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Health Reform 101: Use this primer to navigate the changes ahead

by Geri Aston • December 16, 2011

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Otolaryngologists may want to monitor whether the hospitals at which they have privileges are considering participation in these programs. Physicians interested in participating should fully evaluate their capacity to join these programs beforehand, the AMA advises in its report, “New Payment and Delivery Reform Models” [http://www.ama-assn.org/ama1/pub/upload/mm/399/hsr-payment-reform-models…. Under these models, physicians will have to work collaboratively with other providers, and they may need to invest in tools and systems necessary to coordinate and measure performance, the AMA notes.

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Explore This Issue
December 2011

Patient Access

Physician practices should see a drop in the number of uninsured patients as the law’s health insurance access provisions take effect. Up to 32 million people could gain coverage, according to the Congressional Budget Office. Of that figure, about 16 million would get their coverage through Medicaid and the Children’s Health Insurance Program.

The biggest reforms start in 2014. That’s when the mandate for individuals to buy insurance, income-related tax credits to help individuals and families afford coverage and a Medicaid eligibility expansion kick in. At the same time, state-based health insurance exchanges, which aim to provide affordable coverage options, are supposed to launch.

The law also includes many insurance reforms that affect patients, including:

  • Elimination of pre-existing condition exclusions;
  • A requirement that health plans accept every employer or individual who applies;
  • Guaranteed renewability of coverage; and
  • Prohibition on premium rate differences, except those for rating area, age, tobacco use and whether the plan is for an individual or family.  

 

For More Information

American Academy of Otolaryngology-Head and Neck Surgery

Practice and advocacy resources

http://www.entnet.org/Practice/members/Advocacy.cfm

American Medical Association

Health system reform news and resources

http://www.ama-assn.org/ama/pub/health-system-reform/index.shtml

Centers for Medicare & Medicaid Services

Medicare Shared Savings (ACO) Program

http://www.cms.gov/sharedsavingsprogram/

Commonwealth Fund

Health reform resources

http://www.commonwealthfund.org/Health-Reform.aspx

Internal Revenue Service

Affordable Care Act tax provisions

http://www.irs.gov/newsroom/article/0,,id=220809,00.html?portlet=6

Kaiser Family Foundation

Health reform resources

http://healthreform.kff.org/

U.S. Department of Health and Human Services

Health reform page

http://www.healthcare.gov/

Pages: 1 2 3 4 | Single Page

Filed Under: Health Policy, News, Practice Management Tagged With: CMS, health policy, health reformIssue: December 2011

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  • Health Care as a Commodity: Competition should be focus of health reform, lecturer says
  • A Blessing and a Curse: Health care reform comes at a steep price

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