Many internists and patients alike are still grappling with the multitude of changes taking place as a result of national health-reform legislation enacted six months ago.

"Right now there's an awful lot of confusion both about exactly what happened with the legislation and, in particular, the deadlines," said Dr. J. Fred Ralston Jr., president of the American College of Physicians.

Two new publications may help bring some clarity to the issue.

ACP has updated its comprehensive guide for internists with new information and details about the law. An Internist's Practical Guide to Understanding Health Reform includes a summary of key provisions along with a timetable for their implementation and detailed descriptions of reforms that affect physicians and their patients.

ACP also partnered with AARP to produce a five-page brochure that describes changes affecting patients and their families. The new publication describes key changes affecting people with health insurance, those who do not have coverage or affordable coverage, people on Medicare, people planning for their long-term care and changes for small business owners.

It explains, for example, that many people with Medicare prescription drug coverage have to pay the full cost of their prescription drugs after exceeding a certain dollar amount, falling into a coverage gap (the so-called doughnut hole). However, beginning in 2010, Medicare will begin to narrow the gap, first through rebates and then through discounts. The gap will continue to narrow until it disappears in 2020.

ACP is encouraging its members to download the brochure and make it available to patients.

"What we're trying to do initially, at least from ACP's standpoint, is to make sure that when physicians are asked questions by their patients, that we'll have accurate information to provide to them," Ralston said.

President Obama signed the Patient Protection and Affordable Care Act in March. Though many of its core provisions do not kick in for several years, several key reforms are already in effect, and others take effect Sept. 23.

The Internist's Guide, a 100-plus-page document, was first released in June and re-released this month. The newer version includes a number of important updates:

• On physician fees: Beginning in 2010, the law directs the secretary of Health and Human Services (HHS) to review and adjust "relative values" under the resource-based relative value scale, Medicare's system for paying for physician services.
• On Medicaid services: In 2011, the law creates Healthy Homes, a Medicaid state plan option for program recipients with chronic conditions.
• On Medicare services: By January 2012, the secretary of Health and Human Services must implement a voluntary "shared savings" program that promotes accountability for services to a defined Medicare patient population. The goal is to improve the quality and efficiency of care delivery.
• On Medicare payment bundling: The HHS secretary will create a voluntary, national pilot program to test a concept called payment bundling for specific conditions. The goal is to encourage integrated care among all providers of care during a Medicare beneficiary's hospitalization. The program must be in place by January 2013.
• On Medicare prescription drug coverage: From 2013 to 2020, the co-insurance amounts that Medicare beneficiaries in the Part D coverage gap pay for brand-name drugs will be gradually reduced.

The guide also includes a one-page summary of key provisions affecting patients that physicians can copy and hand out.

"We really feel that it's important to have proper communication on what is and isn't in the legislation," Ralston said. Along with providing information about the law, ACP hopes the guide will help physicians prepare for future changes, he said.

More information

Copies of the AARP/ACP brochure for patients, The New Health Care Law: How It Might Affect You, and ACP's guide for physicians, An Internist's Practical Guide to Understanding Health Reform, can be downloaded from the ACP Web site.