Health care reform in the coming year will go on a kind of shakedown cruise to test the seaworthiness of America's evolving health care system as it becomes more cost-conscious and quality-focused under the Affordable Care Act.
In 2012, the health insurance law, also known as Obamacare, linked Medicare payments to the quality rather than quantity of care, started penalizing health insurers that charge too much in administrative fees and executive bonuses, and began rewarding good doctors who save Medicare money.
Ahead in 2013, the law will attempt to strengthen America's health care safety net by increasing physician pay and expanding preventive care under Medicaid; bolstering the Children's Health Insurance Program, or CHIP; and launching more streamlined Medicare billing. State insurance exchanges to promote health plan comparison-shopping also face federal certification as they prepare for a scheduled opening in 2014.
Dr. Jeff Cain, president of the American Academy of Family Physicians, says the continued emphasis on primary and preventive care is essential to effective reform. "It's not a news flash that healthy people are cheaper to take care of than people who have diseases. One way we know we can cut costs and still maintain good quality is to have better primary care."
Medicaid Pay Raise for Family Doctors
Effective: Jan. 1, 2013
Currently, primary care doctors typically receive less for treating low-income Americans on Medicaid than for treating seniors covered by Medicare, even though both are federal-state programs. But beginning in January, state Medicaid programs will be required to pay at or above the Medicare rates, with the additional money coming solely from the federal government.
The timing of this pay raise is no accident, says Dr. Ron Greeno, public policy committee chair for the Society of Hospital Medicine. "One thing the Affordable Care Act did was provide coverage for about 32 million patients that weren't covered before, and about half of those are eligible for Medicaid," he says. "They're trying to find primary care physicians who are willing to take more Medicaid patients."
In fact, without this and other health care reforms designed to strengthen primary care, America could face a shortage of 21,000 primary care physicians by 2015. "The average family doctor sees eight patients a week on either a discounted or free basis," which includes Medicaid patients, says Cain. "It's important that family doctors be able to have a financially viable practice and remain independent."
Improving Medicaid Preventive Care
Effective: Jan. 1, 2013
Health care reform's unofficial motto might be that old saw about an ounce of prevention being worth a pound of cure. 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 an unprecedented $15 billion over 10 years to catch and manage diseases early.
In 2013, Obamacare picks up the tab for state Medicaid programs that choose to offer preventive services at little or no cost, following in the footsteps of health care reform's earlier extensions of "free" preventive screenings, vaccinations and services across Medicare and private insurance plans.
"A severe disease has two consequences: It's hard on people, and hard on our health care system," says Cain. "Someone who has untreated diabetes is more likely to have blindness, an amputation or heart disease than someone who had good quality screening to prevent those long-term consequences."