We use cookies to give you the best online experience. By using our website you agree to our use of cookies in accordance with our cookie policy. Learn more here.Close Me
Now that the arguments at the Supreme Court regarding the
Patient Protection and Affordable Care Act are over, the nation is
now, more than ever before, confronted with uncertainty in
healthcare. The Court's ruling on President Obama's
healthcare reform law, regardless of whether it affirms the law or
strikes it down, will be have a profound impact on how healthcare
in America is delivered, paid for and regulated. While the
arguments down in Washington may be consuming the headlines and
suggest that change is coming, the development of accountable care
organizations and the physician migration to hospitals indicates
that change is here.
The accountable care organization (ACO) model of healthcare
delivery brings a group of health care providers together in order
to provide healthcare to a population of patients with the
providers being responsible for the cost, quality and overall care
of the patients. This system is intended to tie provider
payments to quality of care metrics and total cost reduction with
this. While there has been much discussion about ACOs, there has
been limited progress made with regard to implementing is
healthcare delivery model. However, ACOs have the ability to
fundamentally transform healthcare, so their development should be
watched closely.
The ACO model is provider-led (physician and hospital) and
required a holistic approach to healthcare management. This
model is then combined with an economic model in which the ACO the
providers will share in any cost savings realized by their
management of the healthcare needs of this group, but such cost
sharing will be dependent on the providers achieving certain
quality of care requirements. The goal of this model is to better
align the interests of the patients, providers and payors so that
providers will have an incentive to increase the quality of the
care and reduce the cost in order to best manage their
patients' healthcare needs.
While the successful implementation of this model could result
in a fundamental and seismic shift in healthcare delivery the model
has not yet been widely implemented. Currently, many healthcare
systems are working to come together to form unified groups of
providers in order to provide services using an ACO model. This
process has been slow to develop as the complexities of integrating
multiple healthcare provider groups has proven to be difficult.
While the implementation may be several years away, this is the
direction where healthcare is headed.
Another change to the healthcare industry that must be watched
is the dramatic increase in the migration of physicians into
hospitals and hospital systems. This migration has resulted in
fewer independent physician practices and a large percentage of New
Hampshire's physicians becoming hospital employees. There
are several reasons for this change, including decreasing
reimbursement rates, increased administrative costs associate with
running a practice, the need for hospitals to support significant
capital investments, and uncertainty regarding healthcare
regulation changes. From the hospital's perspective, by
controlling the physicians it can preserve market share, put it in
a better position to negotiate with payors, and prepare it for
regulatory changes that require bundled payment systems or creation
of accountable care organizations.
In the short term the movement of physicians has limited impact
on patients. However, over the long term this may lead to a
significant consolidation of control in the hospital. Although
hospitals are highly regulated, too much consolidation can begin to
influence how services are delivered.
While healthcare is constantly evolving and changing, the impact of
the opinions of the Supreme Court on the Patient Protection and
Affordable Care Act legislation and the direction these opinions
provide to the nation with regard to viability of national
healthcare, the continued implementation of ACOs will challenge
traditional payment and delivery models, and the movement of
physicians into hospitals and healthcare systems will impact how
healthcare services are delivered. Each of these issues will have a
fundamental and profound impact on how your health will be cared
for in the future.
The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
To print this article, all you need is to be registered on Mondaq.com.
Click to Login as an existing user or Register so you can print this article.
Whether you are an employer that provides health insurance for your employees, a business in the growing healthcare industry, a hospital, or other medical provider—or you provide services to any of those entities—you need to know about changes to the privacy and security rules under the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Understanding the complexities of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules is often a challenge for health care providers and consumers.
Marilyn Tavenner received bipartisan support from members of the Senate Committee on Finance in her confirmation hearing to lead the Centers for Medicare and Medicaid Services (CMS) though a full Senate vote is being held up, the president released his FY 2014 budget proposal with health care reform and specified reimbursement reductions to providers and manufacturers totaling $400 billion over 10 years sprinkled throughout it, and Department of Health and Human Services (HHS) Secretary Sebelius
The Office of Inspector General for the Department of Health and Human Services has recently issued an updated Special Advisory Bulletin on the Effect of Exclusion from Participation in Federal Health Care Programs.
On Tuesday, the North Carolina legislature has enacted into law, pending the governor's signature, a prohibition on the use of most favored nations clauses in contracts between commercial health insurers and providers.
