Part I of IV
Implications for Employers, Insurance Availability,
Provider Managed Care Contracting and Charity Care
Originally presented on April 16, 2010. This Roundtable focuses on the provisions intended to promote the availability and purchasing of health insurance, through the establishment of individual and employer incentives and through extensive federal insurance industry regulation.
- Insurance market changes prior to 2014
- Federally qualified insurance plans and health insurance exchanges
- Options for the creation of new insurance entities
- Premium subsidies and the individual mandate
- Rewards and penalties for employers
- Implications for provider bad debt and charity care
- Impacts on provider/insurer relationships and managed care contracting
- Potential future evolution of the delivery and payment system
Part II of IV
Medicare, Medicaid and Delivery System Reform
Originally presented on April 23, 2010. This Roundtable focuses on the impact of healthcare reform on healthcare providers, with particular emphasis on Medicare and Medicaid changes affecting reimbursement and on cost effectiveness initiatives.
- Reductions in market basket adjustments
- Wage index reform
- GME/IME changes
- DSH reductions
- Medicaid expansion and hospital enrollment efforts
- Overpayment reporting
- Enhanced payments for primary care
- Quality incentives, including value based incentive payments
- Penalties for readmissions and hospital acquired conditions
- Accountable care organizations
- Post acute care bundling
- Changes in the 340B drug discount program
Part III of IV
Enhanced Fraud & Abuse Liability and Compliance Challenges
Originally presented on May 7, 2010. This Roundtable focuses on changes to the federal False Claims Act, Civil Monetary Penalties law, and other fraud and abuse liability authorities, enhanced compliance requirements, and the intersection with various provider enrollment, program integrity, and quality of care initiatives.
- False Claims Act Update (overpayment reporting and refunds)
- Anti-Kickback Statute
- Stark Law (self disclosure protocol, restriction on physician ownership of hospitals)
- Civil Monetary Penalties law
- Revised scope and penalties for ?criminal healthcare fraud? offense
- Increased levels under U.S. Sentencing Guidelines for healthcare fraud convictions
- Extension of RAC program to Medicare Parts C and D and Medicaid
- Program integrity efforts (provider enrollment and screening issues)
- Mandatory compliance programs
- "Sunshine" provisions (reporting of certain payments to physicians and teaching hospitals)
- Increases in healthcare fraud enforcement funding
Part IV of IV
Reform Driven Strategies and Tactics & State Options and Responsibilities
Originally presented on May 21, 2010. This Roundtable identifies healthcare organization strategies and tactics that may be considered as responses to various provisions of the healthcare reform laws, as well as a review of the various options and responsibilities that the federal government has provided for State governments in these laws.
- State government options and responsibilities
- Required changes in employee health benefits
- Tradeoffs between health benefits costs, government subsidies and penalty payments
- Provider strategies relating to more extensive insurance coverage
- Provider strategies relating to Medicare/Medicaid payment cuts
- Managing risk-based and quality-adjusted payments
- Organizational and legal structures for organizations planning to participate in programs for Accountable Care Organizations (ACOs), bundled payments and medical homes
- The role of health information technology in ACOs, bundled payment arrangements and medical homes
- Actions to reduce compliance-related liability exposures