All of the political rancor during the past couple of years made it hard to remember that the Patient Protection and Affordable Care Act actually contains provisions beyond the insurance mandate. The 906-page law includes dozens of mandates that will dramatically change the way health care is accessed, delivered and paid for, some of which are already in place. Others have yet to be promulgated by the Department of 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 key provisions impacting hospitals and health systems will unfold over the next couple of years and will likely 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 impacting hospitals and health systems in the Affordable Care Act.

2010

  • 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 is 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.

2011

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

2012

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

2013

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

2014

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