Here's how President Obama's healthcare package could impact your facility.

• More insured patients. The overall goal of the bill is to bring some 32 million Americans who currently lack coverage onto the insurance rolls by mandating that every U.S. citizen buy health insurance or face a tax penalty, and by prohibiting insurers from rejecting patients based on pre-existing conditions. Hospitals and ASCs are expected to benefit from an expanded pool of surgical candidates, although both will face cuts in Medicare reimbursement.
• Physician-owned hospitals in peril. The bill prohibits existing facilities from growing and bans new ones from contracting with Medicare. Dec. 31, 2010, is the deadline by which physician-owned hospitals must have achieved Medicare certification in order to be grandfathered into the bill. The Physicians Hospitals of America estimates a little over 60 physician-owned hospitals currently in development would be unable to make that deadline to receive Medicare certification.

About 300 existing physician-owned hospitals that would be grandfathered into the bill would be prohibited from expanding by adding beds, ORs or procedure rooms unless they can meet hard-to-reach growth criteria.

• Productivity adjustment applied to payments. Beginning in 2011, the productivity adjustment will start to be applied to Medicare payment rates for ASCs and hospitals. A longtime MedPAC recommendation, the adjustment means Congress will reduce the annual inflation update by a measure of economy-wide productivity gains. "The impact will be to reduce our future annual updates by 1% to 2% each year," says Andrew Hayek, chairman of the ASC Advocacy Committee and president of Surgical Care Affiliates.
• Co-insurance waived. Effective next year, the bill waives co-insurance for Grade A and Grade B services in an effort to increase access to preventive services such as screening colonoscopy. Marian Lowe, executive director of the ASC Advocacy Committee, says it's logical to assume that patients will be more willing to undergo such testing if there's no out-of-pocket expense associated with it.
• New entity to set Medicare rates. The bill establishes an Independent Payment Advisory Board tasked with submitting legislative proposals to the president and Congress on annual Medicare payment rates, with the goal of reducing costs. The 15-member board, appointed to 5-year terms by the president with advice from the Senate, would be made up of physicians, employers, third-party payors and other health experts. The IPAB won't begin recommending payment reductions until 2015. OSM