Patient Protection And Affordable Care Act

In March of 2010, President Barack Obama signed into effect the Patient Protection and Affordable Care Act, or widely known as “Obamacare.” The changes that the act is making with all of health care will slowly be implemented throughout the years, and should be completed by 2022 (Obamacare Facts: Dispelling the Myths). In the Affordable Care Act it changes or alters almost all programs that we have today and creates new programs to assist people and properly state what type if care is expected and required of health care professionals. The Patient Protection and Affordable Care Act includes all of the following departments of health care, Affordable Health Care for America Act, the Patient Protection Act, the Health Care and Education Reconciliation Act, the Student Aid and Fiscal Responsibility Act, and effects the Food, Drug and Cosmetics Act and the Health and Public Services Act (Obamacare Facts: Dispelling the Myths). The Affordable Care Act will make many changes, but some of the big changes that will occur involve the patients quality of care, the benefits that all of America will receive with the prevention measures it will be taking, the total availability and access of health care for all Americans, and how all Americans health care finances will be altered.

When president Obama was a candidate in the 2008 election he promised wide scale health care reform that would increase the availability and affordability of medical insurance for a large portion of the American population. At the time of his campaign, millions of low-income Americans were stuck in the Medicaid gap – where they could not afford health insurance, but also were not eligible for the joint state and federal government Medicaid program. This promise eventually became the bill later named the Patient Protection and Affordable Care Act that was passed by the senate on December 24, 2010. The bill’s policy seeks to expand health care coverage to low-income families

On March 23, 2010, President Obama signed comprehensive health reform, the Patient Protection and Affordable Care Act (PPACA), into law. The United States is at the beginning of a long overdue and much needed overhaul to the health care system. The changes made to the law by legislation, focuses on: provisions to expand public health coverage, an effort to control health care costs, initiatives to improve health care delivery system, and reorganization of spending under Medicare (Henry J. Kaiser Family Foundation, 2014). More than 90 changes were included in the law; some went into effect almost immediately such as: posting of caloric details at major chain restaurants, taxation on tanning, and more breastfeeding rooms and

Since 1992, health cares like Medicare have reimbursed physicians on a fee-for-service basis that weighs their service and expenses and then converts the weights to money (Wilensky, 8). According to Gail Wilensky, “Congress replaced an existing spending constraint with the Sustainable Growth Rate (SGR) to reduce reimbursements if overall physician spending exceeded the growth in the economy” (Wilensky, 8). Physicians and PAs are having a hard time with health-care reimbursement. It is causing many problems and Congress needs to come up with a solution. ¨This article states several promising models, including patient-centered medical homes, accountable care organizations, and various payment bundling pilots, that could offer lessons for a larger reform

Historically, reimbursement has been Fee-For-Service (FFS): tied to volume of visits, hospitalizations, procedures, and tests. This reimbursement structure creates misaligned incentives and fragmented, suboptimal patient care resulting in burgeoning costs and a lack of focus on outcomes. As a result, CMS and the industry have been

The Medicare FFS payment system, providers are rewarded for the volume and concentration of services provided. Consequently providers are not rewarded for efforts to improve care quality, such as through spending time on care management and guaranteeing patients obtain necessary preventive care services (Froimson et al., 2013).

Under the ACA, there are several tax provisions that is scheduled to take effect as different sections of the health reform legislation are implemented. The US government has given the IRS the authorized to provide premium tax credits to individuals and insurance companies. The calculations are based on the family size specifically those that are making between 138% and 400% of the federal poverty levels, in states that have expanded the Medicaid eligibility and 100% to 138% are available in states that have not accepted the expansion. Another requirement is individuals not eligible for Medicare and Medicaid and Individuals whom have purchase qualifying health insurance plans on federal and state – run exchanges.

In today’s society concerning health care there are many aspects. These aspects are not limited to the provider, the patient, and the financial aspect. The aspect that is found quite interesting is the financial aspect. To be more specific about the financial aspect, this paper will cover the healthcare insurance. Healthcare insurance comes in different forms whether it is private, employee-based or government insurance, A significant event that has brought among change in the Healthcare system is

According to the United State’s Centers for Disease Control report in 2003, 86% of Americans over 65 have one cardiovascular disease, arthritis, asthma, cancer, chronic pulmonary disease or diabetes and the cost for treatment of these will create a drain on an already taxed health care insurance agency (Implications for Health….Workers, 2003). Although the government has attempted to curb the cost of health care with The Tax Equinity and Fiscal Responsibility Act, The Prospective Payment System, HMOs and DRGs they were not able to demonstrate a high rate of return that has been associated with bundling of payments, pay-for-performance and shared savings programs (Williams & Torrens, 2010). In addition, as the population ages and requires additional services, the need to adjust physician reimbursement model will have to accommodate the new trend. In the 1990, physician services reached a high of 23 percent of Medicare spending and in 1992 Medicare initiated a resource based relative-value scale were implemented to adjust for geographic cost/price variations but CMS is now moving toward pay-for-performance to link the patients overall healthcare to outcomes (Williams & Torrens,

Medicare proposed revisions to payment policies in regards to the Physician Fee Schedule while focusing on primary care, chronic care management, mental health and diabetes. The recently proposed rule regarding physician fee schedules aims to improve payment, payment systems, and payment policies, as well as coordinates accountable care organizations’ quality measures with the current Medicare reimbursement rules, specifically, the Quality Payment Program and Medicare Access and CHIP Reauthorization Act, which rewards quality of care rather than the volume of care. CMS is updating payments to better reflect the changing healthcare community and value a service provides by increasing the amount of quality measures. Furthermore, in order to

Many doctors see this as a decease in payments, howeve,r according to CMS Medicare PCIP payments for 2011 exceeded 560 million. Medicare patients’ are being turned away, strangely enough doctors are refusing to accept patient with Medicare insurane. As doctors become more frustrated with Mnedicar’s reimbursement rates and rules, many are displaying their dissatifaction by not treating Medicare Patients (Bengel, 2013). Although, it is believed that the decline in of Medicae is on a production of possibility

As of July 2015, BPCI had 2115 participants in Phase 2 with 423 acute care hospitals, 1071 skilled nursing, 441 physician groups, 101 home health agencies, 9 inpatient rehabilitation facilities and 1 long term care hospital that will each can select from any of the 48 clinical episodes to participate that include anything from amputation, back/neck, cardiac value, chest pain, congestive heart failure, diabetes, fracture femur hip/pelvis, knee procedures, renal failure, red blood cell disorders or urinary tract infection (CMS: Bundled Payments for Care Improvement, 2015). Although there were limited participants during the first year, as of August 5, 2014 approximately 2,368 new potential participants joined Phase one and new episodes will be added until October 2015 and more episodes will be added to additional models and phases along with the patient survey to evaluate the patient’s experience therefore CMS is expecting the program to continue to expand throughout the market (CMS: Bundled Payment for Care Improvement Initiative (BPCI) Fact Sheet,

Managed care is the formation of a delivery system of medical assistance and other associated programs through contracted arrangements with additional partners or organizations. On a global scale, we are witness to a wide-range of health care delivery systems that have contrasting opinions on the financial crisis that is affecting every designed scheme. The United States health care system has continued to evolve through the years, so it is a continuous evolution of arrangements to address the needs or requirements of the addressing a health-conscious public. The U.S Health Care System is a complex arrangement (Figure 1), that is facing a multitude of issues that affect the financial ability to maintain continued

Hospitals are reducing the growth rate of inpatient hospital spending, mainly by decreasing the length of time one spends in the hospital. PPS has increased the share of Medicare spending where beneficiaries have higher coinsurance. The short-run beneficiary response appears to be an increase in demand for Medi-gap health insurance rather than a dampening of demand for services. To this point it appears that Medicare's PPS has been successful in containing the growth in hospital costs while avoiding, or managing, unwanted consequences. Prospective Payment Systems Is a form of Reimbursement that is established before the healthcare services are rendered and monies are expended. Reimbursement is based upon a specific prospective payment system

The future of health care can be rocky with the push to mandate population health and bundle payments as the standard measure for future reimbursement. The ACA, increasing cost of health care and mortality rates are the driving force. Although population health and bundle payments are voluntary programs at this time, it will become the standard of care model in the future. Although population health has been associated with ACOs and the MSSP programs, the future reimbursement model for health care goes beyond these programs as more and more insurance companies are pushing for quality care and reduction in cost. In addition, CMS is leading the charge to increase bundled payment models. In regards to bundled payments there is a growing momentum and as of August 5, 2014 approximately 2,368 new potential participants joined Phase one and new episodes will be added until October 2015 and more episodes will be added to additional models and phases along with the patient survey to evaluate the patient’s experience therefore CMS is expecting the program to continue to expand throughout the market (CMS: Bundled Payment for Care Improvement Initiative (BPCI) Fact Sheet, 2015). Therefore these two models that are voluntary today are moving toward being the stand of tomorrow.