Devices & Diagnostics

US health reform facts for the new year

A host of new rules and regulations included in the Patient Protection and Affordable Care Act kick in this week.

A host of new rules and regulations included in the Patient Protection and Affordable Care Act kick in this week.

The healthcare reform act brought a wave of new regulations to the lawbooks as the new year rolled in, with a significant segment of the rules making changes to Medicare, the country’s largest payer of medical bills.

An effort to close the so-called “donut hole” of Medicare Part D commenced Jan. 1 for Medicare beneficiaries. Members of the federally-funded health insurance program will get a 50 percent discount on brand-name prescriptions while the government puts together additional changes. The discount is only applied to pharmaceuticals whose makers signed agreements with the Centers for Medicare & Medicaid Services. The new rule could drive down prescription drug costs as much as $700 for a typical Medicare beneficiary.

A new Medicare reimbursement regulation that pays physicians to discuss end-of-life care options with patients and their families also takes effect. The provision was included in the original healthcare reform bill, but after reform opponents began referring to it as a “death panel,” lawmakers felt compelled to remove it from the bill.

Primary-care physicians and general surgeons will begin receiving a 10 percent bonus payment for treating Medicare beneficiaries. Healthcare providers qualify for the bonus if 60 percent or more of their services provided are for primary care. Surgeons also will receive the bonus if they’re practicing in areas where physicians are in short supply.

Medicare recipients will begin to get free preventive services, including annual checkups, vaccinations and certain screenings, and their will be no more cost sharing for those items.

Since 2007 wealthier Medicare beneficiaries have paid more than the standard premium for Part B, which covers physician and outpatient services. The healthcare reform law froze the limit at the current level — incomes of $85,000 or above for individuals and $170,000 for couples.

A system called Medicare Advantage provides benefits to certain Medicare recipients through private insurance companies. Beginning Jan. 1, Advantage payments will be set at increasingly smaller percentages of the traditional Medicare fee-for-service rates, eventually eliminating an occasional discrepancy that resulted in over-payments to insurers and increased premiums.

CMS created a new Innovation Center that will serve as a testing ground for new practices. The 10-year, $10-billion effort lays a foundation for what experts believe could be one of the most far-reaching benefits of healthcare reform. The center aims to test new ways of delivering care to patients that reduce costs but maintain or improve quality. In one of the center’s initiatives, eight states will take part in a Medicare demonstration project that evaluates the performance of healthcare providers when they collaborate and receive coordinated payments.

Health insurance companies are now required to spend 80 to 85 percent of revenue on medical care and quality improvements for patients, not on administrative costs.

Beginning shortly after the Food & Drug Administration finalizes rules governing the disclosure of meals’ nutritional values new this year, chain restaurants with 20 or more locations and owners of 20 or more vending machines will have to display calorie information on
menus.

The so-called Community Based Care Transitions Program was designed to improve care for seniors after they leave the hospital and reduce their re-admissions.

The Massachusetts Medical Devices Journal is the online journal of the medical devices industry in the Commonwealth and New England, providing day-to-day coverage of the devices that save lives, the people behind them, and the burgeoning trends and developments within the industry.

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