Healthcare reform is a topic of much debate. Of course, delivery of healthcare services affects every citizen from all social and economic classes. In this regard, healthcare reforms have purposely been focused towards addressing the traditional problems that face the healthcare system. Examples of these challenges include; limited access, under-insurance as well as other social and economic barriers. A number of recommendations and legislative initiatives including the Patient Protection and Affordable Care Act (ACA) have been adopted to improve the healthcare delivery system (Blumenthal, Abrams & Nuzum, 2015). According to Blumenthal, Abrams and Nuzum (2015), the ACA has been described as a watershed in the US healthcare system reform journey. As a reform, it has been seen by many as a promising move aimed at addressing the traditional issues of access and health coverage. Nonetheless, this law has not been without its opponents, especially from the opposition divide. The controversy over the ACA continues today as changes proposed by the law continue to be phased in over time (Blumenthal, Abrams & Nuzum, 2015). The Health Care Reform Act threatens the way we deliver healthcare and are reimbursed for services.
As afore-mentioned, ACA is one of the sweeping healthcare legislations that have been adopted in the past century. The law in many ways is complex and difficult to operationalize in the current healthcare delivery environment. The law attempts to address access to care deficits, the high costs of healthcare, and the quality of the care that is delivered. Because of the sweeping nature of many of the provisions that address these three areas, healthcare entities have had difficulty adapting to and understanding the changes that are recommended by the law (Blumenthal, Abrams & Nuzum, 2015). Better understanding how these three aspects impact the healthcare delivery system is important to assessing the efficacy of this legislative effort.
One area in particular that is problematic is the proposed changes in payment that are recommended as a part of the law. The healthcare delivery system relies on reimbursement from third-party payers to operate. The ACA introduces several changes to the current payment system that threaten the level of reimbursement that healthcare organizations receive (Blumenthal, Abrams & Nuzum, 2015). The changes are proposed in the following areas including reductions in reimbursement due to readmission rates and hospital acquired infections, reimbursement for value provided by both hospitals and physicians, bundled payments, and Accountable Care Organizations as a suggested structure for reimbursement (Decker et al., 2013). These changes have proposed adoption on a tiered basis over a number of years and not all healthcare entities are required to be a part of an ACA. Measuring the effectiveness of these programs will be important to understand its appropriateness and bring into limelight areas that require improvements. In as much as this legislation has its imperfections, it shows a lot of potential in promoting quality, safety and at the same time, not compromising access or affordability.
The ACA as a legislative initiative attempted to do too much in a short period of time. These changes have systemic impacts on the healthcare delivery system. Because the government pays almost half of the reimbursement to the healthcare delivery system, these changes have a major influence on the stability of healthcare reimbursement. In addition, many private insurance companies are adopting similar payment programs and other provisions that mirror what is suggested through the ACA. These changes in payment have the potential to cripple the delivery system. Inadequate resources can limit access. A goal of the ACA was to improve access. Since healthcare organizations have limited resources, some doctor’s offices or other organizations can choose the type of patients they accept (Blumenthal, Abrams & Nuzum, 2015). This leaves individuals with ACA plans without access to healthcare services. In essence, the ACA was fundamentally intended to place control of the healthcare market in the hands of the consumers- a twist from the norm. This was intended to give the public more bargaining power and control over their health. Nonetheless, discrimination against a certain class of patients or hospitals, pharmaceutical firms and insurance merging to increase their market command, totally contradicts the basic intention and purpose of this law (McGreal, 2012). This accentuates the need to re-examine, this reform with a view to address the existing weaknesses and guard the potential pitfalls that have the potential to compromise care.
The research plan for investigating this topic should include a search of information about how each of these changes in payment are being introduced in specific healthcare entities. Further, understanding how changed payment or most of time reduced payment impacts the functioning of these entities is integral to determining how this law threatens both the delivery of and payment for healthcare services (McGreal, 2012). Peer-reviewed journal articles should be searched to obtain evidence related to the thesis for this research. Additionally, research from government related websites such as the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid Services (CMS) and state health department websites that handle the delivery of Medicaid services should be examined to further underpin this research (McGreal, 2012). Any information or research about ACOs will also inform the premise of this research.
References
Blumenthal, D., Abrams, M., & Nuzum, R. (2015). The Affordable Care Act at 5 Years. N Engl J Med, 372, 2451-2458. doi:10.1056/NEJMhpr1503614Schalk, D. M.,
Decker, S. L., Kostova, D., Kenney, G. M., & Long, S. K. (2013). Health status, risk factors, and medical conditions among persons enrolled in Medicaid vs uninsured low-income adults potentially eligible for
McGreal, C. (2012). Obama's healthcare reforms: your guide to the key provisions | US news | The Guardian. Retrieved from http://www.theguardian.com/world/2012/jun/28/obama-healthcare-reform-key-provisions Medicaid under the Affordable Care Act. Jama, 309(24), 2579-2586.
