Health Care Reform Case Study

DaVita Dialysis is no different in 2005 the organization fell prey to the nursing shortage and had to

The pharmacist submitted claims for reimbursement on brand name medications rather than on the less expensive generic drugs that were actually dispensed. This is a result of health care fraud on Medicare part D, which is in violation of the False Claims Acts (FCA) and anti-kickback statues. "The FCA protects the government from being overcharged or sold substandard goods or services" (CMS, 2015). The federal Anti-Kickback Statue is designed to protect patients and federal health care programs from fraud and abuse. It states "that anyone knowingly and willfully offer, pay, solicit, or receive any remuneration directly or indirectly to induce or reward referrals of items or services reimbursable by a Federal health care program" (CMS, 2015)."The

The Affordable Care Act includes a requirement that all citizens must have some level of health coverage. The primary method through which the mandate is attempting to create 100% coverage in health care is by instilling fear into the minds of hardworking citizens as those who ignore the rule will have to pay a hefty fine. This mandate, unconstitutional according to the law, will deteriorate the quality of health care, hamper economic growth and cause spikes in insurance premiums. The hope of universal health care may or may not arise under the mandate but new dilemmas and hardships on U.S. citizens will undoubtedly surface.

When Medicare was first established, Medicare adopted the payment methods of Blue Cross Blue Shield which meant that the program was paid hospitals on the basis of their own costs and physicians were being reimbursed by the fees that they charged which caused hospitals and physicians to provide care without boundaries (Anderson et al., 2015). This method caused Medicare to dissipate the budget that was established for beneficiaries to utilize. Now, with the ACA being implemented, Medicare had done an overhaul of payment reimbursement. Medicare is now moving toward a volume to value payment initiative that links payment to patient outcomes, experience of care, while giving providers an incentive to limit spending

In today’s seemingly ever-changing world of healthcare regulation, medical professionals are burdened with many compliance requirements. On October 14, 2016, the Department of Health and Human Services released its final rule implementing the Quality Payment Program as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Starting January 1, 2017, clinicians who are reimbursed by the Centers for Medicare and Medicaid Services(CMS) are required to participate in the Quality Payment Program (QPP). (Centers for Medicare & Medicaid Services, 2016) The QPP replaced the Sustainable Growth Rate formula with the new payment structure in which clinicians are rewarded for delivering high quality care. There are now two pathways for

Conclusion: The Obamacare has its very good points it does benefit the economy in ways that are meant to take the economy out of debt. But they do cause side effects that may not have been thought of.

Cheryl has been diagnosed with Generalized Anxiety Disorder, Major Depressive Disorder, and Alcohol Use Disorder. When asked about her concerns for post discharge she states that she has been heavily reliant on her parents and their health benefits for her treatment and that she is nervous that she may not have coverage to continue therapy. She reports that she felt safe knowing that “Obamacare” would be in place to help her afford the treatment she needs to stay mentally healthy and sober. She states that she is concerned about the possible repeal of the Affordable Care Act because she will need help paying for her mental health expenses. The Affordable Care Act made a giant leap in extending the work of the Mental Health Parity and Addiction Equity Act. These two acts work together to ensure that treatment for mental illness is accessible to many Americans that need treatment. Throughout this paper I

HCA is a healthcare provider that was established in 1968. Their main focus is on offering cliental with a number of different services to include: inpatient, intensive care, outpatient, diagnostic and emergency services. To achieve these objectives they operate a variety of facilities such as: outpatient, psychiatric, surgery centers, freestanding emergency care facilities, diagnostic / imaging centers and comprehensive rehabilitation / physical therapy centers. They are structured to create increasing earnings for its policy and shareholders. This is achieved by contracting with private doctors to deliver services to its preferred providers members. At the same time, they receive fees from these entities and they negotiate lower group rates.

There are over 45 million people in the United States who are uninsured when it comes to healthcare. Many are uninsured due to the expensive health care costs. To combat this, the Obama Care administration created the Patient Protection and Affordable Care Act to provide nationalized healthcare. The Affordable Care Act is meant to expand health coverage, lower health care costs and hold insurance companies accountable. The Affordable Care Act will allow more people to be insured but the issue lies in the question, do the costs outweigh the benefits? The Affordable Care Act will be used in an attempt to lower health care coverage costs for citizens. An example can be seen from a report in the Kaiser Family Foundation. The premium is required

The implementation of the Affordable Care Act (ACA) will propel changes that were on the horizon for pharmaceutical and biotechnology firms. Pharmaceutical and biotechnology industries knew there was going to be some type of healthcare reform so they began to take the necessary precautions to prepare. The ACA had key provisions related to the pharmaceutical and biotechnology industry affecting Medicare and Medicaid. Legislation in the ACA will reduce cost for brand name prescriptions (Rx); this will reduce drug cost for patients, but increase rebates and discounts for pharmaceutical and biotechnology firms, therefore, imposing cost on the firms. The pharmaceutical and biotech industry was key in creating legislation for the ACA, according to CMS (2009), “despite

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,

Universal health care is not impossible to achieve, but takes lots of planning and strategy to make it work. As President Obama campaigned, he strongly emphasized the importance of universal health care. With a great team and planning, the Affordable Care Act, also know as Obama Care, was passed. The ACA should be kept because it covers health disorders, businesses with employees have to have insurance, and allows parents to add their children to their plan up to the age of 26.

The A single-payer national health program (NHP) has similarity to the Affordable Healthcare Act. However, it better because is addresses some of the issues that were left out of the ACA. Like, free choice of providers and the preservation of doctor–patient relationships are threatened by our current system (Gaffney, Woolhandler, Angell, & Himmeslstein, 2016). With each enrollment cycle, patients seeking affordable premiums or changing jobs must often switch insurers and risk breaking existing relationships with providers.

Large employers will soon face additional challenges in the reporting and compliance of health care benefits for their employees. The Patient Protection and Affordable Care Act (PPACA), more commonly known as the Affordable Care Act, has new reporting requirements for the counting and tracking of all employees. Without understanding the new rules, large employers face substantial tax penalties if they aren't compliant.

In an effort to regulate how physical therapists provide and bill treatments, Medicare has implemented numerous laws and regulations that providers treating Part B patients must follow and be recorded in documentation. The issue arising was considered a “moral hazard”; physical therapists were able to bill treatments and provide treatments that had the greatest reimbursement rate, for any length of time, without consequence. One on one and group therapy, services provided by physical therapy assistants, co-treating, and the “8 minute rule” are among the regulated scenarios implemented. If a pattern of inaccurate documentation is discovered by the CMS it can lead to a fraud and abuse investigation from enforcement authorities2.