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The Politics of Healthcare

Two More Provisions of ACA Now in Effect

Published October 31, 2012 11:41 AM by Lisa Brzezicki

(Editor's Note: This guest blog was written by Michael LaMagna.) 

As of Oct.1, 2012, two very important provisions of the Affordable Care Act (ACA) went into effect, which will significantly impact hospitals and other healthcare facilities. The two provisions are: 1) penalizing hospitals for readmitting patients within 30 days of discharge and 2) utilizing hospital value-based purchasing, which ties hospital payments to achieving clinical thresholds.

It is anticipated that more than 2,200 hospitals will be fined at least $125,000 this year as a result of readmissions. As expected, the hospitals are outraged for being fined for conditions that may be out of their control, which includes the readmission of chronically ill people. The variables that will be measured in the first year include: heart attacks, heart failure and pneumonia. The penalty is capped at 1% of the hospital's Medicare payments, rising to 3% in the next few years and adding variables, which includes: joint replacements, stenting, heart bypass and stroke.  

Hospitals have been looking to after-hospital care, including: rehab centers, hospices, home health agencies and nursing homes to decrease the incidences of readmissions. The major emphasis has been on effective discharge planning and wellness programs.

Regarding the Hospital Value-Based Purchasing Program, Medicare will look at a set of standard clinical quality measures and on surveys of patients' experience, to determine reimbursement.  Medicare has been sharing data with the hospitals to assist with diminishing their impact and the public can view the information on Hospital Compare, located at http://www.medicare.gov/ starting later this month.     

This article is provided for informational purposes only. Nothing in this article shall be construed as legal advice or should be relied upon as such.  Michael LaMagna is a partner at Timins & LaMagna, LLP, practicing Health Care Regulatory, Elder /Probate/Disability/Trusts and Estates, Social Security and General Legal practice in both New York and Connecticut. Michael was just appointed to the ACO Task Force of the American Health Lawyers Association.  Email him at Mlamagna@nyandctlaw.com, call him at 914-819-0663 or visit Attorney LaMagna's website at www.nyandctlaw.com for more information.    

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