Tag Archives: long term care

Title III

So – we are moving into Title III of the PPACA. If you recall, we already did Title IX, and of course Titles I and II. They are not evenly distributed.

Title III is “Improving the Quality and Efficiency of Health Care”.

The first subtitle looks at the delivery system, and the first part of the first subtitle looks at “Linking Payment to Quality Outcomes in Medicare”. Look out olds!

Section 3001 sets up hospital value-based purchasing programs. Even though the name is confusing, it basically gives money to hospitals as an incentive to improve quality in a few key areas, namely acute myocardial infarction (heart attack), heart failure, pneumonia, surgeries, and healthcare-acquired infections. After 2014, these payments will include measures of efficiency, given by the spending per beneficiary.

Section 3002 creates improvements in the physician quality reporting system. The biggest improvement is that it goes from an incentive to participate, to a penalty if you don’t. Which, I suppose, is an improvement from the government’s point of view.

Section 3003 improves the physician feedback system, used to identify issues of quality with physicians. It should be noted that these are physicians that receive money from Medicare and/or Medicaid.

Section 3004 improves quality reporting for long term care facilities.

Section 3005 discusses quality reporting for PPS-exempt cancer hospitals. PPS is the prospective payment system, which reimburses hospitals based on diagnosis codes when the patient enters the hospital. PPS-exempt hospitals, are well, exempt from that – since cancer patients may develop many more diagnoses while in the hospital. There are 11 of these in the US.

Section 3006 sets up a plan similar to 3001, only for skilled nursing facilities and home-health care agencies. You have to remember that when Medicare was set up, most of the health care of the elderly took place in a hospital. So everything is sort of set up around that idea. But that has changed in the 50+ years since Medicare was set up.

Section 3007 establishes payment modifiers for physicians based on the quality of care.

Section 3008 adjusts payments for people who acquire infections in the hospital. It reduces them by 1%. I would be interested in some experimental economics study about whether a 1% reduction was enough incentive to alter behavior.

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New Options!

Subtitle E of this section says that it provides new options for states to provide Long-Term Services and Support. You know, in case your state is in to that kind of thing.

Section 2401 allows the states to pay for home care or a home-like community care place in situations where they might previously be required to send a person to a nursing home or hospital.

Section 2402 removes more barriers to providing this kind of option. Given what they are doing, the barriers seem to have a lot to do with a lack of coordination on the part of the various entities responsible for such care. Also, there were apparently rules about the level of benefits these people could receive, and for how long, and etc. So these are eliminated by this section.

Section 2403 is called “Money Follows the Person” reduces the waiting period for payment for people who have been admitted to long-term care.

Section 2404 protects these people from spousal impoverishment. It doesn’t actually describe what the process of spousal impoverishment is, but it will protect you from it if you are in a long-term home care situation being paid for by Medicaid.

Section 2405 gives $10,000,000 a year until 2014 to increase aging and disability resources in the states.

Section 2406 is another “Sense of the Senate” section. It says that even though we said as a country we should improve the way we handle elder care in this country, we didn’t. These provisions should help improve this possibility, mostly by not requiring that we shove our sick and old into institutions rather than trying to care for them in their homes and their communities.

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