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HCA 812 Week 6 Discussion Question One

HCA 812 Week 6 Discussion Question One

 

The Affordable Care Act (ACA) will certainly have an economic influence on American consumers and providers of health care insurance. To what extent might the ACA influence the fiscal stability of health care organizations? Why?

To provide an overview of key elements of the Affordable Care Act (ACA). To evaluate ways in which the ACA will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the ACA.

Data Sources and Synthesis
Data sources for this concise review include search results from the PubMed and Embase databases, as well as sources relevant to public policy such as the text of the Patient Protection and Affordable Care Act and reports of the Congressional Budget Office (CBO).

HCA 812 Week 6 Discussion Question One

HCA 812 Week 6 Discussion Question One

As all of the ACA’s provisions will not be fully implemented until 2019, we also drew upon cost, population and utilization projections as well as the experience of existing state-based healthcare reforms.

Conclusion
The ACA represents the furthest reaching regulatory changes in the US healthcare system since the 1965 Medicare and Medicaid provisions of the Social Security Act. The ACA aims to expand health insurance coverage to millions of Americans and place an emphasis on quality and cost-effectiveness of care. From models which link pay and performance to those which center on episodic care, the ACA outlines sweeping changes to health systems, reimbursement structures, and the delivery of critical care. Staffing models that include daily rounding by an intensivist, palliative care integration, and expansion of the role of telemedicine in areas where intensivists are inaccessible are potential strategies that may improve quality and profitability of ICU care in the post-ACA era.

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Key words for indexing: health care reform, health care quality, access and evaluation, delivery of health care, health services administration, critical care, health care costs, patient protection and affordable care act, policy
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Introduction
The Affordable Care Act (ACA) consists of two pieces of legislation: the Patient Protection and Affordable Care Act (PPACA), which was signed into law on March 23, 2010; and the Health and Education Reconciliation Act, which was enacted on March 30, 2010 (1, 2). The ACA, which was upheld by the United States Supreme Court in the case National Federation of Independent Business v. Sebelius on June 28, 2012, is a complex and multifaceted piece of legislation consisting of 10 separate legislative Titles each with a variety of goals.

This article aims to provide an overview of key elements of this far-reaching legislation, as well as a summary of potential implications that it may have for the ICU including a discussion of ICU care and staffing paradigms that may be best-suited to the evolving payment models brought about by the ACA. The ACA has been challenged numerous times within both the legislative and judicial arms of the federal government and has survived all of those challenges. It appears, at least for now, that the ACA is here to stay. Of course, no one really knows for sure, as a change in party control through the 2016 election could support fresh challenges. Given the act appears stable for now, this article should prove useful to those interested in what the implications of the act may be at the level of the ICU.

The centerpiece of the ACA aims to expand health insurance coverage to cut the number of uninsured in America by more than half. The Congressional Budget Office (CBO) has projected that once all of its provisions have been fully implemented, approximately 94% of the American population will have health insurance coverage, which represents a 31 million person reduction in the uninsured population (3). Nearly half of this reduction is anticipated to come from expanded Medicaid enrollment with a projected 15 million person increase in Medicaid beneficiaries. Additional mechanisms for expanded health insurance coverage include an employer mandate, setup of health insurance exchanges, subsidies for exchange consumers to buy coverage, and tax credits for small businesses.

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