Nursefriendly.com: Out-of-Pocket Costs

Wednesday, April 6, 2011

The Affordable Care Act includes a number of policies to help physicians, hospitals, and other caregivers improve the safety and quality of patient care and make health care more affordable. By focusing on the needs of patients and linking payments to outcomes, these delivery system reforms will help improve the health of individuals and communities and slow cost growth.
On March 31, 2011, the Department of Health and Human Services (HHS) released proposed new rules to help doctors, hospitals, and other providers better coordinate care for Medicare patients through Accountable Care Organizations (ACOs). ACOs create incentives for health care providers to work together to treat an individual patient across care settings – including doctor’s offices, hospitals, and long-term care facilities. The Medicare Shared Savings Program will reward ACOs that lower growth in health care costs while meeting performance standards on quality of care and putting patients first. Patient and provider participation in an ACO is purely voluntary.

via healthcare.gov

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A legislative organization calls on hospitals, insurers and physicians to disclose when patients must pay for care.

By Emily Berry, amednews staff. Posted March 29, 2011.

As several states consider whether, or how, to restrict balance billing by out-of-network physicians, the National Conference of Insurance Legislators on March 6 adopted model legislation on the issue.

Rather than explicitly banning or allowing physicians to bill patients when insurance doesn't cover what a physician is owed, the model legislation calls for greater transparency on the part of hospitals, insurers and doctors to alert patients to the possibility that they could end up paying out of pocket for care.

The model bill builds on laws recently adopted in Louisiana and Texas, according to NCOIL's announcement.

via ama-assn.org