Contents of Obamacare - Part 8 - The Donught Hole

Improving Medicare for Patients and Providers. New rules allow Physician Assistants to order post-hospital testing, allow funding for complex diagnostic testing such as genetic testing or cancer chemotherapy sensitivity assays, improved access for certified nurse mid-wife services, and extension of “hold harmless” provisions and other protections for small rural hospitals. Improving Payment Accuracy. This section includes adjustments to payment for Home Health Care, more modifications for rural care, hospice care payment modifications, procedures for reevaluation and modification of misvalued codes under the physician fee schedule, adjustments to payments for “power-driven wheel chairs”, payment rates for ambulatory cancer centers, and payment for biosimilar products (generic versions of biologicals). Medicare Advantage Payment (Part C): Covering someone on a Medicare Advantage plan used to cost 14% more than covering someone on the original Medicare. These payments are being reduced under the law which accounts for the savings in Medicare that are often referred to as “cuts” by Mitt Romney and his advocates. These savings to the government are actually being put back into the Medicare program. Medicare Part D (Prescription Drugs): The law phases out the “donut hole” by 2020. The “donut hole” was a coverage level in the original plan (signed into law by President George W. Bush) where seniors had to pay 100% of their costs for pharmaceuticals until their annual costs became so severe that they qualified for “catastrophic coverage”. Pharmaceutical manufacturers will now be paying 50% of the costs for brand name drugs purchased while the beneficiary is “in the donut hole”, and generic drugs will be offered with a 14% discount. Obamacare offers better prescription drug coverage for people with low incomes. Health Care System Delivery Research: The law directs the “Center for Quality Improvement and Patient Safety”, which is part of the” Agency for Healthcare Research and Quality”, to conduct studies and determine workable best practices for health care that can be promoted across the board to all providers. The center may identify certain health care programs that are particularly astute and successful in their delivery of services and develop methods for dissemination of such techniques nationwide. Grants are offered to conduct pilot projects for various health care delivery systems to determine the effectiveness and feasibility. The law promotes the availability of trauma care centers for all local areas. The law promotes grants to develop “patient decision aids” where patients, based upon their value system, provide input into the proper path for their own care; this includes the summaries of the risks and benefits of prescription drugs in a standardized format. NEXT: WOMEN AND OBAMACARE!