Question 1
As a result of reforms in health care encapsulated in the Affordable Care Act, health care exchanges that are state or federally run have been established. The establishment of health care exchanges is bound to alter outpatient treatment as a concept in health care. Some of the benefits that those covered under health insurance enjoy include consultation fees paid to doctors including specialists and payment for examinations and tests requisite to the treatment of illnesses (Carey, 2010).
The implementation of health exchanges has organized the market, making it easier for people to purchase insurance. The health care exchanges provide information centrally, thereby enabling people to compare the benefit designs between different insurance providers. This means that people can choose between providers with the more benefits for outpatient care. For instance, the centrally placed information enables people to determine which insurance providers have benefits for home care. The public health care exchanges enable the administration of public subsidies, thereby enabling the beneficiaries to enjoy discounted health care (Carey, 2010).
Additionally, health care exchanges have mandated that all health plans should offer certain core benefits such as wellness services, preventive services and prescription of drugs among the other aforementioned benefits under outpatient treatment. As a result of the health care exchanges, people will be able to source for a health plan that fits their budget and needs. As a result, more people will change their health seeking behaviors and seek outpatient treatment because it is affordable.
The enactment of the Affordable Care Act, effectively creating state of federally run health care exchanges will enable more people to seek outpatient care in primary health care institutions because it not only offers subsidies in public exchanges, but also enables people the opportunity to source for health plans with benefits that suit their budgets and needs (Aetna, n.d.).
Question 2
There have been changes in the way Medicare reimburses hospitals for the services rendered to people covered under Medicare. Under the Affordable Care Act, Medicare is authorized to reduce the payments reimbursed to acute care centers that have excess readmissions. This is especially the case for acute care centers that are paid under the Centers for Medicare & Medicaid Services Inpatient Prospective Payment System. Additionally, the operational agency for Medicare has altered its operations so that it rewards hospitals that deliver higher value and quality services (Medicare, n.d.).
The linking of health care payments to quality is a good move towards reforming the health care delivery. By linking payments to quality, acute care centers will be motivated to improve the value in the services that they offer. Additionally, this will also motivate acute care centers to offer services of a higher quality because of the incentive attached. It is important to understand that under the provisions of the Affordable Care Act, Medicare has not just reduced the payments that are made out to acute care centers that have a high readmission rate, but also seeks to reward those acute care institutions that improve their service delivery as measured through various indicators that are pegged on quality and value of services delivered. I opine that the move to punish and reward will serve as incentives for acute care centers to improve their service delivery.
However, I also think it is important to consider why acute care centers might have many readmissions within a period of thirty days after initial discharge. Some of these reasons include complications arising from the treatment that is offered during hospitalization, inadequate treatment, insufficient follow up and care coordination when the patient is discharged and enforceable exacerbations of the disease after the patient is discharged. Some of these reasons are beyond the control of acute care centers. However, they can still be mitigated in order to reduce the rate of readmissions through the use of case managers (Finkelman, 2011).
Question 3
One of the approaches that case managers use in order to ensure the high quality care while carefully using the limited resources is through home care. This is where care is coordinated after discharge so that the planned outcomes are managed while the patient is in the home setting. This reduces the hospitalization days, thereby shaving on hospital charges. Palliative care is very important to this strategy. Case management that is done under a home care setting borders on the objectives of palliative care, especially when it is done for disease conditions that do not have a cure, such as chronic obstructive pulmonary disease.
Instead of hospitalization, palliative care can be given in the home setting to improve the quality of life for such patients at a relatively inexpensive setting. This is very appropriate, especially in the bearing in mind the limited resources because such a disease has no cure and the management objectives involve impeding progression of disease, lifestyle management and in cases where the disease progresses severely, end of life care (Ministry of Heath, 2011). Hospice care is also important in this strategy, as it involves enabling a patient with a progressive disease that has no cure to end their life in a dignified manner. This can be done at home to reduce the financial burden on them and their family members.
References
Aetna. (n.d.). Health Care Reform: What is a health insurance exchange? Retrieved 24 Dec.2014 from http://www.aetna.com/health-reform-connection/reform-explained/video- exchanges.html
Carey, R. (2010). Preparing for Health Reform: The Role of the Health Insurance Exchange. Retrieved 24 Dec. 2014 from http://www.statecoverage.org/files/SCI_The%20Role %20of%20Health%20Insurance%20Exchanges.pdf
Finkelman, A. (2011). Case management for nurses. Upper Saddle River. Pearson Education Inc.
Kirk, T. & Jennings, B. (2014). Hospice ethics: Policy and practice in palliative care. New York. Oxford University Press
Medicare (n.d.). Linking quality to payment. Retrieved 25 Dec. 2014 from http://www.medicare.gov/hospitalcompare/linking-quality-to-payment.html
Ministry of Heath. (2011). Chronic obstructive pulmonary disease (COPD). Retrieved 24 Dec. 2014 from http://www.bcguidelines.ca/guideline_copd.html
