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There are Medicare and Medicaid penalties for health care—acquired conditions not limited to hospital acquired , penalties for excessive preventable Medicare readmissions, as well as a focus on value-based purchasing i. ACOs, which will primarily still be fee-for-service, will focus on prevention and wellness to minimize hospitalizations, readmissions, and unnecessary care use.
There are also market-driven innovations in payment through various methods. Increased transparency has led to downward price pressure, tougher negotiations by employers with insurers, and a greater need to demonstrate value. One area of payment reform that was of particular concern to some participants who spoke was cuts to the disproportionate share hospital DSH payments for both Medicare and Medicaid.
This means that states that do not expand Medicaid will provide about the same level of uncompensated care to uninsured individuals but will now receive less federal funding for that care discussed further in Chapter 3. Many participants noted this has dire implications for safety net hospitals, especially in a disaster. Bruce Rueben, president of the Florida Hospital Association, discussed what states are doing to prepare for payment reform and the change in emphasis from volume-drive to value-driven payments.
These collaborations have made meaningful improvements statewide, reducing the cost of care while improving the outcome. For example, avoiding unnecessary readmissions, Rueben said, is really about improving care of the patient through the continuum. Keeping these readmitted patients out of the hospital also allows for greater bed availability in the case of an emergency or disaster when hospitals may need to surge.
Through the collaborative, hospitals worked to improve hand-offs and information sharing, and established programs to help patients schedule follow-up visits and better understand their discharge instructions and medications. As a result of these initiatives, the AHRQ assessment showed that Florida's hospital care quality performance relative to other states had increased significantly, falling on the borderline between average and strong AHRQ, Programs and collaborations such as these can be the future of health care in many geographic areas if the ACA guidelines and provisions work out the way they were designed.
More integrated and collaborative everyday care can then be more easily translated to coordinated response and better continuity of care for patients in disasters. With regard to preparedness, the financial pressures on health systems are immense, and incentives and demands are changing, Tofil said. For example, health systems wanting to control financial risk are looking to repatriate their patients from out-of-network facilities as quickly as possible so they can control their care, costs, or both.
This could have varying effects in a disaster scenario, depending on how hospitals follow up with staffing changes in response to more open beds. There will also be much more data e. Health care delivery is changing rapidly, and adaptation is a necessity, not an option, Tofil concluded. Many changes will occur with the new health care law, and this report will highlight some of them.
The ACA is not just about access, Tofil said, but about efficient, cost-effective care. Together with the ARRA and the MHPAEA, there are opportunities for all three laws to improve care delivery, build mental health resilience, and augment and improve information-sharing capacity to allow for better awareness of patient needs and patient tracking. All health care providers will be held financially accountable for patient safety and quality with meaningful outcomes measurements.
Educated and empowered providers will do the best they can for patients. The better the system can operate on a daily basis, the better it will be able to respond when tested in a disaster.
ACOs are groups of doctors, hospitals, and other health care providers that come together voluntarily to give coordinated high-quality care to their patients. DSH payments are federal funds awarded to qualified hospitals that serve a large number i.
The project uses Medicare data to document national, regional, and local variations in medical resources and health care spending. Turn recording back on. Help Accessibility Careers. Search term. Highlights of Main Points Made by Individual Speakers 1 There will still not be universal coverage under the current reform; recent projections are that 30 million Americans will still lack coverage by There will be significant gaps in coverage in states that opt not to expand Medicaid eligibility, potentially leaving 6 million uninsured nonelderly adults without access to care specifically because of lack of expansion.
In addition, undocumented residents and those who opt to not purchase coverage will also add to the coverage gaps. Affordable Care Act payment reforms are changing the emphasis from volume-driven to value-driven reimbursement based on meaningful outcomes measurements, incentivizing high-quality, safe, efficient, and cost-effective care.
A fundamental change in delivery reform is a shift in care management and infrastructure to a system that is more collaborative and integrated. Copyright by the National Academy of Sciences. Federal government websites often end in. The site is secure. Before the passage of the Affordable Care Act, getting adequate and reliable health coverage was a challenge for millions of Americans.
Since , the ACA has made health coverage more accessible and affordable for many Americans. Thanks to the ACA,. And more importantly, the ACA ensures all Americans have access to health coverage. Through the marketplace, you can find and compare coverage options, so you can decide which is best for you. And you may qualify for a tax credit that lowers your monthly premium, as well as for reductions in the amount you pay for deductibles, coinsurance and copayments.
By making these plans available and affordable, the marketplace has reduced the number of uninsured by about 80 percent over the last dozen years.
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