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Impact of Health Care Reform on Health Care Providers

OnDemand Webinar (91 minutes)

Health care providers face multiple challenges and are presented with numerous opportunities brought about by the enactment of the Patient Protection and Affordable Care Act and the Health Care Reconciliation Act, commonly referred to as health care reform or ACA. While advancing the overarching themes of accountability, efficiency, quality and access to care, health care reform also will focus providers on alignment strategies and integration to enable coordination of care and ability to manage bundled payments. Hospitals will need to adapt to Medicare value-based purchasing while physicians can benefit from increased rates of payment through a quality driven relative value unit modifier. With the anticipated onset of as many as 34 million newly insured under the insurance mandate and coverage expansion to include preventative care, providers will be required to find necessary capital and personnel to respond to a potentially unprecedented demand for their services while incentives will be provided to encourage medical students to take up primary care. For tax-exempt hospitals, there are also new obligations to satisfy additional requirements for demonstrating they are meeting the needs of their communities and physicians will face increased scrutiny on their economic interests in referrals and payments from drug manufacturers. Putting health care reform in perspective for providers, our panel of nationally recognized legal authorities will bring to bear their depth of knowledge in health care reform and their experiences in the policy arena, creating new structures for care delivery and advising on regulatory compliance.


Gerry Hinkley, Pillsbury Winthrop Shaw Pittman LLP
Nandan Kenkeremath, QSI/NextGen Healthcare
Amy Leopard, Bradley Arant Boult Cummings LLP


Overview and Focus of ACA Payment and Health Care Delivery Reforms

• Overview of Reforms in the Context of ACA

• General Impact of Quality Incentive Programs on Payment Reform

• Incentives for New Patient Care Models

Demonstration Programs

• Center for Medicare and Medicaid Innovation (CMMI)

• Accountable Care Organization Programs

Changes to Medicare Payment Systems for Sustainability and Budget

• Changes to Payment Update Systems for Fee Schedules

• Acceleration of Competitive Bidding for DME

• Independent Payment Advisory Board

• Coordination of Medicare and Medicaid Dual Eligibles

• Enhancements to Program Integrity

Related Ongoing Legislative Discussions

• Congressional Doc Fix Discussions and Payment Reforms

• Sequestration and Deficit Reduction

Provider-Based Initiatives

• Governance for Community Health (Community Needs, Public Health, Health Information Exchange)

• Patient Engagement/Consumer Health (Portals/Personal Health Records/Social Media)

• Wellness and Outreach (Wellness Programs, Work-Based Clinics, Telehealth)

• Care Coordination (Accountable Care Organizations, Patient-Centered Medical Homes, CMMI Initiatives)

• Physician Alignment (Bundled Payments, Accountable Care Organizations)

• Quality and Performance Reporting (Value Based Purchasing, Readmissions, Clinical Documentation Improvement, Analytics)

• Impact of Health Insurance Exchanges