The Patient Protection and Affordable Care Act-health system reform legislation signed into law by President Obama on March 23-contains a number of key provisions for providers and patients. Some changes may have an immediate impact on Medicare payments, while others will take effect over the next five years. We asked Medicare Payment experts what impact they believe the new law will have on Medicare Payment jobs. Here's what they had to say:
Overall, as hospitals are mandated to continue to demonstrate enhanced value in their services, the pressure will be on to elevate service delivery at higher quality and reduced cost. Administrative personnel will perhaps be more vulnerable than the clinical resources required to deliver the service quality. Nonetheless, as government and payers increase oversight and measurement of quality standards, I see continued demand for talented, dedicated professionals in Medicare payment jobs as hospitals will still be required to maintain regulatory compliance and optimize reimbursement and collection.
R-C Healthcare Management Services, Inc.
Professionals who specialize in Medicare and Medicaid reimbursement will be busy as providers seek guidance on the health care reforms. In addition, lawyers may be busy bringing legal challenges to the reforms (some litigation has already been filed) or the government's regulatory implementation of the reforms.
Barbara Straub Williams,
Powers Pyles Sutter & Verville PC
The new legislation does not change Medicare payment policy for hospitals. In the future, as the law is implemented and possibly challenged, we may see regulations that complicate payment (e.g. hospital payment tied to quality measures) and these might create the need for more Hospital Medicare Payment people as well as additional consulting services. For now, however, there is nothing specific to project.
Paul Shoemaker, FACHE,
American Hospital Directory
"Reductions in Medicare payment rates should not be confused with reforming the delivery system. The reduced payments just continue the same dysfunctional incentives that reward more and more complex rather than high-quality outcomes at efficiently produced prices. The real reforms depend on the pilots described in the legislation, in particular regarding development of accountable care organizations in which physicians and hospitals team together to share resulting savings, and bundling of payments across all providers involved in an episode of care.
"These congressionally mandated pilots are intriguing and could help drive the current delivery system, where most physicians practice in small single-specialty groups unaffiliated with the hospitals where they practice, to a more functionally integrated system. However, it would be difficult to overestimate the challenges involved in getting pilot projects up and running in a timely way, making midcourse corrections where needed, validating the results, and then implementing those that prove successful wherever such implantation makes sense."
Gail Wilensky, economist and senior fellow, Project HOPE; former Administrator of the Health Care Financing Administration (now called CMS)
"The ultimate credit effect of the recently passed federal healthcare reform for the not-for-profit hospital sector will be negative despite reduced bad debt expense and charity care provided by expanded insurance coverage for previously uninsured patients.
"The key longer-term challenge for not-for-profit hospitals is the reform's reliance on extracting long-term cost efficiencies from hospitals, probably resulting in diminished hospital revenues. The trend will become more pronounced over time as key provisions of the law do not become effective until 2014.
"The effects will include more difficult negotiations with private health insurers due to increasing regulatory scrutiny of the insurers by federal regulators. Hospitals also will face reimbursement pressures from government payers as the reform includes provisions that squeeze savings out of Medicare and Medicaid, including initiatives to identify improved operating efficiency."
Moody's Investors Service: "Long-term Credit Challenges of Healthcare Reform Outweigh Benefits for Not-for-Profit Hospitals"
Publication Date: Monday, April 19, 2010