What Healthcare Reform Means for Providers

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 in order to remain profitable. Healthcare reform is currently in a state of uncertainty, with Congress at an official standoff that has contributed to the shutdown of the government. The majority of the controversy is focused on 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 several 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 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, and this deeply impacts healthcare providers. Some of the costs that impact providers include changes in infrastructure, such as revamping electronic health records (EHR) to ensure patient information is both protected and readily available to the particular providers involved in that patient’s care. 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 on providers, causing shifts in the way business is conducted in order to find ways to remain profitable. Penalties have been assessed for hospitals, in particular, that have readmission rates above an established standard. While hospitals are the ones currently assessed the penalty, there are outside factors that also come into play and are not as easy to control. Primary care, as well as community resources, can have a dramatic effect — both positive and negative — on readmission rates. 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 to 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 system. Knowing what the current laws require and what changes have been proposed is key 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.

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

Do you need assistance with reducing readmissions? Do you need assistance with reducing medical denials? Do you need assistance with transforming to an Accountable Care Organization, or 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 health reform regulations, please contact BHM Healthcare Solutions at 1-888-831-1171 or re*****@***pc.com.