How Doctors and Hospitals Fare in HCR
What does the Patient Protection and Affordable Care Act (HR 3590) and the Health Care and Education Affordability Reconciliation Act (HR 4872) — both signed into law by President Barack Obama in March — mean to the health care service industry? Overall, doctors, hospitals, insurers, and pharmaceutical companies stand to benefit, says Kaiser Health News staff writer Phil Galewitz. Read an excerpt from Galewitz’s article:
“Primary care doctors got a bump up in funding and overall, doctors got a pass,” said Gail Wilensky, a senior fellow at Project Hope and former head of the Medicare program.
– Primary care doctors and surgeons practicing in areas with a shortage of physicians get a 10 percent bonus payment from Medicare between 2011 to 2015. Medicaid will pay primary care doctors Medicare rates in 2013 and 2014, to coincide with the Medicaid expansion. Medicare typically pays at least 20 percent higher rates than Medicaid.
– No significant medical liability changes are in any of the overhaul bills, though there is money for states to run pilot programs.
– The Medicaid expansion, to everyone under 133 percent of the federal poverty level ($29,326 for a family of four) means more patients have insurance, though at the lower Medicaid rates.
– The current Medicare physician payment formula that each year threatens to slash doctor payments was left untouched. But Congress traditionally steps in to nullify the cuts.
“The hospitals are ultimately the winners — one doesn’t increase spending on health care by nearly $1 trillion without some significant part of it flowing to hospitals,” said Sheryl Skolnick, a hospital analyst with CRT Capital Group in Stamford, Conn.
– Worried they might get hit hard by the health legislation, hospitals were the first industry to make a deal with President Barack Obama and the Senate Finance Committee last year. Hospital groups agreed to give up $155 billion in Medicare funding over the next decade. But they are expecting to make more than that — at least $170 billion — by having to treat fewer uninsured patients.
– An individual insurance mandate and subsidies for low-income Americans to buy coverage means hospitals will have more paying customers.
– Hospitals received guarantees that cuts in federal Disproportionate Share payments for treating the uninsured wouldn’t occur until the insurance expansion is in place. And even then, some of the funding will remain to help hospitals treat illegal immigrants and recipients of Medicaid, the state-federal program for the poor.
– Hospitals are slated to lose $155 billion in federal funding over a decade.
– A new independent commission would have broad authority over Medicare spending, though most of its powers don’t kick in until 2018.
– The bill sharply expands Medicaid, which will reduce the number of uninsured patients. But Medicaid typically pays less than private insurers or Medicare.
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