Health Care Reform and Health Care Providers

Healthcare Training Resource
August 5, 2013 — 1,081 views  
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A landmark event in the health care reform arena has been the signing of the Patient Protection and Affordable Care Act (PPACA). This reform in health care was long awaited in view of the growing consumers and an overall increase in poor quality care services.

Importance of Health Care Services

Care is critical and required by everyone in society. However, the health care providers had not been attending to the required level of services, especially in context of quality. The recent reform is likely to change the way the industry has been functioning. If health is the universal and primary need of everyone, it is clear that health care facilities must be affordable to all. Prior to the reform, a significant segment of the population remained deprived of basic care because they could not afford it. Even those who could afford the cost of health care did not get a satisfactory level of service. 

PPACA has changed the way the health care industry works. The revenues to the health care providers will have less to do with the volume of the patients and more to do with cost efficiency, quality, and clinical outcomes. Also, the ‘accountable care’ has begun to take hold.  

Impact of Heath Care Reforms

PPACA is among the radical health care reforms that promise to make a tremendous impact on health care providers. It promises to lead to improved quality of care in addition to an increase in patients’ access to care. The cost of care is also expected to be under control. The reform makes a number of initiatives to meet these goals. The primary care physicians and the general surgeons will be paid 10 percent Medicare bonus payments if they are working in rural areas. This would be applicable between the year 2011 and 2016.

Quality metrics will be put in place to enable payments to physicians. In addition, disclosure requirements and regulatory compliance will be expanded. Abuse and fraud compliance has been expanded and the act has dedicated 200 million dollars over the next ten years to this purpose. Other than the policing role performed by the government, the physicians are put to active involvement by the PPACA to identify violations of Stark Law. The self disclosure protocol designed for this purpose has been prepared by the HHS or the Health and Human Services. There is also a provision in the PPACA known as the Physician Payments Sunshine Act, according to which companies are mandated to record and report any payment over $10 made to physicians.    

The measure of provider quality will be made more transparent through Physician Quality Reporting Initiative or PQRI published on the CMS website, Physician Compare. Although the participation in the program is voluntary, the provider will get Medicare incentive payments.

These reform measures are likely to meet the goal of quality care at an affordable cost. What is even more important is that these reform measures will eventually benefit both the providers as well as the consumers.  

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