The main aim of the Patient Protection and Affordable Care Act or what later came to be referred as the Affordable Care Act was to cut the number of uninsured Americans by approximately 50%. At the same time, it was also meant to increase Medicaid enrollment by approximately15 million Americans. Initially, the Act proposed to reduce the number of uninsured Americans by 31 million. The second objective of the Act was to improve the value and quality as well as the efficiency of the healthcare services. Improving the quality and fairness of the health coverage was the other aim. Finally, the last aim was to ensure strategic investments are made in the public health sector. This was to be achieved through community investments together with the development of clinical preventive care (Rosenbaum, 2011).
Despite the hitches the Act experienced in the initial stage, the program has proved to be an improvement in the American health care delivery system in the following ways.
Reforms in Payment Coupled with Quality Measure
One notable concept in the PPACA is the triple aim. The triple aim represents the concepts of bringing down the per capita cost of healthcare, improving patient quality and finally bettering the health of American population. This can be demonstrated using the value-based purchasing program for Medicare which is within PPACA. This program achieves its objectives by encouraging health-care providers to embrace the quality based model of business. The value-based purchasing program (VBP) was introduced in October 2012 and has since then distributed about $ 850 million in the form of incentives to health care providers. This distribution is based on hospital performance that is guided by a set of quality measures. Such measures include a clinical process of health care.
Another payment reform which is as a result of the Accountable Care Organization is the Centers for Medicare and Medicaid Services (CMS) bundled payments. This program has been implemented in hundreds of hospitals. The Bundled Payments for Care Improvement (BPCI) works on the idea that individuals in the healthcare service usually collaborate to ensure better coordination of healthcare services. This has resulted in improved healthcare outcomes as well as a reduction in the number of readmissions been experienced in health care facilities. It has also resulted to an eradication of duplicative care and also resulted in reduced Medicare costs. This reform has, therefore, improved our healthcare services as there are a discounted payment and hence savings for everyone involved.
Proliferation of Accountable Care Organizations
As of 2013, there were 428 ACOs across 49 states. Delaware was the only state without ACO. California had the highest number with 46, followed by Florida with 42. Third came Texas with 33 ACOs. PPACA has since then established the Medicare Shared Saving Program (MSSP) that is under ACO. Many AMCs have then pursued these services. What MSSP does is to help achieve better care for all persons across the USA, ensure better health for the whole population and at the end ensure that there is slow or minimal growth in the cost of health services.
The ACOs charged with the role of ensuring that the provision of Medicare beneficiaries as well as delivery of quality services has succeeded in this. There has been a significant reduction in costs. Despite their relative youth, some few ACOs have since then released what they have been able to achieve. There have been significant outcomes in quality of services offered as well as significant reduction in costs. For instance, the Oak Brook, an advocate health care provider has released some improvements that it has been able to achieve. There has been a reduction in the readmission rates. This is from its ACO. Advocate Care, was a program that was launched in partnership with Blue Cross Blue Shield from the state of Illinois. Using their data from year one, it is possible to show how PPACA through the ACO has improved our healthcare.
The data shows that there has been a 26% reduction in readmission rates to patients related to ACO. This is for patients who were suffering from chronic illnesses. The program also showed that there was an 11 % reduction in the hospital admission per member related to ACO. There was also a 6 % decrease in emergency visits reported previously. ACO has managed to emphasize on preventive care and at the same time ensure that quality healthcare is provided at low cost (Lee, 2010).
Strong Fraud Fighting Techniques
The PPACA has introduced new tools that have proven very effective in fighting fraud. For instance, the program comes with tougher sentences for those involved in healthcare fraud. The regulation has proposed a 20-50% longer jail sentences for crimes dealing with $1 million loses. This is in comparison with what the same individual would receive before the implementation of PPACA
Medicare and Medicaid Recovery Auditor Contractors have been introduced by the regulation to scrutinize hospitals for any wrong doing such as edited payment amounts as well as services that have been coded wrongly. The RACs is divided into four regions. They also look for duplicate services. By December 2012, for those hospitals participating in the RACTrac survey, approximately 90% indicated that they had been victims of the RAC activity.
The implementation of the program has seen the fight against healthcare rise. This is especially through the False Claims Act. Since its implementation up to the year 2012, more than $9.5 billion has been recovered by the Department of Justice (DOJ) through the use of False Claims Act. The reclaimed money is mostly one that touches Medicaid as well as Medicare. The implementation has also resulted in lawsuits against pharmaceutical companies which has resulted in billions of money in recovery. A good example is the $1.5 billion that has been paid to settle an FCA allegation by GlaxoSmithKline. The Giant manufacturing farm had been accused of off-labeling marketing its products. Before the implementation, the recovery would have been long, tedious and unsuccessful (Herman, 2015). Undoubtedly, the implementation of PPACA has improved our healthcare system.
Medicare and Medicaid Uncertainty
Despite improving our healthcare as explained above, the implementation of PPACA has resulted in uncertainty surrounding the Medicare as well as Medicaid. The subsidy that treats the poor, as well as the elderly, has been cut significantly. Many states have, therefore, toyed with the suggestion of implementing the Medicaid expansion. A good example of this scenario is the state of Texas. Having the nations largest uninsured population, the state has refused to expand it for the less fortunate as well as the ones been discharged from hospitals.
Concerning the issue of ACO, some patients see the program as a repetition of Health Maintenance Organization (HMO), a program of the 90s. This results in restriction of choices as well as poor quality services that are very cheap. Theres also a concern that doctor-patient confidentiality is likely to be undermined. Finally, other concerns are that the FTC, as well as Department of Justice (DOJ), will likely quash ACOs under antitrust issues. For the full implementation of the program, state governments may have to change some rules concerning insurance to fully comply with the program (Shafrin, 2010).
BIBLIOGRAPHY \l 1033 Herman, M. G. (2015, January 25). Becker Hospital review. Retrieved from 3 Years of PPACA: http://www.beckershospitalreview.com/hospital-management-administration/3-years-of-ppaca-the-5-biggest-changes-in-healthcare-since-the-laws-passage.html
Lee, L. P. (2010). Creating Accountable Care Organizations. The New England Journal of Medicine.
Rosenbaum, S. (2011, January). The Patient Protection and Affordable Care Act: Implications for Public Health Policy and Practice. Retrieved from Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001814/
Shafrin, J. (2010, January 10). Healthcare economist. Retrieved from What are Accountable Care Organizations?: http://healthcare-economist.com/2010/01/26/what-are-accountable-care-organizations/
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