Impact of the Health Care Reform Act on Medicare and Provider Payment Models
Introduction
The Patient Protection and Affordable Care Act of 2010, which is colloquially known as the Health Care Reform Act, has been a major catalyst for change within the US healthcare system. One of its pivotal contributions is the restructuring of financial arrangements among hospitals, physicians, and other providers dealing with Medicare through the introduction of a bundled payment system. Previously, Medicare utilized a fee-for-service payment model (Cleverley & Cleverley, 2019). In this structure, each provider involved in a patient’s care is billed separately for their services, leading to fragmented care and increased healthcare costs. The Health Care Reform Act aimed to address these issues by implementing the bundled payment approach.
Changes Brought by the Health Care Reform Act
Under this new approach, a single payment is made for all care obtained by a beneficiary from 72 hours before an individual’s admission to 30 days after their discharge from a healthcare unit. This payment includes hospitalization, physician fees, tests, treatments, and post-discharge care like rehabilitation or home health services (Cleverley & Cleverley, 2019). One should note that the system was designed to encourage coordinated care among all providers involved in a patient’s journey.
The shift towards bundled payments under the Health Care Reform Act has had a significant impact on the way physicians, hospitals, and other providers operate. It incentivizes providers to work collaboratively in order to deliver cost-effective, high-quality care. Furthermore, this approach also challenges providers to be more accountable, efficient, and patient-centered. Preventive measures and careful planning are promoted in this case to avoid unnecessary services or hospital readmissions, which would now come at a cost to the providers (Cleverley & Cleverley, 2019). This system also presents new challenges, such as managing financial risks and the logistical complexities of coordinating care among multiple providers.
Conclusion
In conclusion, it is possible to state that the Health Care Reform Act has profoundly reshaped the financial landscape in association with Medicare. Altering payment models encourages a more integrated and patient-focused approach to healthcare. This result is achieved through pushing the system toward improved patient outcomes, the quality of care, and cost efficiency.
Reference
Cleverley, W. O., & Cleverley, J. O. (2019). Essentials of health care finance (8th ed.). Jones & Bartlett Learning.