Do you know what healthcare reform means for you and the nation? October 1, 2012 marked the change in how hospitals received payment for health care provisions. The changes came in the form of two different areas of reform:
Administers a penalty to hospitals for the readmission of patients within 30 days of treatment for a condition that was dealt with improperly on the first visit.
Aims to reward hospitals for performing better quality care to patients in the form of higher Medicare payments. The reform laws are putting more emphasis on the quality of healthcare in the United States, versus the number of visits and services provided. Quality has become paramount.
What Healthcare Reform Means
Return Visit Penalty
Do you know what healthcare reform means in terms of return penalties? Hospitals must deal with a payment cut for patients who have to be readmitted to the hospital within 30 days of a previous visit. The stipulation involves readmissions in Medicare that were preventable. The law’s guidelines are designed to cut down on overcrowded emergency rooms and lessen the extraneous use of medical resources, time, and labor. They include penalties for hospital readmissions (have discharged patients who have contracted additional conditions during or after their initial treatment).
No Extra Income
Multiple and/or follow-up visits for care of the same conditions will not necessarily equate to added payments as it did in the past. The Medicare Payment Advisory Commission has identified a problem with multiple visits, most recently identifying hospital readmission averaging as high as 15.3 percent nationwide. In 2010, there were 1.9 million readmission visits, resulting in a $17.5 billion expenditure. The emphasis for quality care on first-time visits in the future should become a priority for the staff, physicians, and health care providers.
In order to ensure that hospital care facilities take time to accurately and fully diagnose, they stand to lose a 1 percent reimbursement for patients who make return visits within weeks of treatment. Hospitals will be penalized for unsuccessfully treating patients. In order to receive full reimbursement, hospitals will be required to keep their patients in relatively good health to avoid re-admittance when possible.
The federal government is holding back 1 percent of payments to approximately 3,000 hospitals in an effort to boost quality care. This nudge (or incentive) is a program called Value Based Purchasing and involves placing approximately $850 million into a collective pool. Hospitals that show high performance levels in quality care areas are entitled to receive additional funds on top of the funds they have contributed. Hospitals that perform poorly are subject to a loss and may receive nothing—even a rate cut.
The increased emphasis on quality over quantity will affect the care facility’s view on hiring better qualified personnel as well as instituting new, updated programs and educational resources that will provide the best health care available. Hospitals will be required to spend more time screening applicants for key and high-tech positions. Staff who have negligible or poor performance records will have to be released or re-educated at the cost of the facility. The entire hospital network may have to be retrained in order to refocus. With the health care reform program in place but still young, it is difficult to predict what will happen in the next few years. It will be up to the hospitals to take on the challenge, rethink issues and retool their programs. If they fail to see the benefits or decide to waive the positive aspects of the program, they will face the consequences. After all, the new health care reform program was implemented to improve coverage for all people.
Kathy Flute is a resident nurse who works in an assisted living facility. She enjoys writing about mental health, physical fitness, offering advice to expectant mothers, and Top Accelerated NursingPrograms.
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Get Ready for the Changes With a Free ACA Webinar
It is important that every healthcare organization has a thorough understanding of the Affordable Care Act, and how it has the potential to impact them and their organization. Change will be swift and the reform will be sweeping, requiring a number of clinical, administrative, and financial changes in order to operate successfully and profitably. If you would like more information about how to prepare your organization for the ACA Impact, BHM will be hosting a free no obligation webinar entitled The ACA Impact on Hospitals, we hope that you will join us.
Description: Find out what your organization can do to brace for the Affordable Care Act (ACA) and what strategies you can implement now to succeed in a changing environment.
Date & Time: Thu, Oct 3rd, 2013 at 12:00 pm EDT
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