TopMed-Pro Management, Inc.
Medical Practice Management & Consulting
NewsWire                                                                                              April 2010
In This Issue
Health System Reform
Impact on Providers
Impact on Patients
Health System Reform
On March 23, President Obama signed the Patient Protection and Affordable Care Act into law. The following points out the key provisions of the legislation that impacts provider practices and patients, respectively.
Impact on Providers
Medicare Payment Changes
  • 10% incentive payments for primary care physicians - family medicine, general internal medicine, geriatrics and pediatrics. Timeline: 2011-2016.
  • 10% incentive payments for general surgeons performing major surgery in health professional shortage areas. Timeline: 2011-2016.
  • 5% incentive payment for mental health services. Timeline: 2010.
Medicaid Payment Changes
  • Raise Medicaid payments to family medicine physicians, general internists and pediatricians for evaluation and management services and immunizations to at least Medicare rates.  Timeline: 2013 & 2014
  • Employers with more than 50 employees are required to offer health insurance coverage to their employees or be assessed a range in fees.  Employers with 50 employees or less are exempt from this requirement. Timeline: 2014.
Preventive & Screening Benefit Expansions
  • Medicaid will be required to cover tobacco cessation services for pregnant women.  Medicare payments for certain preventive services will be increased to 100% with no cost-sharing (i.e., co-payments will be eliminated). Timeline: 2010.
General Changes 
  • Health plans will be required to provide a minimum level of coverage without cost-sharing for preventive services such as immunizations, preventive care of infants, children and adolescents, and additional preventive care and screenings for women. Timeline: 2010.
"You can't hit the target unless you have one!" 
                   Yogi Berra
Quick Fact
Number of Americans who lacked health insurance at one point since January 2008:
58.4 million
Number of Americans who did not have health insurance for more than 1 year:
31.9 million
Number of Americans who die every year due to lack of health insurance:
Source: CDC
Medicare 21% delayed for 10 days.

Medicare audits to be expanded 
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Impact on Patients
Patient benefits that take effect in 2010
  • Insurance companies can no longer drop patients from their plans if they get sick.
  • Children ages 18 and younger can no longer be denied private insurance coverage if they have a pre-existing medical condition.
  • For adults with pre-existing medical conditions who cannot obtain private insurance coverage, a temporary national "high-risk pool" will be established to provide coverage.
  • Young adults up to age 26 can remain as a dependent on their parents' private health insurance plan.
  • Lifetime financial limits on benefits are eliminated.
  • Preventive services for women, such as mammograms, and immunizations for children must be covered by insurers, with no co-payments or deductibles required. Medicare Part D (prescription) patients who will hit the coverage gap known as the "doughnut hole" will receive a $250 rebate from Medicare. 
Patient benefits that take effect during the next 4 years
  • All U.S. citizens and legal residents must obtain insurance or pay a tax penalty. Timeline: 2014.
  • There will be state-based health insurance exchanges where people can shop for health insurance. Timeline: 2014.
  • Federal subsidies through tax credits or vouchers will be provided to people who cannot afford to purchase coverage through exchanges. Timeline: 2014.
  • States can require insurance companies to submit justification for premium increases and can impose penalties for excessive increases. Timeline: 2011.
  • Medicaid coverage will be expanded for those at or below 133% of federal poverty level. Timeline: 2014.
If you are interested to find out more about any of the topics mentioned, please do not hesitate to send us an email at or call us at (888) 549-1713.
Med-Pro Management, Inc.

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