Specialty Hospitals Finally Regulated by PPACA Essay

"In the past two decades or so, health care has been commercialized as never before, and professionalism in medicine seems to be giving way to entrepreneurialism," commented Arnold S. Relman, professor of medicine and social medicine at Harvard Medical School (Wekesser 66). This statement may have a great deal of bearing on reality. The tangled knot of insurers, physicians, drug companies, and hospitals that we call our health system are not as unselfish and focused on the patients' needs as people would like to think. Pharmaceutical companies are particularly ruthless, many of them spending millions of dollars per year to convince doctors to prescribe their drugs and to convince consumers that their specific brand of drug is needed in

In He and Mellor’s article, cuts in the Medicare payments would increase the amount of care provided to the uninsured by for-profit hospitals (He and Mellor, 2016). In the article, “How Much Do Hospitals Cost Shift?” Frakt explains that nonprofit and for-profit hospitals are in competition with each other. Nonprofit hospitals encourage for-profit hospitals to enhance trustworthiness and quality. For-profit hospitals persuade nonprofit hospitals to cut costs and become more efficient (Frakt,

The payment system in the healthcare industry has appealed to specialty care providers, they make a higher income than the primary care physician. The physicians are attracted to specialty care, and the individual feels that specialty care is better. If physicians were all paid well, in order to pay for their education and then continued quality training, we would not be confronting the lack of primary care doctors who are available to treat the general needs of the population (Fisher, 2013). Just as the physicians seem to be treated differently in our health system so are the patients. Using a multi-tiered system of health care where some insurance gives out a higher payment to physicians, some patients seem to be wanted while others are less well received, this leads to an “everyone for himself or herself ethic” within our medical system (JAMA, September).” The design of the system is flawed in reference to the primary care physician and with the patient who has insurance which pays less, the way to reorient both is to make the pay scale more competitive for both. The primary care physician should be able to make money and cover this educational expenses and the patient should have insurance that will equate to

In many ways, the hospital system in America is set up mirroring our government. They are similar in the way that checks and balances have been set in place to ensure the best possible care is delivered to patients. With these checks and balances there are three main bodies; the governing board, medical staff, and executive management (Showalter, 2017). The duties and responsibilities of each body many times is to oversee and continually check the others. A prime example of this system can be seen through the case of Moore v. The Board of Trustees of Carson-Tahoe Hospital, which took place in Nevada and was heard before the Supreme Court of the state in 1972 (Moore v. Board of Trustees of Carson-Tahoe Hospital, 1972). Specifically, in this case, the duty of the governing board to “exercise reasonable care in selecting and retaining medical staff” is questioned in contrast with the right of the physician to have “due process… when disciplinary action is taken” (Showalter, 2017). In hopes of changing a decision by the governing board, and attempting to reverse the decision of a lower court, the appellant, Dr. Moore, brought the case against Carson-Tahoe Hospital (Moore v. Board of Trustees of Carson-Tahoe Hospital, 1972).

The American Medical Association (AMA) published a Code of Ethics for Physicians that includes a list of certain principles physicians should follow in order to be good physicians, practicing in an ethical fashion. This list, which was first adopted in June of 1957 and revised as recently as June of 2001, demonstrates some principles that are not universally accepted to be critical to the ethical practice of a physician. In particular, all physicians do not completely believe the claim that “A physician shall support access to medical care for all people” (Principles of Medical Ethics). Theorist, H. Tristam Engelhardt believes that the lack of access to care for some may be unfortunate, but it is not unfair and that this access does not need to be mandated, nor does believing it should be make you an ethical physician. In fact, Engelhardt supremely believes that by providing access of care to all, you will hurt certain patients that already have access to care, negating your function as a physician practicing beneficence. Engelhardt would retract this statement from the Principles of Ethics. However, this belief of and drive to implement access of care to all is critical to one’s job as a physician and it goes against core values of physicians to claim otherwise. Theorists such as Tom Beauchamp and Norman Daniels would agree that the universal access to health care is a critical component of the values physicians hold.

Melnick, G., & Fonkycj, K. (2013). Fair pricing law prompts most California hospitals to adopt policies to protect uninsured patients from high charges. Health Affairs, 32(6), 1101-1108. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/1372932073?accountid=2532

The Hospital Fairness and Transparency Act, state of Massachusetts, I feel it is important for communities’ to be aware, and to ensure their taxpayer dollars are instead dedicated to safe patient care and necessary services in the Commonwealth, and in other states as well. I find it admirable that Advocates actually provided legislators with a list of hospitals with funds stored in offshore accounts and will urge legislators to demand greater transparency by passing the HPTFA. Today communities are asking more questions related to healthcare facilities finances in their communities. Massachusetts health care costs

Critics believe that the present functioning of managed-care is degenerative to health care. Managed-care firms control costs by requiring patients to use a “network” of approved doctors and hospitals, and by reviewing the actions of doctors. Patients have to pay more to visit a doctor who does not participate in the “network.” Managed-care firms second-guess doctors, considering only the costs. Patients are often prevented from visiting specialists to reduce costs. A managed-care company might insist that its doctors prescribe inexpensive generic drugs instead of commercial products. Many patients must, also, receive the insurer’s approval before undergoing treatments or operations. HMOs have been criticized for refusing to pay when a patient goes

In the current U.S. system the free market prevails and companies, in this case, major insurance providers “compete” for business. This competitive business approach should in theory drive costs down. For some reason, however, an argument can be made that it has produced the opposite result in profiteering. The nation’s largest insurer, UnitedHealth, boasted over a 10 percent revenue increase in 2013 according to Forbes (2013). Health insurance affordability contributes to the disparity in access to health care, as evidenced by the fact that there are millions that are still uncovered. A greater majority of certain minorities lack both health insurance and the financial resource to seek out either health care or insurance. While insurance companies reap huge profits the percent of private sector companies offering health insurance has dropped to less than 50 percent (Kaiser, 2013). There is decidedly a lack of coordination of care for this at risk population as well, since treatment is rendered sporadically and with continuously changing providers. The last major challenge is that of improving the quality of health care. According to a 2010 report by the U.S. Department of Health and Human Services, Office of Inspector General (OIG), an estimated 13.5 percent of Medicare beneficiaries experienced adverse events during their hospital stay and an additional 13.5 percent experienced a temporary

Also by rejecting the Medicaid expansion community-based providers, including hospitals are casualties. Hospitals will continue to provide care to the uninsured without sufficient compensation, increasing shift costs to the privately insured. This also has a chilling effect on enrollment in private insurance plans through the new federally facilitated marketplace. Opposing the Medicaid expansion also ignores the real needs of the uninsured and the massive financial burden shouldered not only by the hospitals but taxpayers and businesses. (Stultz, 27)

As you are likely aware, 75% of the voters in our state recently voted to approve PAS and it is now legal here.  The law is in direct opposition to our hospital’s moral and ethical policies and the hospital’s mission statement.  The hospital will not allow any of our employed physicians to perform PAS here on hospital property or in any other setting where the physician is acting in official capacity representing the hospital. We recommend the BOT approve the following statement from the hospital administration:

What proponents of private health care delivery fail to mention is the multitude of evidence demonstrating that private delivery models often fair worse than public delivery models in terms of health outcomes and of quality of care. For example, a 2002 systematic review of 26,000 for-profit and not-for-profit hospitals found that private for-profit delivery was associated with a 2% higher risk of death for patients (Devereaux et al., 2002). Similarly, a review of 149 studies spanning 20 years of data concluded that private for-profit models do not perform better on measures related to access, quality and cost-effectiveness (Vaillancourt-Rosenau & Linder, 2003). Moreover, evidence suggests that having more private, for-profit clinics may be associated with reduced access to care, as these clinics drain the limited supply of physicians and other health professionals from

Apart from the Affordable Care Act, there has been increased government and court involvement in the determination of how healthcare issues are run, like the recent denial of the nonprofit tax exemption status to some hospitals in Chicago (Bergen 2). These hospitals, which include the Northwestern Memorial Hospital and the Prentice Women’s Hospital, are known to provide important healthcare services to patients who cannot afford to pay the expensive costs in private hospitals (Bergen 2). These unfavorable healthcare policies among others are bound to be more frequent and the resultant problems may promote the emergence of other bigger ones unless immediate action is taken.

Non-Profit hospitals can often assist potential patients to care for the uninsured in their community (Kovner & Knickman, 2008).

Hospitals and health systems in the U.S. are experiencing a remarkable transformation in their business models directed from numerous influences that are projected to ultimately turn the industry around. Pressures include providers troubled with the quantity of services they are responsible for, to providers who concentrate on presenting high-cost services that give emphasis to sustaining healthy populations (Dunn & Becker, 2013).