7 Ways the ACA Will Change How Your Hospital is Run

by webadmin on December 17, 2013

AFA101-thumbTony Leys of the Des Moines Register has produced a handy list that adequately summarizes the seven ways in which the Affordable Care Act is going to change how your hospital is run. We’ve covered many of these separately before, but this is a concise overview that ties a nice, big bow around most of the issues healthcare has been discussing for the past year.

First, your hospital will have to change its approach to “tracking patients with chronic health problems.”

It used to be that there was little financial reward for taking care of chronically ill patients. But healthcare reform is changing that, writes Leys.

According to data provided by Dr. David Swieskowski, vice president of Des Moines’ Mercy Medical Center, “Wellmark Blue Cross and Blue Shield pays Mercy’s ACO about $960 per month to care for patients with two or more chronic conditions… If Mercy can effectively keep such people well for less than that amount, it could keep half of the savings. That amount could be substantial. But the insurer only pays Mercy’s ACO about $65 per month to care for healthy people, so there’s less room for cost savings… Under the new arrangements, clinic systems are rewarded for taking on tough patients and making them better.”

Second, patient monitoring will also apply to healthy patients.

Under ACOs, there is actually a vested interest in keeping everyone healthy and out of the hospital. Therefore, hospitals will be more persistent in making sure their patients come in for vaccinations, screenings, and routine tests.

Third, quality and value are buzzwords that aren’t going to be leaving us at any time soon.

The ACA’s cheapest insurance plans are “narrow-network” plans, Leys writes. “People who buy them could save $100 or so per month on premiums, but they would be encouraged to use a single healthcare system…Patients with these insurance plans could face substantially higher costs if they go to clinics or hospitals outside their network, unless they could show they really needed a specialist who was otherwise unavailable.”

He adds, “If these new insurance plans prove popular, the healthcare companies will be under increased pressure to convince consumers that they provide the best, most efficient care.”

Fourth, wait times to see physicians are going to be longer.

This is mainly because of the influx of newly insured patients and the physician-shortage crisis that we’ve written about extensively before.

Fifth, physician extenders will increasingly be assigned to so-called “routine cases.”

According to Judith Collins, president of the Iowa Nurses Association, “…[T]here is growing interest among nurses to take the extra two to four years of training required to become a nurse practitioner.” Furthermore, “[p]atients seem increasingly willing to entrust their primary care to specially trained nurses…especially if it means the patients receive more time to discuss their health issues. “

Sixth, expect mental health to be given more attention under the ACA, especially on the primary-care level.

Why?

“Because of increasingly clear links between psychological issues and physical ailments,” writes Leys, meaning depression, obesity, and stress, as well as less obvious conditions. According to one expert, “Many primary-care doctors have found that patients ignore them when they suggest making appointments at separate mental health clinics… But if the primary-care doctor can send the patient down the hall to a mental health therapist in the same clinic or hospital wing, the patient is more likely to give counseling a try.”

Finally on Leys’ list, an increase in empty hospital beds could result from the attention being paid to excess hospitalizations and readmissions (all of which are cost factors).

But don’t worry. The beds may be emptier, but the baby boomers are about to explode on the medical scene again, with “a surge in demand for new hips, heart valves, and other worn-out parts.”

In other words, hospitals will always be needed.

What are some of the operational changes that have been brought about in your system thanks to the ACA? How is this affecting costs, quality, and efficiency within your organization?

-by Pete Fernbaugh

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