for hospital services. These criteria will link a part of a hospital’s Medicare payments to its ability to satisfy certain performance standards. In addition, hospitals who readmit patients for preventable complications will see their reimbursement for these readmissions adversely impacted.
The election. The fate of PPACA and the current effort to reform the way in which the federal government pays for healthcare items and services may very well depend on who are the winners and losers.
Under PPACA, each state has the option of establishing its own health insurance exchange. While those exchanges will not “go live” until 2014, by the end of 2012 the federal government must certify that a state is progressing toward that goal or risk having to implement a federally run exchange. NOTE: so far Florida has opted have its citizens participate in a federally run exchange, because the State has decided not to establish its own health insurance exchange.