Question

In a 3- to 5- page paper, critique Vogenberg & Smart (2018) and discuss the impact of changing laws and regulations on healthcare delivery and the practice of public health.

Answer 1

The Importance of Healthcare Policy And Procedures

Health care policies and procedures aim to provide standardization of day-to-day operating activities. In our many years of working with policies and procedures, it has become clear to us that in coping with problems and practices that are important to health and safety, legal obligations and regulatory requirements, they are necessary for clarification. The value of health policies and procedures can not be questioned but the manner in which they are best handled can differ from one company to the next. Since the importance of manuals of policies and procedures may not be as obvious as it ought to be, we thought it would be resourceful to share our expertise on the matter. On our end, we are trying to build practical strategies, to help manage policies and other documents to improve a health care facility's effectiveness and quality, and to ensure that it does not break any regulations. Having said that, we recognize that we may not be the cup of tea for every organization and another vendor could deliver a better match.

Healthcare policy is vitally important as it sets out a general action plan that is used to guide desired outcomes and is a basic framework for decision making. Health care policies and practices aim to convey the organization's desired results to workers. They help workers understand their positions within the company and their responsibilities. Specifically, legislation should lay the groundwork for providing secure and cost-effective quality care in healthcare environments.

As new laws and standards such as the Affordable Care Act, HIPAA, and Practical Usage continue to grow, the responsibility of setting policies and communicating them efficiently to workers has become burdensome.

New Laws And Regulations

Policies must be developed and disseminated to workers for any new law or regulation, whether new or revised. The Affordable Care Act, other federal health-care provisions, state laws and regulations, CMS terms of membership, Joint Commission standards and other accreditation criteria are constantly evolving. This makes it difficult to ensure not only that proper policies are developed but that they are effectively communicated to the employees. The existing decision management systems for managing policies are therefore no longer viable and can jeopardize the organisation. Only keeping up with any new legislation or regulatory reform is difficult as it is just as hard to ensure that policies and procedures are efficiently carried out to workers as well. The challenge of ensuring that policies and protocols are up-to - date, accessible, and efficiently shared within the enterprise can be very difficult with the rapid pace of new and revised laws and regulations that providers must address. Here is where more state-of-the-art tools for policy management will improve.

Health care Reform

Although a number of ACA provisions will not be enforced until 2014, many components of the law will become a reality in the next 2 years, promoting risk sharing among providers and the CMS. Final rules for Accountable Care Organizations (ACOs) were published in October 2011 in order to provide guidelines to entities that are prepared to take financial responsibility for the total Medicare beneficiariesA radical change to this type of performance-based treatment is likely if the Medicare experiment with ACOs is successful. The ability of pharmacy suppliers and managers to explain and record the importance of these ACOs is an essential opportunity to extend the current scope of practice and begin formulating pharmacist-service reimbursement models. In these ACOs, the value that drug therapy managers bring to patients could dramatically turn pharmacy practice from a product-reimbursed career to a service-reimbursed one.

Medicare's pilot payment model follows a similar approach to organized treatment by bundling payments for all services from 3 days to 30 days after discharge before a patient's hospital admission. Since a panel to discuss "never incidents" (preventable medical errors that should never occur in a hospital) was set up by the CMS, as acknowledged by the National Quality Forum, and physician profiling, proper use of medicines during the post-discharge period was necessary.

Implementing the proposal to fix these "never-events" would adversely impact financially on institutions that mismanage patient care. Through these numerous ACA required programs, pharmacists and other clinicians have the ability to extend their positions on health care teams and, possibly, their area of practice.

Forms in payment for Medicare are important aspects of both the ACA and other plans for a federal deficit reduction. Many of these measures favor efficiency and reliability for the amount of services that they offer. For example, reductions to Medicare Advantage plans under the ACA are linked to quality-driven benchmarks. Similarly, Value Based Purchase Payment (VBPP) schemes are expected to be set up at the end of 2012 to pay for acute care hospitals on the basis of clear performance thresholds being achieved. Physician payment systems in their infancy would depend on achievement of established quality targets. The CMS is mandated to provide recommendations to Congress for the implementation of VBPPs in other settings and it can be assumed that quality-based reimbursement in long-term care (LTC) facilities, hospice services and other settings will be included in these recommendations for potential implementation

ACA regulations have significantly strengthened the provisions of the 2003 Medicare Modernization Act (MMA) creating Drug Therapy Management (MTM) programs in Medicare Part D. Again, a big opportunity has been given to practitioners in a number of health-care environments, and their quality and reimbursement may depend on proven merit.

Lastly, the ACA regulations would in many ways have a spillover impact on the pharmaceutical industry and on the prices and accessibility of drug products. In February 2012, as a result of the mandates in the ACA, the FDA released new rules for a systematic process for authorizing biosimilars (generic biologics). These provisions allow for a period of exclusivity for innovator biologics and as well as guidelines for the speedier introduction of biosimilar alternatives.

Centers for Medicare & Medicaid Services (CMS) Regulatory initiatives

The fact that the CMS and other agencies are empowered to establish guidelines for administering the services approved by Congress is an frequently ignored element of the federal direction of the health care system. These agencies may need to review certain rules and issue exceptions. In this period of extraordinarily tight state budgets, the CMS was overwhelmed with requests to authorize adjustments in public health programmes, Particularly Medicaid. These exemptions demands also aim to cut funding for the indigent and the elderly in this critical programme. Reductions in drug reimbursements, limits on access to LTC hospitals, and cuts for various ancillary services and initiatives make the healthcare sector a difficult business environment.

The latest draft regulation on the inclusion of LTC facilities in Medicare's prescription drug insurance program is an example of the effect that executive agencies have on the healthcare industry. This regulation allows consulting pharmacists at the LTC facility to have no association with the distribution pharmacy or a pharmaceutical producer of the facility. Although this provision has taken root in some states, the CMS ruling demands a fundamental transformation of the LTC pharmacy model , creating valuable career opportunities for certain stakeholders while posing a market challenge for others.

The profound impact of introducing health care reform, attempts to rein in the federal budget deficit, and review of such operations by the judiciary branch can not be overestimated. Pharmacists, surgeons, and other professionals need to be mindful of the laws that are being discussed by Congress and the judicial branch. The result of these decisions will alter the structure of health care organizations; how individual clients are reimbursed; how the position of physicians may change; and, eventually, how patients are handled. Successful budget deals in Congress would have a trickle-down impact on federally sponsored initiatives as well as total state funding.

This delicate economic and clinical balance faces the stresses of rising costs in medical environments driven by technology and the increasing adoption of genomics and biotechnology solutions which could have a drastic impact on patient care and on professional clinical practice.However, this modern approach, with its focus on the importance of clinical results, will also provide opportunities to develop their business model for creative and enterprising health care practitioners.

The degree to which physicians, including pharmacists, participate in practices that promote patient care and are compatible with the goals set out in the ACA and CMS guidelines may assess the probability of success in preventing legislative or legal dilemmas surrounding reimbursements or standards of practice. In addition , increased fraud and abuse monitoring, as advocated by the ACA, would continue to tighten legal – regulatory restrictions on physicians while exposing those outside the system to faster inquiries or disciplinary action.