The United States is in the midst of Healthcare Reform; as such, providers need to be aware of the effects and how to proactively adapt to remain profitable. Healthcare Reform is currently in a state of uncertainty, with Congress currently at an official standoff, contributing to the shutdown of the government. The majority of the controversy is focused upon the individual mandate as well as the medical device tax. Neither side is willing to compromise at this juncture. As for providers, as the current law stands, there are four key areas of concentration.

Regulatory

Healthcare Reform requires companies to make changes in written policies as well as standard operating procedures. A thorough review of current policies should be conducted to ensure compliance with new regulations. Failure to comply can result in penalties in the form of taxes, reduced reimbursement, and other types of negative repercussions. For example, certain notifications need to be available to patients in a timely manner and certain quality and patient safety measures need to be made publicly available. Quality patient care is first and foremost a focus of Healthcare Reform.
What It Costs

Healthcare Reform can’t occur without affecting the cost of coverage for all or most Americans. This deeply impacts healthcare providers. Some of the costs which impact providers include changes in infrastructure such as revamping electronic health records (EHR) to ensure patient information is both protected and readily available to those particular providers involved in providing patient care. The cost of complying with EHR regulations can be very costly from both a start-up and a maintenance perspective. In addition to actual costs, providers are hit on the other side with reimbursement issues. Changes in Medicare reimbursement, for example, have had a dramatic impact upon providers, causing shifts in the way business is conducted to find ways to remain profitable. Penalties have been assessed for hospitals, in particular, which have readmission rates that are above an established standard. While hospitals currently are assessed the penalty, there are outside factors which also come into play which are not as easy to control. Primary care, as well as the community resources, can have a dramatic effect both positively and negatively on readmission rates.  The follow up and continuum of care are crucial to providing the best care for the patient, which in turn will reduce readmission rates.

Looking Ahead
Healthcare Reform is at a pivotal time. Delays have been made in many of the provisions and it is anticipated that more delays and/or changes are coming down the pipeline. Healthcare Reform is a dynamic and fluid healthcare system. Knowing what the current laws require and what changes have been proposed are keys to the success of each provider. As time moves forward, healthcare providers must continue to adapt to the changes in order to remain competitive, viable, and a place of choice for patients.

Kathy Flute is a registered nurse who works in an assisted living facility. She enjoys writing about mental health, physical fitness, offering advice to expectant mothers, and Top Online Masters of Nursing Programs.

Do you need assistance with reducing re-admissions? Do you need assistance with reducing medical denials? Do you need assistance with transforming to an Accountable Care Organization? Do you need assistance with strategic planning? Do you need ACA training assistance? Are you in need of physician advisor services to manage your claim appeals? If you need assistance in complying with the Health Reform regulations, please contact BHM Healthcare Solutions 1-888-831-1171 or results@bhmpc.com.