Affordable Care Act Case Study

The overall process of discharging a patient from a hospital and the transition back home or to a care facility are critical advancements in the overall course of both acute and long-term care. It is important that the hospitals releasing these patients have ensured the proper overall course of care from beginning to end. The lack of consistency with both the discharge process and the quality of discharge planning has led to many avoidable readmissions. To reduce the amount of hospital readmissions, it is imperative that hospitals recognize the need for focused patient care and that programs are being implemented to assist in the care transition.

Patient access to affordable health care is an ongoing issue in the United States. The first portion of the policy process involves three different stages, the formulation stage, legislative stage, and the implementation stage. Three main stages exist in the process to transform a topic into a policy (Morone, J. A., Litman, T. J., & Robins, L.S., 2008). Coupled with the implementation stage is an evaluation of all the stages to determine effectiveness and gather information for use in future public health care policy making. In the formulation stage, the ideas, concepts, and information steam from this process of policy making. The

This model reimburses hospitals based on quality of care instead of the volume of patients. The quality of care is assessed by patient questionnaires and if hospitals are unsatisfactory penalties may be imposed (Edwoldt, 2012). The value-based system also affects Medicare and Medicaid. It was reported that Medicare readmissions within 30 days of discharge cost 17 billion dollars annually (Edwoldt, 2012). Due to the high costs of readmissions Medicare and Medicaid have implemented a Hospital Readmission Reduction program. A formula is utilized to evaluate readmission rates within 30 days of discharge for any medical reason related to their original admission such as heart failure and pneumonia. Upon review the hospital is potentially penalized. It is important that nurses strive to provide excellence in care despite their beliefs on the ACA. Nurses have the ability to provide a safe patient environment and reduce the risk of hospital associated infections by following hospital protocols such as hand washing.

The Affordable Care Act reflected a shift from Treatment Model to Prevention Model, which requires well-educated nurses with more scientific understanding and skill in the process of care continuum – promotion and prevention to treatment. Since the medical field is undergoing a transformation, there is an increased need for highly qualified and competent nurses to provide safe and effective patient care in the new system. As the healthcare system has undergone dramatic changes over the last many years, nurses are now required to qualify well to provide more services than they did before. They also require to work as a team to provide optimum patient outcome. The Affordable Care Act also covers pre-existing conditions, which were once rejected by insurance providers. Such inclusion of the pre-existing conditions requires the nurses to increase their knowledge bases to cope

Healthcare in the U.S is most expensive than any other developed country. The U.S spends far more on per capita as compared to any other developed. U.S scores low on many outcome measures, inefficiencies and wastes and quality measures as compared to other countries. The Patient Protection and Affordable Care Act is developed to strengthen these failures in the health care system. The U.S healthcare is transforming care from volume based reimbursements to value based payments. The healthcare law works around providing more patient centered care and better preventive care. One of the payment reforms with Obamacare is to penalize the hospitals with high readmission rates for the three conditions – Acute Myocardial Infarction, Heart Failures and Pneumonia.

Hospitals nationwide have been striving to reduce the rate of patient readmissions. Both the federal government and private insurers are tired of picking up the tab. In a 2009 study in the New England Journal of Medicine, researchers estimated that a year's worth of unplanned re-hospitalizations cost Medicare alone $17.4 billion. Congestive heart failure is a particularly big target, as one in four patients end up back in the hospital within 30 days of discharge. Starting in the fall of 2012, the government will cut Medicare reimbursements for hospitals with higher-than-expected 30-day readmission rates for heart failure and two other conditions: heart attack and pneumonia (Avril, 2011).

In other words, ever since the Affordable Care Act was passed, millions of Americans have insurance. This can be worrisome to non-profit hospitals due to the large number of patients. For example, there are far more patients than there are physicians, which causes the quality of care for these patients to diminish. Physicians cannot keep up with the amount of patients they need to see as well as give every patient 100% of their attention it is simply impossible. Therefore, hospitals may start to implement a policy where only certain insurances can be seen at the hospitals, excluding emergency situations of course, while others have to either see there primary doctors or specialists. In other words, physicians are discharging patients too early, which cause a large amount of them to be readmission. Therefore, this is costing the hospital millions of dollars as well as affecting the patients’ overall health. If there was a stricter policy on who can and cannot go to the hospital than patients may start to receive better care and non-profit hospitals can focus on their main mission and that is to treat the people of the community with a high and effective quality of

Partnership for Patients (PfP) has made significant progress in decreasing the number of preventable hospital acquired conditions (HACs), hospital readmissions, hospital patient deaths, and health care expenditures. Nonetheless, much work remains to be done so that PfP is more effective in their mission to make and improve care safety and care transitions. The progress made is part of a program that has been in effect since April of 2011, soon after sections 3011 and 3026 of the Patient Protection and Affordable Care Act (PPACA) were signed into law. These sections allowed then Department of Health and Human Services (DHHS) Secretary, Kathleen Sebelius, and Center for Medicaid and Medicare Services (CMS) Administrator, Donald Burwick, to create and provide funding through Medicare for a dual program to reduce hospital readmissions and transition care services.

In 2008, the United States elected Barack Obama as our President. He came into office with determination and promising the citizens great things. During President Obama time in office one of his greatest accomplishment has been passing the Affordable Care Act in 2010. After five preceding presidents were unable to create a universal health insurance plan, Obama provided insurance for 32 million previously uninsured Americans. However, the Affordable Care Act raised many questions from citizens over rather or not the bill was constitutional.

This savings would be a direct result of decreased overpayment by Medicare to hospitals, physicians and insurance companies (Perez, 2013). As a result, Centers for Medicare and Medicaid is incentivizing increased quality care in hospitals. Consequently, hospitals are not getting reimbursed for hospital acquired conditions. In addition, CMS is penalizing hospitals for readmissions (Bauchner, 2015). Lawmakers are expecting resounding savings related to CMS expectations. The short term savings of more than $200 billion through 2016 (CMS, 2015). As a result, hospitals are in a paradigm shift from volume based care to value based care. The expectation is that hospitals will reduce waste and decrease inappropriate waste which will result in savings that be used for other therapies (Bauchner,

Once again, we have a new president who is working hard to put change once again to America. Our new president Donald Trump is using executive orders to try and replace Obamacare. What are executive orders? Executive order are orders that the current president gives to the government and basically has the full force of power to make changes. Obamacare was a plan that our former president Barak Obama created to make affordable healthcare and insurance (Amadeo). The issue that Donald Trump was trying to go at was completely removing Obamacare and puting in a new plan that will be more affordable and more beneficial to people.

In the Care About Your Care video discussion one of the transitional care implementations was a nurse visit after leaving the hospital. In the article, Transitional Care Interventions Prevent Hospital Readmissions for Adults with Chronic Illnesses, the author’s identified that same intervention of a nurse visit, but stipulated that the visit should be within three days of discharge and be performed by a registered nurse or advanced-practice nurse, along with other interventions such as, “care coordination by a nurse and communication between the primary care provider and the hospital” (Verhaegh, MacNeil-Vroomen, Eslami, Geerlings, Rooij & Buurman, 2014). During the nurse visit it would be beneficial to perform a drug reconciliation to reduce

Bill H.R.2083, Registered Nurse Staffing Act of 2015, proposes that title XVII (Medicaid) of the Social Security Act to necessitate all Medicaid associated health care facilities to execute at facility nursing staff strategy for nurse-patient ratio throughout the hospital. The plan proposes that each shift is accurately staffed with an appropriate quantity of health care personnel to deliver safe, effective, and efficient patient care. The plan concentrates on the specific acuity of each medical unit and treatment specific to each patient. The bill recommends financial fines and other penalties for any health care facility who violates the obligations of this act. The bill also proposes protection for whistleblowers who report bias and unfair

The future of the nursing practice lies in the capability of nurses to appreciate and implement valuable changes that will support and improve service delivery. The introduction of medical homes is significant progress in nursing practice that would likely impart nurses with relevant abilities to offer quality care. The future of the nursing practice would be great if nurses learn to appreciate medical homes. Medical homes involve the formation of teams that will offer comprehensive and continuous medical care to patients. In particular, this essential strategy will eventually make the nursing profession an effective system of care delivery.

This data yields conclusive evidence that current nursing practices are failing to generate worthy patient outcomes while failing to control health care costs. The United States health care system needs to take control and implement effective viable solutions. Implementing processes that avoid preventable readmissions signifies the appropriate course the health care system needs to take, thus ensuring appropriate outcomes are being attained, for patients, families, payers, health care purchasers, providers, etc. Proper care needs to be taken so that as new processes take hold