The Potential Impact Of The Affordable Care Act On Urban Safety Net Hospitals

The Inpatient Prospective Payment System is based on CMS (Medicare) standards because it is the largest reimburser. It was created to control rising healthcare costs by determining reimbursement prospectively. The costs of inpatient acute hospitals stays under Medicare Part A are fixed so that each patient case aligns with a Diagnosis Related Group (DRG).

The Affordable Care Act will adjust Medicare’s annual payment updates to Part A hospitals to account for economy-wide productivity increases for cost savings, which is estimated to reduce Medicare associated with Medicare for 10 years. Under previous laws, the market basket part of the physician update or the Medicare economic index was adjusted to

The current paper examines the Disproportionate Share Hospital Payment Reduction CMS 2367F rule which was effective on November 18, 2013. The Disproportionate Share Hospital Payment Reduction CMS 2367F is Federal Legislation that was implemented due to the Affordable Care Act. The rule was initially proposed by the Centers for Medicare & Medicaid Services (CMS), HHS on May 13, 2013. The proposed rule was to implement the provision of the Affordable Care Act that reduces Medicaid Disproportionate Share Hospital (DSH) allotments.

My organization has policy on Mid-Level Reductions. If the member is seen by a NP or PA we will allow the following reductions: CMS: 15% reduction applied to physician fee schedule for mid-level providers. DHS: 10% reduction applied to physician fee schedule for mid-level provider s. Given complexity of combined fee schedule for members with dual eligibility, apply 10% reduction to physician fee schedule for mid-level providers for all product lines.

The Centers for Medicare and Medicaid Service’s goal is to lower preventable conditions by lowering expenses to the lowest-performing hospitals

This paper deals with the legislative, regulatory components of Medicare Readmission Reduction Program along with recommendation to reduce their readmission rates for a health care facility like Valley hospital in Spokane which has been penalized a higher percentage of 2% as compared to other hospitals in the state of Washington under the third round of penalties.

“The Tax Equity and Fiscal Responsibility Act (TEFRA), signed into law September 3, 1982, mandated the development of a prospective payment methodology for Medicare reimbursement to hospitals.” http://sunlightfoundation.com/blog/2009/09/08/slug/. It changed Medicare reimbursement from a fee for service to prospective payment system. Which is where there`s a reimbursement method where`s there an amount of payment determined in advance of services being performed. The rates are done annually. Reimbursements for inpatient care by a classification scheme called diagnosis-related groups. If the patient might have to stay longer in inpatient care more than average days, the hospital may lose money on that patient.

In order for a hospital to be eligible for reimbursement through Medicare, they have to show that they are compliant by way of the Conditions of Participation. One way to show this is by getting an accreditation through The Joint Commission who meets the Medicare Condition of Participation standards. (La Tour, 2013).

Since 1984, Medicare patients have been serviced under the prospective payment system of the Medicare program. Under this system, primary care providers are reimbursed for their services using a fixed payment for each patient that is determined by the patient’s diagnosis-related group at the time of the admission. Therefore, under the prospective payment system a hospital’s reimbursement is unaffected by the actual expenditures that are required to care for a patient.

“Starting in 2009, Medicare, the US government 's health insurance program for elderly and disabled Americans, will not cover the costs of "preventable" conditions, mistakes and infections resulting from a hospital stay. So for instance, if you are on Medicare and you pick up a hospital acquired infection while you are being treated for something that is covered by Medicare, the extra cost of treating the hospital acquired infection will no longer be paid for by Medicare. Instead, the bill will be picked up by the hospital itself since the rules don 't allow the hospital to charge it to you” (Paddock, 2007).

In 2013 an average of one out of eight Medicare patients are readmitted within a 30-day period which lead to the estimated costs of around $18 billion a year for Medicare patients alone. Hospitals will either be penalized or receive bonuses for their performance with readmissions. This program will encourage hospitals to concentrate on ways to improve coordinating transitions of care while improving the safety and quality of care provided. In order to

This includes people with pre-existing conditions or sex. It was in 2011 that Congress 's budget office projected that this new act would lower not only the future debt, but also Medicare spending all around (Perera 1). This new law seems to work very well for the people that need it.

After the inception of ACA that is Affordable Care Act on March 23, 2010 various policies and regulations has been proposed which has more controversy (www.healthcapital.com, 2013). Affordable health act has impact on the stakeholders in different manner. The main concern in the medical field is the input cost which is increasing continuously. This is the biggest challenge for the US government as the increasing cost makes it impossible for the government to allocate appropriate resources in managing the requirements of the ACA public policy. There are more initiatives taken by the US government in implementing the ACA in an appropriate manner by continuously improving the quality of health care at affordable lower costs

Under safety net, the healthcare system should provide healthcare to patients irrespective of other socioeconomic factors limiting access to essential

In 2008, the Centers for Medicare and Medicaid Services changed its payment regulations to eliminate payment for hospital-acquired complications.