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0 pointsmikeyouse9y ago0 comments

The ACA has a ton of cost controls, you should really reconsider your certainty on the topic if you don't know basic facts. A few ways costs are held in check:

1. Rate Review & the 80:20 rule: http://obamacarefacts.com/obamacare-rate-review-80-20-rule/

2. IBAP or "death panels" if you're a halfwit politician from Alaska: https://en.wikipedia.org/wiki/Independent_Payment_Advisory_B...

3. Readmission Reductions Program where hospitals won't be reimbursed if patients come back with the same issues: https://www.cms.gov/medicare/medicare-fee-for-service-paymen...

4. The HCFAC was given an extra $350M to combat fraud and absuse: https://oig.hhs.gov/reports-and-publications/hcfac/index.asp

5. The ACA authorized CMS to run background checks and site visits (which were previously forbidden) on providers to ensure they're legitimate.

6. The ACA authorized CMS to withhold payments if fraud is suspected -- Previously they were required to pay, then try to get the money back.

7. The ACA greatly expanded the Recovery Audit Contractor program to Medicare C and D, mandating post-billing audits of Medicare providers.

8. The ACA gave the OIG the ability to levy large fines ($50,000/false statement) on providers who defraud health programs.

9. The ACA created a centralized databank to share claims information between Medicare/Medicaid/CHIP/VA/DOD/SSDI.

10. There are a litany of provisions about home health care, hospice, nursing homes, and other areas that were formerly high-risk fraud areas. New penalties, restrictions, enforcement mechanisms, etc.

11. The ACA reduces payments to hospitals that have high incidence of hospital-acquired infections in their patients.

12. The ACA greatly expanded competitive bidding for durable medical equipment ensuring that nearly all categories now will have a proper bidding process and regular price updates.

13. The ACA expanded the prescription drug rebate program: https://www.medicaid.gov/medicaid/prescription-drugs/medicai...

14. The ACA established the Center for Medicare/Medicaid Innovation which research and perform trials of new care delivery models with a focus on lower-cost, higher-quality service.

15. The Bundled Payments for Care Improvement changes the focus of hospitals by providing a target cost for an admission instead of paying for each service the patient receives. So if you go to the hospital with a kidney infection, instead of performing every test in the world on you to run up their reimbursement rate, the hospital is now focused on the lowest cost care that will prevent readmission: https://innovation.cms.gov/initiatives/bundled-payments/

I mean.. there are literally hundreds of cost-control provisions..

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3 comments · 3 top-level

fencepost9y ago

While there are a lot of cost-control measures, just about everything you listed except the first item is pretty small - it's only in the aggregate that most of those measures make a big difference.

In addition while this is a contentious subject telling people to "reconsider your certainty [...] if you don't know basic facts" is needlessly confrontational.

em3rgent0rdr9y ago

But these cost-control provisions haven't produced significant reduction in cost, according to my premium & deductible.

antisthenes9y ago

I was speaking about the actual effects. If none of the cost controls introduced actually reduced costs, then you can keep citing millions of provisions, but unless they are effective, they were not cost controls.

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