How has the affordable healthcare act impacted hospitals financially include changes in reimbursemen

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No patient satisfaction surveys are conducted for emergency management, Priest added, so it is difficult to justify this position in every hospital and staff training in this area when faced with strained budgets. The positive side of this downward pressure on operations is that hospitals will have to think differently about what it means to manage surge.

It will be less about how many beds or how many staff can be made available, and more about pooling of shared services. As an example, Priest said that hospital systems in central Indiana recently purchased a linen services company and now provide themselves with their own linen services.

He suggested that hospitals might also pool together to provide emergency management support to one another in much more meaningful and direct ways. Under the ACA, health care is becoming more integrated and care is increasingly being provided outside the hospital setting. Mid-level practitioners e. She agreed that the military has done this consistently for many years.

As an example of new provider roles in the community, Matt Zavadsky, Director of Public Affairs at the MedStar Mobile Community Health Program, described how MedStar is evolving from an emergency medical services EMS organization into a mobile integrated health care organization, and how this has impacted the workforce and local community.

With the ACA emphasis on shifting the payer matrix the way that different payment and reimbursement models are set up within health care and moving away from a fee-for-service model, as well as the population health management focus, employing providers within the community to assist in the effort to decrease day readmissions and improve health outcomes could be a desirable method for the future.

In addition, these paramedics and emergency medical technicians EMTs are gaining valuable knowledge of the needs of the population in their community should a disaster occur.

For years, EMS has been viewed as a transportation benefit, not a health care benefit, Zavadsky explained.

Without funding, revenue has historically been generated by transporting people to the hospital, creating the incentive to use the highest cost transport available to take someone to the highest cost care facility available.

Medicare and most private payers do not provide reimbursement for EMS response, triage, and treatment unless the patient is transported to an ED Munjal and Carr, There is an opportunity for EMS to help fill this gap and extend health workforce capabilities in the community, outside hospital environments. MedStar is a governmental agency that is the exclusive emergency and nonemergency mobile health care provider i. External oversight is provided by a medical control board that includes the medical directors from all area EDs.

According to the National Association of State EMS Officials, there are 37 million EMS house calls per year across the country, and about 30 percent of those patients do not go to the hospital e. The programs in the mobile integrated health care practice are centered on the concept of patient navigation and are designed to align incentives and risk sharing, reduce preventable ED visits and readmissions, and increase capacity of the health care system.

Together, all of the programs of the mobile integrated health care practice are geared toward meeting the Institute for Healthcare Improvement triple aim, 6 Zavadsky said. This not only can build efficiencies in day-to-day responses, but also helps to ensure health systems are not already burdened at the time of an emergency. Regular callers to those who call 15 or more times in 90 days are enrolled in the program and receive home visits from mobile health providers to educate them on alternative resources and how to better manage their health.

Zavadsky said that patients have been through the program since it began in , and there has been a sustained 86 percent reduction in their use of In addition, patient satisfaction with the program has been very high, he said see Figure Results of patient satisfaction survey of Medstar's Community Health Program on a scale of , with 1 being the least satisfied and 5 being the most satisfied. Priest commented that although many tasks could be offloaded to community paramedicine or other providers from a technical standpoint, he wondered if care in the home would result in missed opportunities for a more comprehensive clinical view.

Zavadsky explained that feedback to the primary care mechanism is a foundation of the program. All of the treatment decisions made onsite by the mobile health care paramedics are communicated from their primary care physician. If the primary care physician cannot be reached, then the MedStar medical director will provide medical oversight or the paramedics will follow standing orders e. Another program described by Zavadsky is the Nurse Triage, in which a specially trained nurse navigates low-acuity or low-severity calls to the most appropriate resource.

The program is funded by the hospitals, who benefit from the resulting reduced overcrowding in busy urban emergency rooms, as well as financially, because many of the low-acuity patients do not have coverage.

About 43 percent of the patients that talk to the nurse are referred to alternate resources. Again, customer satisfaction is very high, and there are multiple potential applications for the use of this program in a pandemic or other disaster in the community. From a workforce perspective, MedStar has been able to train community paramedics and other providers who are very adept at managing patients through a health care crisis. Those mobile health care providers are able to treat patients, refer them to the appropriate place in the field, and avoid preventable emergency room visits, Zavadsky commented.

Other disciplines that could be trained to extend the workforce in an emergency, or on a daily basis, include medical, nursing, and allied health students; home health agency personnel; or retired health care workers. Additionally, working with the state licensing agencies to identify types of health care professional licenses that have common or similar skill sets, organizations can facilitate expansion of the scope of practice in emergency situations, and training certain nontraditional providers e.

Available resources can be used in multiple ways. As an example, Zavadsky described a mobile clinic acquired through a grant for the purposes of bringing flu vaccines to the community that was used to transport patients following a tornado. In another scenario, ski patrollers can act as first responders off the mountain during a flood incident, another example of weaving preparedness tools into everyday care delivery and vice versa. The Mobile Integrated Health Care program has helped the community by increasing the capacity of the hospital and the health care system, returning thousands of ED and inpatient bed hours, in other words, freeing up beds and staff time that were previously used because all calls resulted in transports to the hospital.

It has improved collaboration across the health care continuum, and providers in the program work very closely with primary care and ED physicians.

Zavadsky noted that these programs were made possible through the reforms in the ACA. Hospitals are now financially incentivized to use these types of programs, mainly due to the desire to reduce day readmission rates and the increased focus on patient satisfaction as a part of the value-based purchasing model and patient-centered care Hooten and Zavadsky, A few participants discussed further the concept of moving care out of the hospital and into the home.

It was noted that historically, medical care began in homes, and then moved to hospitals and centers where medical technology including computers was located. Now, technology can be almost anywhere, and most people do not receive their care in hospitals. An advantage of care in the home, Embrey said, is a greater involvement of and support from the family with regard to compliance and follow-up.

Turner said one valuable aspect of care is the time of the provider, because it may be more efficient in general for patients to go to where the doctor is located. However, there are a number of reasons why it might be better for the provider to go to the community or to the patient directly, and she added that with the models that community practitioners discussed, there is potential to reach previously underserved populations in their homes.

Priest suggested payment drives where care is delivered, not what is the most efficacious route of delivery. The move toward community-based care is a result of evolving payment paradigms under the ACA. Workshop co-chair Georges Benjamin, executive director of the American Public Health Association, alerted participants that state-based professional associations have a lot of control over what types of providers can offer what types of services. Despite demand for various types of providers, if the associations do not allow them, then they will not happen.

He cited the example of the position of dental therapist, which has been successful in reaching underserved populations in Alaska, but has been met with significant resistance in other states. Challenges such as these may continue to be a barrier to workforce innovations unless buy-in happens on a broad level.

One example of these is Section under Title 5, where the law creates a public health sciences track at selected health educational institutions to merge public health and clinical practice and emphasize team-based service. The grants program for fellowship training in public health has also been expanded, and there are public health recruitment and retention programs, including a loan repayment program. Turner said that although it is useful to look at the big picture broadly across the country, one must then take into account the reality at each location on the ground.

With regard to physician supply, for example, big-picture planning helps to coordinate training programs and funding to educate new physicians, but there is also the opportunity to better align supply and demand in geographic area or across specialties. In terms of defining roles, Turner said there is a spectrum of health care services that is required by an individual or a population, from advanced subspecialty care to interventions that can be performed by someone with hardly any medical training.

At each step along the way, various people can perform any of those functions, with overlap across roles. There is not necessarily one right way to define roles, she said, and incentives need to be in place to measure innovation when defining new health care roles and take care that they are financially feasible.

DeSalvo raised two related concerns about the training of the physician workforce. First, physicians are generally not trained in incident command management principles or emergency preparedness. As a result, they often arrive at the site ready to volunteer, but do not know who to contact, where they fit in, or how to be the most useful.

Second, physicians are becoming more and more distanced from basic skills and procedures in their everyday work e. Cairns concurred and cited a study of the procedural experience of medical students entering residency programs. The study found that less than 10 percent had ever inserted a central line, and half had never started an intravenous IV line Promes et al.

To have a prepared workforce, it is important to ensure that medical schools are training doctors in these basic procedures, and not just first responders. As they become more distanced from these basic procedures, their ability to give help and support on the ground lags, which could limit capacity to respond in a disaster.

By contrast, Cairns said the special operations medics at Fort Bragg have each inserted hundreds of central lines and must insert about six or seven IVs and central lines during training to be considered competent. Priest agreed, but cautioned that there is currently no real evidence base for what skills are needed. Citing his own experiences, Priest noted that the military focuses on stress inoculation, preparing the medical responder to make a good decision under difficult conditions.

Priest suggested that there are pedagogical ways to teach this that do not take a lot of time, and that could be incorporated into different courses in professional schools. Embrey said that in a crisis normal standards of care may not be possible, and there needs to be a training to prepare providers and the community for this possibility.

While specific training may not be standardized, many communities have begun to have conversations within their health care coalitions about developing standards of care for allocation of scarce resources. As a result, the number of such infections have plummeted and , fewer deaths have occurred. Health-care spending still makes up nearly a fifth of the country's gross domestic product.

Many Americans can't afford to take care of themselves. The Trump administration has been hostile toward the Affordable Care Act. The overhaul of the tax code in repealed the individual mandate penalty. That central provision of the Affordable Care Act required every American to sign up for health insurance or face a tax penalty.

Advocates say it's now harder for people to learn about their health insurance options. These changes are likely among the reasons , fewer people signed up for health insurance on the marketplace in than in Between and , the number of uninsured children swelled by , Since more than a dozen states continue to refuse to adopt the Affordable Care Act's Medicaid expansion, 2.

In Texas, one of the states that hasn't expanded Medicaid, nearly 1 in 5 people live without health insurance. Some 10 states are in the process of trying to impose work requirements for their Medicaid benefits. The new qualifications could lead to , Americans losing their health coverage. Starting in January, many Medicaid recipients in Michigan will have to show at least 80 hours a month of workforce engagement to maintain their coverage.

Other states, meanwhile, have fully adopted the Affordable Care Act — and gone further to cover their residents. In , California will become the first state to offer state subsidies to people who earn too much to qualify for federal tax credits on the health-care marketplace. The Affordable Care Act required insurers to cover dependents until their 26th birthday.

Yet in New Jersey , some dependent, unmarried adults are eligible to stay on their parents' plan until they're Washington state signed into law this year a public option for health insurance.

Two front-runners for the Democratic presidential nomination — Sens. Bernie Sanders, I-Vt. More from Personal Finance: Where the wealthiest investors are finding opportunities Credit card debt is worse for those with high income Congress approves major changes to retirement saving.

Skip Navigation. Investing Club. Key Points. The page-plus bill aimed to curb swelling health-care costs, increase quality and flip more than 30 million Americans from uninsured to insured. What happened next, of course, didn't go as planned. Here's how the law succeeded and failed. Despite suffering from a past heart attack and diabetes a woman was able to receive medical coverage through Medicaid expansion under the Affordable Care Act.

Yet there are problems — old and new.

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In addition, the analysis compares changes among hospitals in states that expanded Medicaid with hospitals in states that did not expand Medicaid. Key findings include:. Overall, hospitals in Medicaid expansion states saw increased Medicaid discharges, increased Medicaid revenue, and decreased cost of care for the poor, while hospitals in non-expansion states saw a very small increase in Medicaid discharges, a decline in Medicaid revenue, and growth in cost of care to the poor. Specifically, hospitals in Medicaid expansion states saw a 7.

Looking at total revenue, Ascension hospitals in expansion states saw an increase 8. Hospitals in non-expansion states actually saw a 9. Growth in Medicaid revenue from outpatient care outpaced increases in inpatient revenue in expansion states, suggesting that these hospitals experienced greater increases in demand for outpatient care from new Medicaid patients compared to inpatient care. The bill was unanimously opposed by. After months of protest and outrage, Congress dismissed pleas from their constituents, patients and working families by passing legislation to take away healthcare from millions of Americans by dismantling the ACA.

House Republican leaders, facing a revolt among conservatives and moderates in their ranks, pulled legislation to repeal the Affordable Care Act from consideration on the House floor Friday in a major defeat for President Trump on the first legislative showdown.

The lowest-income New Jerseyans of all ages, and most of those 60 and older, regardless of income, would be the biggest losers under the Republican plan to amend the Affordable Care Act, according to a nonpartisan analysis of the issue.

The American Healthcare Act AHCA will cause millions of people to lose their insurance and raise healthcare costs for working people and seniors. This plan will take away health coverage for millions of patients, while providing large tax cuts for the very wealthy and pharmaceutical and. Republican plans to repeal the Affordable Care Act have encountered a new obstacle: adamant opposition from many older Americans whose health insurance premiums would increase.

Hundreds of concerned citizens came to a rally in Philadelphia on Saturday to defend the gains we've made in providing healthcare benefits to millions of previously uninsured Americans through the Affordable Care Act ACA. Repealing the federal Affordable Care Act would have a direct impact on more than 1 million New Jersey residents — and could even kill nearly of them over the next 12 years.

Across the country, Senator Cory Booker emphasized that the repeal of the Affordable Care Act would have devastating consequences for Americans.

HPAE members, leaders, and staff participated at rallies in Camden, Newark, and Philadelphia today to demand that the Affordable Care Act ACA not be repealed and that millions of people maintain essential health care coverage. On Sunday, Jan. Congress may be moving to repeal "Obamacare," but millions of people are still signing up. The administration said Tuesday that About 6.

If President-elect Donald Trump succeeds in repealing the Affordable Care Act, one in 10 adults in New Jersey would likely lose their newly acquired coverage. An insurance company might have decided not to sell any insurance to someone like you.