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Title III. Improving Health Care Print Page
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Donut Hole

  • Health Reform and Medicare: The Doughnut Hole in 2012
    Medicare Rights Center, September 2011 (PDF file)
    The Affordable Care Act closes the Part D doughnut hole—the gap in Medicare prescription drug coverage—by gradually reducing beneficiaries’ share of drug costs over a period of ten years. In 2012, just as in 2011, people in the doughnut hole will receive a discount on brand-name and generic drugs at the time they buy them and will not have to spend as much out of their own pockets.
  • More savings in the drug coverage gap coming through 2020
    Medicare.gov (web site)
    If you’re in the donut hole, you'll also get a 50% discount when buying Part D-covered brand-name prescription drugs.
  • THE RESPONSE OF DRUG EXPENDITURES TO NON-LINEAR CONTRACT DESIGN: EVIDENCE FROM MEDICARE PART D
    NBER, August 2013 (PDF file)
    NBER's estimates suggest that "filling" the donut hole, as required under the Affordable Care Act, will increase annual drug spending by $180 per beneficiary, or about 10%. Moreover, almost half of this increase is anticipatory," coming from beneficiaries whose spending prior to the policy change would leave them short of reaching the donut hole. We also describe the nature of the utilization response and its heterogeneity across individuals and types of drugs.
  • AARP Doughnut Hole calculator
    WANT TO AVOID THE MEDICARE DRUG COVERAGE "DOUGHNUT HOLE"?If you have Medicare Part D, you may be at risk of falling into the coverage gap, or "doughnut hole."

Improve Care

Areas of interest under this provision: Health Homes; Provider-Preventable Conditions Including Health Care-Acquired Conditions; Quality Improvement; Adult Quality Measures; Prevention; TEFT
  • Medicare Hospital Readmissions Reduction Program
    Health Affairs, November 2013 (PDF file)
    To improve care and lower costs, Medicare imposes a financial penalty on hospitals with excess readmissions.
  • Medicare Readmission Penalties by Hospital (Year 2)
    Kaiser Family Foundation, August 2013 (PDF file)
    This chart shows the first year of penalties, which are being applied from Oct. 1, 2012, through Sept. 30, 2013.
  • Examining the Drivers of Readmissions and Reducing Unnecessary Readmissions for Better Patient Care  
      
    American Hospital Association, September 2011 (PDF file)
    Policymakers are proposing incentives to reduce hospital readmissions by publicly posting data on readmission rates and lowering payments to hospitals with high rates.
  • Hospital Patient Safety  
      
    National Business Coalition on Health, September 2011 (PDF file)
    Hospital-acquired conditions, readmissions and serious reportable events are significant issues impacting employee health and the health care claims costs incurred by employers.
  • Doing Better by Doing Less: Approaches to Tackle Overuse of Services
    Urban Institute, June 2013 (web page)
    This Robert Wood Johnson Foundation-funded analysis presents what we know about the provision of medically inappropriate and unnecessary services that drive up health care spending without making a positive impact on patients' health outcomes.
  • Federal and State Policy to Promote the Integration of Primary Care and Community Resources  
      
    NASHP, August 2013
    In May 2013, NASHP convened and facilitated a discussion among high-level federal and state leaders.
  • Evaluating Quality Improvement Training Programs
    RWJF, August 2013 (PDF file)
    The goal of Evaluating Quality Improvement Training Programs was to learn what works in QI training programs so that more organizations adopt best practices and more health providers acquire training in quality improvement.
  • Access to Physicians’ Services for Medicare Beneficiaries
    HHS, August 2013 (web site)
    This issue brief summarizes recent trends in: a) the degree to which physicians accept new Medicare and privately insured patients; and b) Medicare beneficiaries’ access to care before and after the enactment of the Affordable Care Act.
  • Improving Health Care Quality Through Community Collaboratives
    Alliance for Health Reform, August 2011 (PDF file)
    This issue brief looks at efforts to bridge the “quality chasm” by promoting collaborative efforts to improve the quality of health care on the community level. It looks at how local coalitions are advancing the use of health information technology (HIT) to improve quality, reporting quality measures and overcoming challenges going forward.
  • ON THE ROAD TO BETTER VALUE: STATE ROLES IN PROMOTING ACCOUNTABLE CARE ORGANIZATIONS  
      
    Commonwealth Fund and NASHP, February 2011 (PDF file)
    With the passage of the Affordable Care Act in 2010 and the enormous opportunities available to states to transform the health care delivery system, the accountable care organization (ACO) model is receiving increased attention for its potential to promote better value in health care spending without some of the perceived problems of past approaches.
  • Refining the hospital readmissions reduction program
    MedPac, Chapter 4, June 2013 (PDF file)
    The current readmission penalty is one step forward in a series of steps to improve care coordination and care outcomes for Medicare patients. However, computation
    of readmissions rates and of the penalty could be refined to address four issues with the current policy: Aggregate penalties remain constant when national readmission rates decline; Single-condition readmission rates face significant random variation due to small numbers of observations; Heart failure readmission rates are inversely related to heart failure mortality rates. Hospitals’ readmission rates and penalties are positively correlated with their low-income patient share.
 

About Title III. Improving the Quality and Efficiency of Health Care

The Act will protect and preserve Medicare as a commitment to America’s seniors.  It will save thousands of dollars in drug costs for Medicare beneficiaries by closing the coverage gap called the “donut hole.”  Doctors, nurses and hospitals will be incentivized to improve care and reduce unnecessary errors that harm patients.  And beneficiaries in rural America will benefit as the Act enhances access to health care services in underserved areas.

The Act takes important steps to make sure that we can keep the commitment of Medicare for the next generation of seniors by ending massive overpayments to insurance companies that cost American taxpayers tens of billions of dollars per year.  As the numbers of Americans without insurance falls, the Act saves taxpayer dollars by keeping people healthier before they join the program and reducing Medicare’s need to pay hospitals to care for the uninsured. And to make sure that the quality of care for seniors drives all of our decisions, a group of doctors and health care experts, not Members of Congress, will be tasked with coming up with their best ideas to improve quality and reduce costs for Medicare beneficiaries.

The Secretary has the authority to take steps to strengthen the Medicare program and implement reforms to improve the quality and efficiency of health care. 

Find out more on Medicare.gov. For Medicare data go to Data.gov.

Performance Measures

Physicians Payments

Areas of interest under this provision: Improving Payments for Primary Care Services; Q & A: Increased Medicaid Payments for Primary Care Physicians; Combined State Plan Reimbursement Template for Medicaid PCP Payment Increases and VFC; Disproportionate Share Hospital (DSH) Payment; Medicaid Emergency Psychiatric Demonstration Project; Improvements to the Medicaid and CHIP Payment and Access Commission (MACPAC)

Medicare

The changes to Medicare fall into three primary categories: 1) expansion of coverage for prescription drugs and preventive care, 2) cost-saving mechanisms to finance that coverage expansion and 3) new coverage for those not eligible for Medicare.

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