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Healthcare Reform Briefing

by James Person
Presented to the NorthLake Association of Medical Managers
September 21, 2011

Biography

James Person is the Public Affairs Specialist for St. Tammany Parish Hospital. He is responsible for analyzing the effects of federal, state and local legislation and regulations on the hospitals ability to deliver worldclass healthcare close to home. He also assists with external and internal communication efforts. Person previously served on Capitol Hill as a legislative aide for two Members of Congress and a prominent public policy think tank. He also managed and worked on congressional election campaigns in North Carolina, Wisconsin and Louisiana.

He is a native New Orleanian and an alumnus of Mandeville High School and Louisiana State University- Baton Rouge where he received a Bachelor of Arts degree in Mass Communication. Currently, he attends the University of New Orleans where he is earning a Master of Business Administration degree concentrating in finance. He lives in Mandeville with his wife and two sons.

Overview

Super Committee

Whats Left to Do
Outlook Presidents Proposals

Healthcare Reform

Super Committee

Super Committee

Stage 1- Budget Control Act


Immediate budget reductions of $917 B

Super Committee

Stage 1- Budget Control Act

Immediate budget reductions of $917 B


Extends debt limit by $900 B until Feb/March

Super Committee

Stage 1- Budget Control Act


Immediate budget reductions of $917 B Extends debt limit by $900 B until Feb/March

No cuts to Medicare or Medicaid

Super Committee

Stage 1- Budget Control Act


Immediate budget reductions of $917 B Extends debt limit by $900 B until Feb/March No cuts to Medicare or Medicaid No tax increases

Super Committee

Stage 2 Find $1.5 T in deficit reduction recommendations by Thanksgiving

Super Committee

Stage 2
Find $1.5 T in deficit reduction recommendations by Thanksgiving

If a deal is reached: Up-or-down clean vote in Congress

Super Committee

Stage 2
Find $1.5 T in deficit reduction recommendations by Thanksgiving

If a deal is NOT reached: Sequestration

Super Committee

Sequestration
$1.2 T in cuts

Super Committee

Sequestration
$1.2 T in cuts Automatic, across-the-board

Super Committee

Sequestration
$1.2 T in cuts Automatic, across-the-board

Cuts $123 B from Medicare

Super Committee

Sequestration

$1.2 T in cuts
Automatic, across-the-board

Cuts $123 B from Medicare


Medicaid exempt

Super Committee

Sequestration
$1.2 T in cuts Automatic, across-the-board

Cuts $123 B from Medicare Medicaid exempt If deal <$1.5 T, pro rata cuts

Super Committee

Sequestration
Some groups may actually prefer this!

Important Dates

October 14: Congressional committee recs due

Important Dates

October 14: Congressional committee recs due November 23: Super committee votes

Important Dates

October 14: Congressional committee recs due

November 23: Super committee votes


December 23: House and Senate votes

Options

Medicaid ($100 B)

Options

Medicaid ($100 B)
No more provider taxes

Options

Medicaid ($100 B)
No more provider taxes Blended FMAP rates

Options

Medicare

Options

Medicare
IME cuts ($15 B)

Options

Medicare
IME cuts ($15 B)

Eliminate bad debt payments ($15-$30 B)

Options

Medicare
IME cuts ($15 B) Eliminate bad debt payments ($15-$30 B) Others ($69-$71 B)

Options

Medicare
IME cuts ($15 B) Eliminate bad debt payments ($15-$30 B) Others ($69-$71 B) Expansion of IPAB

Options

Other
Increase retirement age ($125 B)

Means-testing ($38 B)
Medicare copay reform and increases ($110 B) Medigap restrictions ($53 B) Home health copays ($40 B)

SNF copays ($50 B)

Whats Left to Do?

Expiring tax provisions AMT patch R & D tax credits Accelerated depreciation

Whats Left to Do?

Expiring tax provisions AMT patch R & D tax credits

Accelerated depreciation
Medicare DOC FIX !!!! ($300 B)

Doc Fix

MedPAC doc fix proposal

Doc Fix

MedPAC doc fix proposal Cut specialist payments 6%

Doc Fix

MedPAC doc fix proposal


Cut specialist payments 6%

Keep PCP rates flat

Doc Fix

MedPAC doc fix proposal Cut specialist payments 6% Keep PCP rates flat Paid for with cuts to other healthcare sectors

Outlook

Outlook

Outlook

Outlook

Jobs Proposal

Reduce payroll taxes


Increase spending by $447 B

Jobs Proposal

Reduce payroll taxes Increase spending by $447 B


paid for with

Jobs Proposal

Reduce payroll taxes

Increase spending by $447 B


paid for with

Tax increases and limiting itemized deductions

Jobs Proposal

Reduce payroll taxes

Increase spending by $447 B


paid for with

Tax increases and limiting itemized deductions

Deficit Reduction Proposal

Deficit Reduction Proposal

Deficit Reduction Proposal

Save $3.5 T over 10 years

Deficit Reduction Proposal

Save $3.5 T over 10 years


$320 B from Medicare and Medicaid

Deficit Reduction Proposal

Save $3.5 T over 10 years

$320 B from Medicare and Medicaid


$248 B from Medicare $73 B from Medicaid

Deficit Reduction Proposal

Save $3.5 T over 10 years


$320 B from Medicare and Medicaid $248 B from Medicare

$73 B from Medicaid


OMB baseline assumes doc fix?!

Deficit Reduction Proposal

No cuts to Social Security

No structural changes to Medicare


No benefit changes

Deficit Reduction Proposal

Blended FMAP MOE No provider taxes ($26 B) Increase

Deficit Reduction Proposal

MedPAC recommendations

o IME cuts
o Bad debt payment cuts o Medical imaging utilization rate cuts

Deficit Reduction Proposal

IPAB
PPACA:
Medicare spending per beneficiary

>

GDP growth + 1%

Deficit Reduction Proposal

IPAB
Obama deficit reduction:
Medicare spending per beneficiary

>

GDP growth + 0.5%

Deficit Reduction Proposal

IPAB
Obama deficit reduction:
Medicare spending per beneficiary

>

GDP growth + 0.5%

Deficit Reduction Proposal

Deficit Reduction Proposal

IPAB
Obama deficit reduction:
Medicare spending per beneficiary

>

GDP growth + 0.5%

Sequestration

Deficit Reduction Proposal

IPAB
Obama deficit reduction:
Medicare spending per beneficiary

>
=

GDP growth + 0.5%

Sequestration

Provider CUTS

Healthcare Reform

Healthcare Reform

Policy MGMA Principles


Fix the Medicare physician payment system
Simplify administrative transactions

Medical liability reform


Expand coverage Improve quality and safety Promote adoption of HIT

Policy
MGMA Statement MGMA cannot support this final legislation HCR fails to address SGR and payment fix Independent Payment Advisory Board (IPAB) No meaningful federal medical liability reform Cuts to the technical component of imaging services

Physician-self referral ban


Administrative simplification not fully realized

Expanding Coverage to 32 Million


What Would Happen Under Reform

25 million

158 million

Source: Congressional Budget Office

Coverage: Insurance Exchanges


In 2014, all individuals will be required to obtain coverage or face a penalty. Individuals can purchase coverage from newly created insurance exchanges. Federal help for some individuals to pay for insurance.

Coverage: Insurance Exchanges

Questions