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Living Well: How health care reform affects you

Created date

November 23rd, 2010

Perhaps the most significant legislation passed in 2010 was the Patient Protection and Affordable Care Act signed into law by the President in March. As with any highly politicized legislation, it is difficult to understand what was passed and what will take effect in the coming year. The law is focused on three areas that we all agree are important for effective health care: improving the delivery system of high-quality care, improving access to and coverage for care, and finally the area that creates concern controlling cost.

The good news

If you fell into the coverage gap known as the doughnut hole on your part D drug benefit, you ll receive a $250 refund for costs paid out of pocket in 2010. Starting in 2011, you will also get a 50% discount on brand-name medications if you fall into this same coverage gap. The legislation also provides coverage for an annual wellness exam and increased coverage of preventive services. Medicare only used to pay for a one-time exam for new recipients. While the details are yet to be determined, it is encouraging that greater emphasis will be placed on prevention with more coverage of preventive services. The law also attempts to address the current and worsening shortage of physicians who provide care for Medicare recipients by giving incentives to physicians who practice primary care and by increasing funding of training programs for primary care providers. Doctors meeting certain standards will be rewarded, and doctors who perform poorly may be penalized. Hopefully, this will mean better and timelier care for you, although some are concerned that providers will shy away from complex cases for fear of performing poorly on quality measures.

The (possibly) bad news

In an effort to rein in Medicare expenditures, Congress has created the Independent Payment Advisory Board (IPAB). The Board will have the power to develop proposals to limit health care spending if Medicare exceeds a targeted growth rate. Although Congress clearly specifies that IPAB proposals cannot include recommendations to ration health care; raise Medicare premiums; or increase Medicare beneficiary deductibles, coinsurance, and copayments, the possible reductions in payments to providers is a concern. Some providers may choose to stop accepting Medicare patients if payment reductions are too severe. Finally, where there is legislation, there is politics and room for misinterpretation of information. One benefit of the law, which became controversial, allows Medicare to reimburse doctors for end-of-life consultation visits. This provision, however, does not require Medicare recipients to have these consultations, contrary to a rumor that the consultations are intended to push people into hospice plans rather than receive treatment for their particular health condition. Rather, the consultation would include discussions about advance directives, living wills, and all treatment options all of which are important to have if we cannot speak for ourselves in the setting of illness or injury. In good health, Matt Narrett, M.D. Matt Narrett, M.D., is chief medical officer forErickson Livingand directs the provision of medical care at allErickson Living communities. He received his medical degree from Harvard Medical School and is board certified in internal medicine and geriatrics. He is coauthor ofOld is the New Young, a guide to successful aging (available on amazon.com).

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