Question

HOM:

1.Analyze the operational implications of 2–3 current health care reforms and mandates that might affect the implementation of the initiative.

Answer 1

Patient Protection And Affordable Care Act describing the operational implications of current health care reforms. The implementation of the initiative include:

1. Accountable Care Organizations.

PPACA allows providers organized as accountable care organizations (ACOs) and that voluntarily meet quality thresholds to share in cost savings realized .by Medicare. To qualify as an ACO, organizations must agree to be accountable for the overall care
of their Medicare beneficiaries, have “adequate” participation of primary care physicians, define
processes to promote evidence-based medicine, report on quality and costs, and coordinate care.
Successful completion of these goals will likely reduce hospital utilization rates. This anticipated
reduction may create direct competition between physicians and hospitals, as the physicians will
be incentivized to reduce hospital admissions. Ultimately, the potential exists for a restructuring
of the traditional hospital-physician relationship.

2. Hospital-Acquired Conditions.

PPACA reduces Medicare payments to certain hospitals for hospi-
tal-acquired conditions by one percent (effective fiscal year 2015). This will incentivize hospitals
to improve their infection control programs and pay particular attention to the potential for other pay-
for-performance indicators. Hospitals are concerned, however, that PPACA does little to define the
word “condition.” Under PPACA, “hospital-acquired condition” means “a condition identified for pur-
poses of subsection (d)(4)(D)(iv)18 and any other condition determined appropriate by the Secretary
that an individual acquires during a stay in an applicable hospital as determined by the Secretary.”
Due to the vagueness of this language, hospitals are awaiting further guidance from the Secretary
regarding the scope of these provisions. Hospitals will want to participate in the notice and comment
opportunity regarding these definitions, so as to avoid being penalyzed for conditions that may
be acquired through no fault of the hospitals. In addition, administrative costs will increase due
to PPACA’s additional reporting requirements. A report on these infection rates will be provided
to hospitals and made available to the public.

3. Preventable Readmissions.

PPACA reduces Medicare payments that would otherwise be made
to hospitals by specified percentages to account for excess (i.e. preventable) hospital readmissions
(effective October 1, 2012). The Secretary is to determine what conditions are to be included and
what amounts to a readmission. The legislative text suggests that an admission to the same hospi-
tal within 30 days of the date of discharge could be considered a readmission. Again, hospitals will
want to participate in the regulatory process regarding definition of hospital readmissions to ensure
that the definition of hospital readmissions does include individuals who are readmitted through