Affordable Care Act | Distance Learning Systems (DLSI)

Medicare Hospital Readmissions Reduction Program

The Affordable Care Act (ACA) has new financial incentives and penalties. This is done in order to improve the health care system, mainly hospitals, performance in the country. The new mandate has been proven to be hard to manage and has encountered several problems. However, it provides new opportunities for leaders to have a good collaboration with different health care providers.

Medicare’s Hospital Readmissions Reduction Program or the (HRRP) penalizes hospitals that allow patients to have excess 30-day readmissions specifically for health conditions like myocardial, pneumonia, and heart failure. The program was intended to punish hospitals with surplus 30-day readmissions not considering whether the patient was readmitted to the same hospital or to another hospital.

Actually, the penalty itself is not that substantial or damaging to the hospital’s income. What makes it more significant is its effect on the image of the hospital. The penalty data of each hospital is open for public viewing every year, so they know what hospital has been paying a lot of penalties recently. This could affect the number of patients that will choose that hospital. If the hospital is located in a very competitive location, having a high penalty rating could greatly affect them.

The program has forced hospital leaders to develop, filter, assess, and implement care management programs in different areas. It is essential to use the information technology for data incorporation. Evidence-based decision-making is also important to make the services more effective and fast as soon as the patient was admitted. It is also crucial to the development and rapid-cycle learning. Hospital leaders as well as their management must be aware of the changes in the rules. They now need better collaboration with other health care institutions to be more effective in terms of the services they offer to patients. Keeping the patients from readmission to the hospital due to their total wellness and recovery is a very good sign for the hospital’s development.

The American Healthcare Problem

Two-thirds of the people in America are happy with “the way the new healthcare program is working for them,” a June Gallup study discovered. That measure has stayed generally consistent since the research firm first began tracking healthcare fulfillment in the middle of March in order to evaluate how the changes brought on by the Affordable Care Act were affecting people in America. “Americans’ advanced level of fulfillment with how the medical care program is treating them indicates that medical care is not in a problem for most people in America,” the report said. “At the same time, that 30% of the adult population, more than 70 million people, [who are] not satisfied with the medical care program emphasizes the need for improvement.”

While it helped that Affordable Care Act enrollments topped the Obama administration’s maximum estimate of 7 million, that figure is not the most important measure of the reform’s achievements. If those exchange policies are considered to be affordable and the protection assessed to be good, then the future achievements of the Affordable Care Act will be more assured. For the Obama-care story to be one of growing achievements, the experiences of those people in America who benefit from the changes to the insurance program, including low and middle-income earners qualifying for financial assistance, and those with preexisting conditions who cannot be turned away by insurance providers, it will have to over-shadow the pressure the change may place on those who find their rates too expensive, want to visit doctors out of their network and consider their insurance deductibles too great.

When analyzing how the Affordable Care Act has changed the American public’s understanding of its healthcare program, health insurance status is the most significant forecaster of fulfillment. The biggest rate of fulfillment, 77%, is found among Americans with military or veteran health coverage. Medical health insurance or State health programs recipients follow, with 76%, while 70% of Americans with partnership or employer-sponsored plans and 66% of self-insured Americans expressed satisfaction. By comparison, those Americans without insurance were more disappointed with the medical care program. Only 36% of those participants said they were content and 60% said they were disappointed.

Healthcare Problems

Charles Krauthammer provided us all advice when he recommended that we should neglect what President Obama says and focus on what he does. The reality is that very little that Obama peddled to America when he was attempting to gain support for the Affordable Healthcare Act was true. What is going to happen to many People in America in the next months and years is what individuals should be focused on. We might want to consider some of the following, because it may affect us all, one way or the other.

As many as one-half of all American doctors may refuse to join the healthcare transactions. Without doctors, it will be a very hard to make the transactions work and guarantees long waits to see a doctor.

The White House and surrogates say a few individuals will lose their healthcare coverage. The estimate of a 5% cancellation rate would signify about 16 million individuals, or about one-half the number of the uninsured that was originally used to rationalize this problem. Each cancellation provides with it a tale and for some, a complete loss of insurance plan and lack of ability to get treatment. And perhaps as many as a third of the population could be affected once the employer mandates kick in.

The government gets to decide on the details of healthcare coverage each resident will be needed to buy. An older woman may be needed to buy pre-natal coverage; a younger man may be needed to buy coverage for geriatric care. The Affordable Care Act does not differentiate between the needs of the younger and the old, or the sex of the policy-holder, or the needs and wishes of the individual. It is an all-encompassing, like it program, because there is no leaving it.

In order for the program to work, younger, healthy individuals must buy the government required insurance policy. Since most adolescents have no medical problems and the penalty enforced is much less expensive than buying the actual policy, many will no doubt opt to pay the penalty. The fact that previous medical conditions cannot remove one from buying insurance plan makes the choice to pay the penalty and wait until the need for healthcare insurance coverage occurs, a no-brainer.

Attitude Toward Patient Care

“American physicians need to be totally able to do what they have been trained to do, succeed at practicing medicine. American patients need to be totally able to choose the family health insurance coverage and medications that suit their needs, not something forced by a central power. This simply cannot occur under the imprisoning pressure of the Affordable Care Act.” – Richard A. Armstrong, M.D. “Under the Affordable Care Act, physicians who effectively work together with other suppliers to improve patient care results, the value of healthcare services and patient experiences will flourish and be the leaders of the healthcare care program.” – Robert Kocher, M.D.; Ezekiel J. Emanuel, M.D.; Nancy-Ann DeParle

Physicians have been caught in the middle of the transformation of the American healthcare care distribution program brought on by the Affordable Care Act. Doctors who battle the regulation and those who support it are trying to adjust to a fast changing healthcare environment. A Deloitte Center for Health Solutions survey of American physicians found 44 % thought the ACA was “a good start” and 44% reacted that “it is a step in the wrong direction.” Obviously, older physicians were more likely to be in the second group of participants than younger physicians.

The ACA overhauls the healthcare care distribution program in the following ways:

It improves accessibility healthcare for more Americans
It creates incentives to promote better patient care synchronization and quality
It provides feedback to physicians on cost and quality of their patient care
It changes the payment program from fee for service to value based
It focuses on patient-centered care
It depends on increased use of electronic medical records
It attempts to increase access to primary care and allied health providers

Healthcare Reform and Hospitals

The discussion on whether the Affordable Care Act is a success or not will most likely continue for years, but authorities at St. Rose Hospital in Hayward say, because of the ACA and other state and government cuts, it might not be around to see the accidental complication of healthcare change. St. Rose Hospital has had cash problems for years. In fact, it has almost closed a few times before. Its sufferers are mostly without insurance or under-insured. The new control group is making progress to keep a hospital open, but the discount rates in state and government cash might mean those gates close for good.

For sufferers like Ginny Almond, St. Rose Hospital’s place in Hayward is everything. She was recently rushed there for emergency surgery. She says a few years ago, St. Rose physicians saved her life after she almost passed away in a fire. “Very thankful that they were there and so close to where I stay,” Almond says. The personal, non-profit hospital admits almost 35,000 E.R. sufferers a year. With Kaiser Hayward closing, St. Rose will be the only service getting 911 sufferers in the Bay Area’s fifth biggest town.

Now, because of cash problems, St. Rose might have to shut down. “It’d be terrible for myself and for the group,” according to Almond. St. Rose’s Chief Financial Officer, Mark Krissman, points out, “If St. Rose no longer exists, that means lives are at stake because emergency vehicles have to journey a little bit further to another service.” He says, as a safety net hospital, St. Rose admits a huge number of without insurance and under-insured sufferers.

The charges those sufferers can’t pay have been sponsored by state and government programs, such as, Medicare and MediCal. The Affordable Care Act will decrease Medicare financial assistance by $22 billion dollars over the next five years. The idea is that more people will be covered and able to manage medical care. But Krissman claims his hospital still needs that cash, because St. Rose serves a poor community, many of whom might not sign up for insurance. “We will get $3.6 million less in compensation for the next 12 months,” according to Krissman. Add that to the $10,000 shortage Krissman says St. Rose shelves up every day, in part because MediCal doesn’t cover full service expenses.

Start-Ups Changing the Healthcare Industry

Few sectors stand to gain more from recent enhancements in technological innovation (and certain federal legislation) than healthcare. In 2014 and beyond, consumers will finally start to benefit from some of the enhancements that have been changing over the last year, from 3D prosthetics to cutting-edge DNA testing. Here are some stats: Family care providers offer 83 percent of senior care in the U.S. each year and these family care providers spend about $5,000 and devote 1,000 hours to offer proper care to their families. If care provider mistakes were reduced, which could potentially reduce Medicare expenses, then $60 billion dollars in avoidable healthcare expenses could be removed.

A portion of the Affordable Care Act makes it a requirement that healthcare providers switch to electronic medical records, so there have been several start-ups offering services in that world, including Practice Fusion and CareCloud. The appearance of 3D-printed prosthetics symbolizes a major landmark in not just the performance and appearance of artificial limbs, but also the availability of them. Over the last season, a number of powerful applications of big information approaches to healthcare problems have appeared as appealing solutions. Start-ups are using quantified self information to fix infertility (Glow), running big information analysis on differential diagnoses for cancer treatments (HC Pathways) and applying ad tech techniques to find connections in disease treatment (Flatiron Health).

The Supreme Court decided against the patent-ability of naturally sourced human genes this previous June. This previously meant that companies were able to patent a particular gene series that associated to a particular hazard to wellness or drug sensitivity. Not amazingly, the patent certification was expensive for research and avoided bringing DNA testing to the public. The use of technological innovation to build better relationships, improve communication and identify early depending on EMR-integrated provider-patient programs captivates healthcare traders. Although the quantified self gets lots of attention, large sections of our population are not as tech-savvy and technological innovation needs to have concrete and immediate benefits for high adoption. The second trend is compliance-based technological innovation that allows patients to stay in therapy, receive consistent reviews and rely on a support network.

Hospital Executives and the Affordable Care Act

Of hospital executives surveyed, 65% indicated that by 2020, they believe the wellness care program as a whole will be somewhat or significantly better than it is today. And when they were asked about their own organizations, the positive outlook was even more impressive. Fully 93% expected that the quality of care provided by their own wellness program would improve. This is probably related to initiatives to reduce hospital obtained conditions, medicine mistakes and needless re-admissions, as motivated by financial penalties in the Affordable Care Act (ACA).

On price control, there was similar optimism: 91% expected developments on analysis of price within their own wellness program by 2020. A large proportion, 85%, expected their company to have decreased it’s per individual working expenses by the end of the decade. Overall, the common working reduction expected was 11.7%, with a range from 0% to 30%. Most professionals believe they could save an even higher amount if Congress introduced regulation to speed up the move away from fee-for-service payment toward models like included payments. In such a case, the hospital executives estimated regular yearly benefits of 16.0%, which, if used across the wellness care program, would amount to benefits of nearly $100 billion dollars per year.

How can such benefits be achieved? Hospital executives anticipate three strategies rising to the top: decreasing the number of hospitalizations (54%), decreasing the number of re-admissions (49%) and decreasing the number of E.R. trips (39%). Other likely resources included decreasing expenses for medical devices (36%) and medicine (27%), along with enhancing back-office performance (23%). These leaders believe that benefits can be found through a mixture of better management performance, price discount rates and decreased dependency on hospital services.

NLN Creating Inclusive Environments

Health professional teachers must master novel techniques and strategies to make and maintain a racial, social, gender-diverse nursing labor force ready to provide excellent care to individual communities of varying backgrounds and sources across powerful, complicated wellness techniques.

As the Affordable Care Act (ACA) takes full effect with the start of the new year, nursing professionals must keep pace with the law’s inherent call for social understanding and inclusivity. For nurse teachers, that means mastering novel techniques and strategies to make and maintain a racial, social, gender-diverse nursing labor force ready to provide excellent care to individual communities of varying background scenes and sources across powerful, complicated wellness techniques. In keeping with this challenge, the National League for Nursing or NLN presents its 2014 Leadership Conference in Savannah, Georgia, Friday through Saturday, February 6-8: Academic Leadership Excellence: Developing Inclusive Environments.

NLN CEO Beverly Malone, PhD, RN, FAAN, will open the conference on Friday evening with her talk: “Now Is the Time: Developing Inclusive Environments to Advance the Nation’s Health.” The next morning, following welcoming comments from the NLN’s president, Marsha Adams, PhD, RN, CNE, ANEF, Antonia Villarruel, PhD, RN, FAAN, will provide the keynote address, “Integrating the Three Ds: Diversity, Differences, Social Determinants, Nursing’s Perspectives.” Dr. Villarruel is lecturer and Nola J. Pender Collegiate Chair at the University Of Michigan School Of Nursing. Throughout the three-day gathering, national experts will guide conference members in plenary sessions, panel conversations, and large classes to:

Explore inclusivity and its importance to nursing education and nursing care.

Understand the Affordable Care Act’s impact on nursing education’s role in preparing students to provide culturally competent care to different communities.
Take part in courageous dialogues about inclusivity.
Identify action techniques to develop a base for social due diligence and inclusivity in nursing teaching programs.

Efforts on Improving Senior Care

Larger mattresses are a big deal in Valley Hospital’s emergency department, as part of its attempt to make a “senior-friendly” ER. At 5 inches thick, the mattresses (changing from the conventional 3-inch-thick ones on the department’s 21 beds) are more comfortable, according to ER employees and help protect patients’ delicate skin. Other new features at Valley and Deaconess emergency departments recognized open houses include easier-to-use call control buttons, floor-gripping footwear and yellow-colored dresses that alert employees to seniors’ greater risk of falling and seniors-only vehicle parking areas or valet service.

Along with making clients happier, the changes at both medical centers are developed to cut the number of seniors’ return trips and the duration of their medical center stay, Valley CEO Tim Moran informed a group gathered at the medical center to see the developments. The medical centers, part of the region’s Rockwood Health System and owned by Community Health Systems Inc., have been making the changes as more sufferers age and as the Affordable Care Act places a new focus on enhanced ER care and senior care. Under the new health care law, emergency departments have some new reasons, financial rewards and disincentives to enhance care, said Dr. John Tilson, medical directors of Valley Hospital’s emergency department.

Among disincentives, Dr. Tilson said the center is compensated less to cure sufferers who continue to come back to the ER, especially in the first 30 days after their first visit. The idea is that if emergency departments better deal with patients’ health-related problems, assisting them set up better support at home, for example, they can avoid upcoming conditions and accidents. How much an ER gets refunded by medical health insurance also will rely partially on how quickly sufferers get services and their fulfillment with their care, Tilson said. In 2012, people 65 and older showed nearly 17% of Valley’s emergency department trips and nearly 20% at Deaconess. More senior sufferers are required as middle-agers age. While the first trend of senior care emergency departments or specific senior departments within ERs in the U.S. started out just a few years ago, senior care is getting more attention among emergency doctors in the U.S., Tilson said. Some ERs in areas with large senior communities are building entire departments in their emergency departments for older people, he said: “It’s just taken off.”

Efforts for Advancing Nursing Education

Creating larger, more extremely trained medical employees will improve access to higher-quality, more patient-centered and more cost-effective care. That is especially important now: Demand for medical care is growing as the population ages and millions more individuals are entering the medical care program under the Affordable Care Act. Nurses, the largest segment of the medical care work force, provide critical care to our members, many of whom are aging and managing multiple chronic health issues.

That is why AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF) jointly released the Center to Champion Nursing in America six years ago, to help the medical career better serve consumers. When a subsequent, groundbreaking Institute of Medicine (IOM) review called for transformation of the nursing career, AARP teamed up with RWJF to launch a nationwide strategy to implement the report’s recommendations. These focus on nursing education, practice, leadership, diversity, data, inter-professional collaboration and more. Since its creation three years ago, the Future of Nursing: Campaign for Action has organized action coalitions, groups of nurses and health professional champions comprising business, government, academia, consumer groups, philanthropy and other sectors in all 50 states and the District of Columbia.

The coalitions have so far jointly raised more than $6 million and released projects to advance nursing education, build the nursing workforce and expand access to nursing professionals and other advanced practice nurses. Seven states have removed major barriers to advanced practice registered nurse (APRN) practice and proper care, and one state has given gave APRNs full practice authority and expanded prescriptive power. Nine action coalitions, meanwhile, have been funded to test models to increase the number of baccalaureate-prepared nurses, a key IOM review recommendation. And leaders of national organizations comprising nursing education and community colleges have come together in support of nurses’ advancing the training and learning.