Revised Internist's Guide Reflects Changes to Affordable Care Act

ACP publication showcases what internists need to know in coming years

March 12, 2013

(Washington) An updated version of An Internist's Practical Guide to Understanding Health System Reform, including revisions that offer an up-to-the-minute understanding of how the Affordable Care Act will roll out in the years to come, has been released by the American College of Physicians (ACP).

The guide focuses on how the act will affect physicians and their practices.

"We've published this since 2010, and the guide really helps define the provisions of the law being implemented," said David L. Bronson, MD, FACP, ACP's president. "This is a great source and it is written with the internist customer in mind: How does this affect you?"

The new version of the guide mainly reflects changes in the Affordable Care Act that have taken place since the Supreme Court handed down its ruling last June deeming the law constitutional. The revised guide also takes into account the political opposition the law has faced at the state level.

Specific revisions include:

  • Medicaid expansion. The original law relied on a federally funded expansion of Medicaid in 2014 to extend health coverage to millions of Americans, with the threatened loss of existing Medicare funding if states refused to expand the program.

    "The Supreme Court's ruling gave states the option to not expand without the threat of losing Medicaid funding," Bronson said. "That was a significant shift and change, and the guide was updated to reflect that decision. States across the country are in the process of deciding whether they will expand their Medicaid programs, and we are keeping a close eye on that."

  • Health insurance exchanges. The law also requires states to set up health insurance exchanges by 2014, which would serve as open marketplaces for individuals and groups looking for health coverage. If a state balks at setting up its own exchange, the federal government will step in and set up one on the state's behalf.

    "In December, states were required to declare whether their exchanges would be state or federally operated," Dr. Bronson said. Of all states and the District of Columbia, 24 have refused to set up an exchange and will have theirs implemented by the federal government, 19 have elected to run their own exchanges and six will partner with the federal government. Two states remain undecided.

  • Cost of implementation. The Supreme Court decision to make the Medicaid expansion optional has reduced the cost of implementing the Affordable Care Act, and that reduced cost is included in the report. According to the Congressional Budget Office, the expansion of coverage as a result of the health law is estimated to cost roughly $1.2 trillion over the next decade, down $84 billion from the CBO's last estimate in March 2012.

  • Value-based payment modifier. The guide gives an updated description of the Centers for Medicare and Medicaid Services value-based payment modifier, which provides the opportunity for financial incentives for physicians in practices of 100 or more eligible professionals who participate in the Physician Quality Reporting System. "Practices that participate in PQRS, when they meet certain criteria, will have the opportunity to receive a positive (or negative) adjustment in their Medicare payments," Dr. Bronson said. "It's telling folks that if you participate and you do well, you're going to get a bump up in your payments."

Though the payment modifier will not be implemented until 2015, Dr. Bronson said it's important for physicians to understand its provisions now because the 2015 modifier will be based on performance and PQRS participation in calendar year 2013.

Dr. Bronson said he urges all internists to review the guide so they'll have a clear understanding of what is coming up. "We wanted to give physicians one place to look for information so they can be ahead of the game," he concluded.

About the American College of Physicians
The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 133,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

David Kinsman, (202) 441-3573
Jacquelyn Blaser, (202) 261-4572