The Potential Impact Of The Affordable Care Act On Urban Safety Net Hospitals

The Affordable Care Act that is commonly known as the Obamacare can be explained as healthcare declaration that was enacted by the Federal government on 23rd March 2010. The main objective of the Act was to reform the US health systems by offering and bettering access to quality and affordable health care, health insurance, and by offering American citizens with more rights and safeguards by minimizing healthcare expenses for both the government as well as the American residents. Moreover, it can also be pointed out that the Act also aimed extending private and public insurance coverage while also regulating the insurance sector. Nevertheless, since enactment of the Act, the Act has been heaving criticized by some quarters to the extent that some political leaders in the USA have expressed their views on repealing the Act (Everett and Dawsey, 2017). Nevertheless, it can also be pointed out that there are those who strongly support the Act and give different reasons to explain the reasons why they are in support of the Act. This essay focuses on the topic of Obamacare and discusses in detail the reasons why the Act should be ammended.

In order for a hospital to be eligible for reimbursement through Medicare, they have to show that they are compliant by way of the Conditions of Participation. One way to show this is by getting an accreditation through The Joint Commission who meets the Medicare Condition of Participation standards. (La Tour, 2013).

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.

After the inception of ACA that is Affordable Care Act on March 23, 2010 various policies and regulations has been proposed which has more controversy (www.healthcapital.com, 2013). Affordable health act has impact on the stakeholders in different manner. The main concern in the medical field is the input cost which is increasing continuously. This is the biggest challenge for the US government as the increasing cost makes it impossible for the government to allocate appropriate resources in managing the requirements of the ACA public policy. There are more initiatives taken by the US government in implementing the ACA in an appropriate manner by continuously improving the quality of health care at affordable lower costs

“Starting in 2009, Medicare, the US government 's health insurance program for elderly and disabled Americans, will not cover the costs of "preventable" conditions, mistakes and infections resulting from a hospital stay. So for instance, if you are on Medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare. Instead, the bill will be picked up by the hospital itself since the rules don 't allow the hospital to charge it to you” (Paddock, 2007).

The current paper examines the Disproportionate Share Hospital Payment Reduction CMS 2367F rule which was effective on November 18, 2013. The Disproportionate Share Hospital Payment Reduction CMS 2367F is Federal Legislation that was implemented due to the Affordable Care Act. The rule was initially proposed by the Centers for Medicare & Medicaid Services (CMS), HHS on May 13, 2013. The proposed rule was to implement the provision of the Affordable Care Act that reduces Medicaid Disproportionate Share Hospital (DSH) allotments.

Since 1984, Medicare patients have been serviced under the prospective payment system of the Medicare program. Under this system, primary care providers are reimbursed for their services using a fixed payment for each patient that is determined by the patient’s diagnosis-related group at the time of the admission. Therefore, under the prospective payment system a hospital’s reimbursement is unaffected by the actual expenditures that are required to care for a patient.

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

The Patient Protection and Affordable Care Act, commonly called Affordable Care Act or, more informally known as, Obamacare, is a United States federal ruling signed into law by President Barack Obama on March 23, 2010. Together with the Health Care and Education Reconciliation Act amendment, it represents the most drastic refurbish of the United States healthcare system since the Government passed the Medicare and Medicaid in 1965(healthcare.gov). This act is supposed to make primary doctors and hospitals transform their practices and policies to make it more accommodating for all civilians. This means they would transform everything about their

This paper deals with the legislative, regulatory components of Medicare Readmission Reduction Program along with recommendation to reduce their readmission rates for a health care facility like Valley hospital in Spokane which has been penalized a higher percentage of 2% as compared to other hospitals in the state of Washington under the third round of penalties.

“The Tax Equity and Fiscal Responsibility Act (TEFRA), signed into law September 3, 1982, mandated the development of a prospective payment methodology for Medicare reimbursement to hospitals.” http://sunlightfoundation.com/blog/2009/09/08/slug/. It changed Medicare reimbursement from a fee for service to prospective payment system. Which is where there`s a reimbursement method where`s there an amount of payment determined in advance of services being performed. The rates are done annually. Reimbursements for inpatient care by a classification scheme called diagnosis-related groups. If the patient might have to stay longer in inpatient care more than average days, the hospital may lose money on that patient.

The delivery system reform include: Mandates that the Secretary of Health and Human Services adopt value-based purchasing and payment methods for Medicare reimbursements for both physicians and hospitals. Creates incentives to reduce preventable hospital admissions. Creates a new Center for Medicare and Medicaid Innovation that will research, develop, test, and expand innovative payment and delivery arrangements. Encourages the formation of Accountable Care Organizations (ACOs) that allow hospitals and doctors to work together to manage and coordinate care and provides that these ACOs will receive a share of the savings they achieve for Medicare

My organization has policy on Mid-Level Reductions. If the member is seen by a NP or PA we will allow the following reductions: CMS: 15% reduction applied to physician fee schedule for mid-level providers. DHS: 10% reduction applied to physician fee schedule for mid-level provider s. Given complexity of combined fee schedule for members with dual eligibility, apply 10% reduction to physician fee schedule for mid-level providers for all product lines.

Under payment, an ideal healthcare system will have the challenge of delivering higher quality for lower costs. The system’s payment reform will involve a transition from fee-for-service to global from systems that are value-based important for the achievement of the overall healthcare goals. An ideal healthcare payment system will give a great deal of support to value-driven system of healthcare delivery (Kent, 2013). The fee-for-service payment system will be of great importance to the healthcare system as it will help control the costs of health care.

In 2008, the Centers for Medicare and Medicaid Services changed its payment regulations to eliminate payment for hospital-acquired complications.