Medicare, Medicaid, and the Health Insurance Portability and Accountability Act (HIPAA) have had significant impacts on the healthcare industry. Consider the most significant benefits that Medicare, Medicaid, and (HIPAA) have brought to the healthcare industry and the most significant challenges they have presented to decision making in the industry.
Research Medicare, Medicaid and HIPAA. Identify two benefits as well as two challenges.
Peer Response 1:
Erika Corbett posted
CONS
Disclosure to relatives. This means that hospitals will not reveal information over the phone to relatives of admitted patients (U.S. Department of Health & Human services, n.d.). I do agree with this, however in cases where a patient may be out of state and is injured, unable to speak on their behalf, families are left to wonder where they are and what has happened to them. I agree that everyone has a right to privacy but if you look at it from a standpoint of an injured loved one and no way to contact them and find out what has happened, this can be a bad part of HIPAA laws in my opinion.
Victims of abuse, neglect, or domestic violence. While this section of the HIPAA privacy rule is good, it could also be bad. If the allegation does not look to be in the favor of the person it was meant to protect, the worry of retaliation is of great concern to the patient. If CPS or Police do not have enough to deem neglect or abuse the child or person being abused may fear retaliation from their abuser. This puts them in a difficult position.
PROS
Right to access your PHI. I think this is great because it allows patients to review their conditions, labs, imaging, and treatment plans. It can help keep them on track with caring for themselves and participate fully in the provider’s care. Patients can also request that their records be transferred to someone else that is caring for them, keeping with continuity of care.
Victims of abuse, neglect, or domestic violence. The HIPAA privacy rule allows providers to disclose PHI to authorities regarding victims. By having this in place, it helps protect children of neglect and abuse as well as domestic violence victims who are unable to speak out for themselves. By allowing us to share healthcare information that can help get them to a safe place and/or protect them from their abuser.
PROS
Medicare/Medicaid: These health plans are regulated by the Government; therefore, certain standards of care must be met by the providers in order to be reimbursed. I think this is good for the patients because if they receive poor care, hospitals/Doctors are fined, and it makes them want to improve their standards. An example of this is hospital-acquired infection rates. If a patient is admitted and develops a bed sore, or pneumonia, that is the hospital’s cost not the patient’s insurance.
Medicare/Medicaid provides care to patients who may not be able to afford it. Seniors and American’s with disabilities do not have to go without insurance because of Medicare/Medicaid. There is still the potential for out-of-pocket costs (Medicare Part B) and for patients on a fixed budget this may prove to be difficult.
CONS
Medicare/Medicaid: This health plans serves the low-income population or disabled. To qualify you must meet certain financial criteria. However, there is a loophole for families that may have members that work and get paid cash, instead of being taxed like others. They get the benefit of getting free health insurance and not paying taxes. I feel like the Medicare/Medicaid system is abused a lot in this way. A lot of times, it is a challenge to even prove that this is happening.
Medicare/Medicaid: Another challenge of medicare/Medicaid from a business standpoint is that if a medical practice has many patients with Medicaid, they are less profitable. Reimbursement for Medicaid are lower than patients with traditional insurance plans. Also, the administrative work for patients with Medicaid/medicare is excessive at times. To get the proper reimbursement for services and get the money into the business, you must make sure that proper documentation is done and for certain testing or specialists, pre-authorization is required which can delay treatment for patients.
References
U.S. Department of health and human services. (n.d.). Health information privacy. Retrieved from: https://www.hhs.gov/hipaa/for-professionals/regulatory-initiatives/index.html.
Medicare Interactive. (n.d.). Medicare coverage overview. Retrieved from: https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/differences-between-medicare-and-medicaid.
Peer Response 2:
Medicare, Medicaid and HIPPA all have both negative and positive effects on the healthcare industry. The challenges and benefits impact both patient and provider.
Pros Medicare
· Medicare costs to the consumer is very little each month compared to other insurances.
Medicare results in increased medical standards. “With the creation of Medicaid and Medicare. Congress created a set of standards for hospital enrollment in the programs. As time went on, the government became more involved in overseeing these standards and now requires public reporting on things such as hospital infection rates and readmissions” (Nowicki, n.d.)
Cons Medicare
· Fraud and abuse, physician kickbacks.
· Overall healthcare strain on the healthcare system because of preventable conditions patients are hospitalized for
Pros Medicaid
· Families with in low income brackets are able to receive healthcare.
· Medicaid covers a broad range of health and long-term care services.
Cons Medicaid
· Reimbursement rates are lower.
· Physicians may refuse patients with Medicaid insurance which leads to discrimination.
Pros HIPPA
· Increases personal privacy in healthcare information and decision making.
· Forces medical providers to look at and pay attention to their security processes.
Cons HIPPA
· Healthcare organizations spending additional money spent on HIPPA compliance.
· Requires providers to pay fines when violations occur.
References
Nowicki, M. Introduction to the financial management of healthcare organizations.
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