Not all Medicare changes are result of Affordable Care Act. Some are cost cutting measures recommended by congress to help balance the budget. Critical access hospitals are facing the same pressures my inner city health system is facing:
Less paying customers.
With insurance rates going up, Employers switched to insurances plans with "Flexible spending accounts" monies employees could use for health benefits only for employees to realize their deductibles and copay is $5,000 --- not many can afford that out of their savings, so held off on elective surgeries.
COBRA benefits cost for laid off employees is out of reach for majority.
75% admissions coming thru ER -- no planned admissions for surgery so can fill up beds and even out census.
Increase in for-profit surgicenters, often physician owned, that siphon paying services from hospital coffers.
Federal government's requirement to provide "stabilization" care to any patient showing up in ER.
Lack of Family and internal medicine physicians that care for inpatient--thus need to hire hospitalists. Add to that dearth of ortho and specialists on staff= less to refer to hospital services.
Managed care contracts demanding pay rates less than Medicare --fearful of being cut out of market and patients, many capitated and agreed.
Shift from pay-per proecdre/test to paying for OUTCOMES of care and quality care.
Refusal to pay for NEVER EVENTS -thus hospital absorbing costs.
Overall economic forces: EVERYTHING costs more each year from toilet paper, to food, medications to electricity to run a building. What CAN hospitals control--staffing budget.
These are the provisions of Affordable Care Act that are affecting Medicare
The Affordable Care Act
: New Tools to Fight Fraud, Strengthen ..
How the Affordable Care Act of 2010 Helps low income families- The Commonwealth Fund
Medicare cost cutting measures started before Obama elected.
Pay for Performance/Quality indicators : Quality Initiatives - General Information | Centers for Medicare ...
Started 2007: Most doctors headed for penalty over Medicare quality reporting
Growing numbers of physicians are earning reporting bonuses, but hundreds of thousands still have not participated in a program that turns punitive in 2013.
2008: Quality Measurement, Greater coordination and intergration of care
A recent trends report from the Centers for Medicare & Medicaid Services shows that fewer than 200,000 physicians, out of the more than 600,000 who were eligible for the incentive program, reported PQRS measures in 2010. More than 125,000 physicians reporting as individuals met enough of the requirements to share a total of nearly $400 million in bonuses, but hundreds of thousands of eligible doctors did not attempt to meet the pay-for-reporting criteria. More than 50,000 tried for the bonuses but did not report enough quality measures to hit the minimum.
American Recovery and Reinvestment Act of 2009 put in $$$ for implimenting Electonic Medical Records (EMR) via HITECH Act
About the HITECH Act of 2009 - Understand the HITECH Act ...
I have a few physicians that refuse to have fax machines in their office "they just generate more paper" and many without computer systems. Try getting their attention for critical lab results and getting homecare orders signed after mailed 2x's and not returned requires in-person visit ---waste of staff time and talent.