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310_week_4_response.docx310 week 4 Response:
Response needed to each Post! I have listed an example of a “response”. There are four “post” total that need responses.
Post:
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Created by Raiza Cruz on Nov 11, 2015 9:49 AM
1. Increased Reimbursement for Medicaid
MACPAC conducted semistructured interviews in eight states during the summer of 2014 to shed light on whether the temporary increase affected access to primary care and to help us understand states’ implementation experiences. In those interviews, states, Medicaid managed care plans, and provider organizations reported the following:
- The payment increase had little to no effect on Medicaid provider participation rates according to state and Medicaid managed care officials.
- There was no change in primary care service use while the payment increase was in effect according to interviewees in six of the eight states.
-Providers increased the number of Medicaid patients they were willing to see, or that Medicaid appointment availability increased concurrent with the payment increase.
- However, the eight states interviewed reported to MACPAC that the payment increase had little effect on recruiting Medicaid primary care providers, as few providers who participated in the increase were new to Medicaid.
Reduced Reimbursement for Medicare
Medicare’s physician reimbursement regimen is fraught with underpayments and perverse incentives. During the health care debate, supporters of the PPACA praised Medicare’s ability to exploit its size to obtain lower fees with providers. While it is true that Medicare can bludgeon down physician fees, this is not one of the program’s greatest strengths, but actually one of its greatest weaknesses. These underpayments are ultimately shifted to patients in the form of shorter visits, less doctor face time, quick hospital discharges, and compromised care. Rather than reforming the government’s flawed reimbursement regimen, the PPACA merely expands its scope to more people.
2. Health Exchanges. The big advantage of the exchanges for healthcare providers is that there will be millions and millions more insured patients. By improving access to insurance, the exchanges will enable many patients to obtain care they may not have been able to afford previously. That has some pretty significant business implications in terms of increased volumes for physicians, hospitals, and other providers. However, the hospitals may expect to see decrease in payments from payers due to these. The exchanges do tend to emphasize price competition, and they will introduce more price transparency. Price-based comparisons are the easiest ones to make for individual consumers.
3. ACOs. About 6 million Medicare beneficiaries are now in an ACO, and, combined with the private sector, at least 744 organizations have become ACOs since 2011. An estimated 23.5 million Americans are now being served by an ACO, which is a network of doctors and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending. At the heart of each patient’s care is a primary care physician.
Health Homes. Many individuals served by Medicaid have complex and chronic health care needs. Under the ACA, these beneficiaries are potentially eligible for health home services if they have at least two chronic conditions, have one chronic condition and are at risk for another, or have one serious and persistent mental health condition. The chronic conditions specified in the law were mental health, substance use, asthma, diabetes, heart disease, being overweight and, HIV (2012). Not only are most enrollees with HIV disabled (74%), half are dually or triply diagnosed with mental illness and/or substance use – more than twice the rate among enrollees without the disease (22%) – and Medicaid spending on those who are dually and triply diagnosed is also very high.
Under the ACA, health home services encompass a range of services designed to help manage care for those who are chronically ill such as comprehensive care management, care coordination and health promotion, comprehensive transitional care from inpatient to other settings, including appropriate follow-up, patient and family support, referral to community and social support services; and use of health information technology (HIT) to link services.
Value-base Care. Value-based purchasing is Obamacare’s main pay-for-performance quality-improvement mechanism. The program began in October 2012 and is intended to financially incentivize hospital performance improvement by reducing Medicare’s diagnosis-related group (DRG) payments for all hospitals, then redistributing the savings according to hospital performance. Hospital performance scores reflect overall achievement compared to other hospitals, as well as improvement from year to year.
References:
MACPAC. (n.d.). Chapter 8: An Update on the Medicaid Primary Care Payment Increase. Retrieved November 10, 2015 from https://www.macpac.gov/wp-content/uploads/2015/03/An-Update-on-the-Medicaid-Primary-Care-Payment-Increase.pdf
Fodeman, J. (n.d.). The New Health Law: Bad for Doctors, Awful for Patients. Retrieved November 10, 2015 from http://www.theihcc.com/en/communities/policy_legislation/the-new-health-law-bad-for-doctors-awful-for-patie_gn17y01k.html
Gold, J. (2015). Accountable Healthcare Organizations, Explained. Retrieved November 9, 2015 from http://khn.org/news/aco-accountable-care-organization-faq/
The Henry J. Kaiser Family Foundation. (2012). Quick Take: An Update on the ACA and HIV: Medicaid Health Homes. Retrieved November 9, 2015 from http://kff.org/health-reform/fact-sheet/quick-take-an-update-on-the-aca/
Nix, K. (2013). What Obamacare's Pay-For-Performance Programs Mean for Health Care Quality. Retrieved November 9, 2015 from http://www.heritage.org/research/reports/2013/11/what-obamacares-pay-for-performance-programs-mean-for-health-care-quality
· Example Response: Raiza,
It will be interesting to see if the increased number of individuals actually aids in facility revenue, as rates have decreased for facilities in expansion states due to lesser compensation as out-of-pocket pay is considerably higher than that from ensured patients. Great post!
-Allen Beach
Post:
Naomi Deroche-Brown posted Nov 11, 2015 11:
· As a Healthcare administrator, this is how I would operationalize ACA for my facility on the following issues:
1. Impact on Health Care Facilities (hospitals, physician practices/clinics) for Medicaid patients when reimbursement is to be increased, and Medicare, where reimbursement is to be reduced. Strategies relating to these two items.
For Medicaid patients when reimbursement is to be increased I would do the following:
a) Focus on quality of care
b) Invest in amenities to compete with other facilities for patients
c) Create more health management programs
d) Invest in facilities outside the hospital (less expensive), moving some aspects of patient care back to the community.
For Medicare patients where reimbursements are reduced I would do the following:
a) Focus on Wellness/ quality of care/preventative care
b) Realign goals to reduce re-admissions so that it would not affect our bottom-line
c) Diversifying programs to a new market
d) Trimming waste wherever possible
e) Invest in amenities to attract higher ratings which brings in more patients
f) Reduce supply cost with vendors and suppliers
2. Impact of Health Care exchanges/ private health plans that provide coverage, and impact good or bad, on your facility. Consider that many of these plans have high deductibles/out of pocket payments so how will you address with your patients from a collections standpoint.
ACA also affected Health care exchanges/private health plans providing coverage. Considering that many of these plans have high deductibles/ out of pocket payments, I would address this issue with my patients from a collections standpoint by investing in a front end revenue cycle. This can be accomplished by providing trained financial counselors who can assist patients with identifying viable payment source.
3. Special models developed as a result of ACA.
(a) Comprehensive primary care initiative – offers physicians evaluation through enhanced payments, technical assistance and feedback on performance. This is designed to improve access and coordination of care and at the same time engage patients and caregivers.
(b) Center for Medicare and Medicaid Innovation (CMMI) – established by CMS to identify, test and spread new payment and service delivery models to reduce expenditures while improving the quality of care for CHIP, Medicare and Medicaid beneficiaries (Commonwealth Fund, 2015).
4. ......primary care medical homes(PCMH) – as defined by AHRO (Agency for healthcare Research and Quality) is a model of the organization of primary care seeking to deliver the core functions primary health care. It can lead to higher quality of care, lower costs, and improve the experiences of the patient and provider. Its five functions are to provide the following: (1) comprehensive insurance; (2) coordinated care(3) Accessible services (4) quality and safety and (5) be patient centered (PCMH 2015).
5. .....accountable care organizations (ACO). – formed by a group of coordinated health care providers referring to a type of payment and delivery reform model, accountable only to patients and third party payers linking provider reimbursements , for providing quality and efficient care. One example of ACO is Blue Shield of California (healthcare it news, 2015).
6. ...Also Health Homes for patient care (not home health organizations for care in the home of the patient) – Section 2703 made way for the provision of health homes as a part of Medicaid benefit. This allows for the coordination of care for people who has chronic conditions with a “whole person” philosophy in mind (Medicaid, 2015).
7.... Value based reimbursement (medical outcomes) which is a shift from traditional fee for service reimbursement (consumption based) – A health care payment model aimed to improve the way healthcare providers are paid. This increases the accountability for quality and the total cost of health as well as shift the focus on the management of health vs being paid for specific services (CMS, 2015).
References:
http://www.bdcnetwork.com/healthcare-planning-post-aca-world-3-strategies-success
https://pcmh.ahrq.gov/page/defining-pcmh
http://www.healthcareitnews.com/directory/accountable-care-organization-aco
Post:
Allen Beach - Week 4 Discussion
Impact on Health Care Facilities:
Upon reviewing the the effects of reimbursement under the ACA on Ascension Healthcare facilities, it would seem that there are significant variances in the effect ACA has on a facility in relationship to the states expansion status. According to Peter Cunningham, "Looking at total revenue, Ascension hospitals in expansion states saw an increase (8.2 percent) in Medicaid revenue from 2013 to 2014 and a 63.2 percent decrease in revenue from self-pay" (2015). This is in stark contrast to non-expansion states which saw a 9 percent decrease in Medicaid revenue and a 3 percent increase in self-pay revenue. With Medicaid reimbursement to be increased, the percentage of Medicaid revenue in expansion states will undoubtedly increase, however self-pay will remain on the decline.
Impact of Health Care exchanges/ private health plans:
While the effect of the ACA on facility revenue is slowly beginning to be realized, there are certain things that administrators can do to ensure optimized revenue for their facility. To begin wiht, facilities need to research insurance options available to there local patient population. Upon conducting this research, administrators can then maximize payments received for services rendered to newly insured patients (Evans, 2014). According to Blake Evans of Health Care Finance, "Having access to available data streams – for example, claims rejection data (that is, initial denials) – will allow organizations to learn and apply lessons and enhance the patient experience" (2014). Increasing patient experience is key to ensuring that they return to your facility now that they have more options for care.
Special models developed as a result of ACA:
Accountable Care Organizations (ACO) are a new model of health care created in response to the ACA. The ACO is a group of volunteer providers that treat Medicare patients. By ensuring continuity of care, the ACO can spend health care dollars more wisely, and share in the savings it achieves for the Medicare program while delivering high-quality care (CMS, 2015).
Sources:
Cunningham, Peter. (30 April 2015) How Are Hospitals Faring Under the Affordable Care Act? Early Experiences from Ascension Health. kff.org. http://kff.org/health-reform/issue-brief/how-are-hospitals-faring-under-the-affordable-care-act-early-experiences-from-ascension-health/
Evans, Blake. (22 July 2014) Health insurance exchanges will impact hospital revenue cycles. health care finance news. http://www.healthcarefinancenews.com/blog/health-insurance-exchanges-will-impact-hospital-revenue-cycles
CMS. Accessed, 11 November 2015. Accountable Care Organizations (ACO). CMS.gov. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/Aco
Post:
· Faneshia Walton posted Nov 11, 2015 8:29 PM
Impact on Health facilities for Medicaid patients when reimbursement is to be increased is seen as one benefit of the ACA. For individuals and families, health insurance enhances access to health services and offers financial protection against high expenses that are relatively unlikely to be incurred as well as those that are more modest but are still not affordable to some. One strategy relating to this would be medicaid beneficiaries and the privately insured have comparable access to preventative and primary health care. Another would be that the care received by people with Medicaid coverage tracks closely with benchmarks for high quality.
Impacts on Health facilities for Medicare where reimbursement is to be reduced is a big concerns to those that work in the health care setting. Reimbursement for medical practices has been impacted by various trends and healthcare industry changes over the years. Medicare and Medicaid have started reducing physician reimbursement. Third party have negotiated fee-for-service contracts with physicians resulting in reimbursement at less than 100 percent of charges. Solution for this would be managing the revenue cycle appropriately in a medical practice. This is critical to the practice’s success.
Impact of Health Care exchanges/ private health plans that provide coverage is not always good nor bad on the facility. The Affordable Care Act of 2010 (ACA) is projected to expand health insurance coverage to an estimated 30 million to 34 million people. However, expansion of coverage is not an expansion of actual care. The American health care infrastructure has had workforce shortages for decades and is not prepared to meet such a vast influx of patients effectively or efficiently. Strategies for this would be to increase the training of new people in the healthcare workforce. Quality training will even out the influx in patients. Another one would be to merge health care. Hospitals, individual physicians, group practices, and other health care businesses are merging and consolidating to remain strong in the marketplace. Mergers and acquisitions reduce overhead costs for billing and claims while spreading out the financial risk and increasing market share.
Medicaid covers a wide range of services to meet the diverse needs of the populations it serves. Medicaid benefits include both acute care services and a broad array of long-term services and supports that Medicare and most private insurance plans do not cover or tightly limit. States have flexibility to charge limited premiums and cost-sharing in Medicaid, subject to federal parameters.As a healthcare administrated I would advise the discussing the issues in advance before primary care start to take place. Knowing these this upfront would help to not blindside the patient. Some facilities and payment options or other option where only a certain percentage is due up front.
Another new the that is become widespread are ACO's. Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high quality care to their Medicare patients. The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors/ The is volunteer only and Medicare offers several programs with incentives for patients.
Another new program is the Primary care Medical Homes Resource Center which is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. The provide comprehensive and centered patients care. All while ensure the quality and safety of its patients.
Source:
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035391.hcsp?dDocName=bok1_035391
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO/index.html?redirect=/Aco
https://pcmh.ahrq.gov/page/defining-pcmh
