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All of the political rancor during the past couple of years made it hard to remember that the Patient Protection and Affordable Care Act contains provisions beyond the insurance mandate. The 906-page law includes dozens of mandates — some of which are already in place — that will dramatically change the way health care is accessed, delivered and paid for. Others have yet to be promulgated by Health & Human Services. The Supreme Court's landmark June 28 ruling on the law clears the way for implementation to move forward. Many of the provisions impacting hospitals and health systems will unfold over the next couple of years and likely will spur a significant realignment of resources. To some extent, that is happening already under the banner of accountable care organizations. Here's a snapshot of some of the key provisions in the Affordable Care Act impacting hospitals and health systems.



  • Reductions to the annual marketbasket update for inpatient and outpatient hospital services, long-term care hospitals, inpatient rehabilitation facilities and psychiatric hospitals started. Since enactment, the Centers for Medicare & Medicaid Services has issued several rules impacting marketbasket updates.
  • Patient-Centered Outcomes Research Institute created. The nonprofit institute is charged with conducting comparative effectiveness research.
  • Federal Coordinated Health Care Office established to better coordinate care for dual eligibles.
  • The Internal Revenue Service in June proposed regulations governing new requirements nonprofit hospitals must meet in order to maintain tax-exempt status.


  • Center for Medicare & Medicaid Innovation established on Jan. 1. The center will test new payment and delivery system models.
  • Community-based care transitions program started. The five-year Medicare pilot targets beneficiaries who are high risk for readmission.
  • Starting Jan. 1, Medicare awarded bonus payments for primary care services and for general surgeons practicing in health professional shortage areas.
  • The law sought to increase the number of graduate medical education training positions by redistributing unused slots.


  • CMS unveiled the federal shared savings program and announced the first wave of approved accountable care organizations.
  • Value-based purchasing program started. Hospital payments for fiscal 2013 are based on 2012 performance.
  • Beginning in fiscal 2013, hospitals will be penalized for "excess" preventable readmissions.


  • States must notify HHS if they'll operate a health insurance exchange.
  • National, voluntary five-year bundled payment pilot to launch.
  • States required to boost payment to primary care providers.


  • Individual insurance mandate takes hold, Medicaid expansion to begin and health insurance exchanges to open.
  • Other key insurance reforms to take effect including no annual limits on coverage.
  • Medicare Independent Payment Advisory Board scheduled to deliver recommendations to Congress.
  • Payments to disproportionate share hospitals will be cut.
  • Penalties for hospital-acquired conditions to start in fiscal 2015 and continue for 10 years.

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