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Health shift under way

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Art Wiederin spends his days sitting in the lobby of Fox Point Independent and Assisted Living in McHenry, talking to other residents, teasing staff, and watching various health professionals come and go.

At 82, Wiederin has a lot of experience with the health care system, but he hasn’t noticed any changes over the past few years as the different provisions of the Patient Protection and Affordable Care Act – the federal health care reform that is sometimes fondly, and more often disparagingly, referred to as Obamacare – began to take effect.

“I’m going to say right up front that I don’t understand it all,” Wiederin said. “My whole feeling is that health care needs, from top to bottom, needs revamping. I think the system is in bad shape.”

The 2010 law has three goals, said Ellen First, a senior consultant with Health Dimensions Group, which is a health care consulting firm working with Hearthstone Communities in Woodstock.

They are, she said, to improve the population’s overall health, to encourage services to be provided in a efficient and cost-effective way, and to ensure good outcomes for patients.

But even professionals such as First are still trying to figure out how this all will work, especially because provisions such as state insurance exchanges haven’t been created yet.

Insurance exchanges are designed to make the insurance market more competitive and transparent, according to a federal website dedicated to the law and health care more generally.

States don’t have to have their exchanges up and running until 2014, and some states, Illinois included, plan on partnering with the federal government for their first year.

Illinois’ General Assembly hasn’t yet passed legislation setting up a financing mechanism or a governing board, said Mike Claffey, a spokesman for the Illinois Department of Healthcare and Family Services.

Several departments have been laying the groundwork, though, for more than two years, and the General Assembly created a 12-member legislative study committee to look at the issue.

But in the meantime, before the exchange is up and running and the best known and most controversial provision – a requirement that most people buy insurance or pay a penalty – kicks in, other portions of the law gradually are taking effect.

Hospitals, doctors and third-party providers have been preparing.

Hearthstone Communities has seen its focus shift from only long-term residential facilities to include more rehab or transitional services, said its chief financial officer, Ric Olson.

It’s a trend that started before the implementation of the Affordable Care Act but has been accelerated because of it, First said. Hearthstone also has had to focus on reducing the number of people readmitted to the hospital, Olson said.

Under a provision that went into effect Oct. 1, Medicare payments are linked to hospital performance in an effort to encourage them to improve quality of care. A similar provision for doctors will go into effect in 2015.

“Research has shown that where our health care breaks down is in those transitions of care, transitions from the hospital to the post-acute provider, transitions from the post-acute provider to home care,” First said. “There’s been a lot of work, specifically in the last five to 10 years, in creating better lines of communication at those transitions of care.”

Hospitals, such as those in Centegra Health System, also are putting more of an emphasis on these transition times and keeping people healthier in general, said Susan Milford, Centegra’s senior vice president of strategy and development.

This year, Centegra implemented its WellBridge program, through which doctors can prescribe exercise to their patients.

Long before the law went into effect, Centegra opened two HealthBridge Fitness centers, one in Crystal Lake about 15 years ago and another in Huntley in 2008. Besides exercise programs, the centers also offer nutrition guidance.

The new program ties those centers with doctors’ recommendations, Milford said.

“The whole idea is that you are returning these patients to a healthier and better quality of life,” she said.

Like other health care providers, Centegra, guided by a new vice president of clinical effectiveness, is still researching the portions of the Affordable Care Act to come, including bundled payments for a type of care.

Under the bundled payments system, there would be, for example, one care path and price for a knee replacement instead of someone being charged for each particular test and visit.

In May, a new electronic medical records system was implemented to allow the different Centegra clinics and facilities to exchange records, Milford said.

“I think for all it is, it’s a good direction for health care to be going because it’s putting the patient at the center, just trying to keep them healthy and well, and when they do get sick, it’s delineated, evidence-based, quality way where we’re incentivized on outcome,” she said.

What’s new

Two provisions of the federal Patient Protection and Affordable Care Act, also known as Obamacare, went into effect in October:

• A program that ties Medicare payments to hospital performance. Hospitals are required to track and report measures connected to heart attacks, heart failure, pneumonia, surgical care, infections contracted in the hospital and patients’ perception of care.

• Regulations that encourage hospitals to standardize billing and adopt electronic medical records.

What’s coming

Some of the law’s biggest provisions have yet to implemented, but 2013 is a relatively light year in terms of changes. The three parts that go into effect at the beginning of the year are:

• New federal funding to Medicaid programs that cover preventive services at little or no cost.

• Requirements that states pay doctors 100 percent of Medicare payment rates in 2013 and 2014 for primary care services. The increase will be paid for with federal funds.

• The creation of a pilot program to encourage “bundling.” Under the proposed system, doctors, hospitals and other providers will be paid a flat rate for episode of care instead of for each individual test or visit.

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