Change in Hospice Operations - Paper Example

The Patient Protection and Affordable Care Act was revised by the Health and Education Reconciliation Act and signed by the former President of United States Barrack Obama on 23rd March 2010. The Act ensures that every American can access a quality as well as affordable healthcare. In addition to that, the Act creates a transformation within the healthcare system that ensures containment of costs. Moreover, the act is fully paid for, thus giving many Americans a quality health insurance they deserve. The Affordable Care Act provides new rights, benefits as well as protections for the people of America by creating subsidies, setting up consumer protection, creating insurance industry, imposing new taxes and much more. Many people are embracing the act and believe it caters for all their needs especially women. Beforehand, women and young women who had pre-existing insurance conditions were not covered by insurance companies. Well, it is good to note that the Affordable Care Act comes with many "Expansion of Public Programs" that make changes to the whole medical industry (Buntin, 2010).In this paper, I will examine and discuss the major changes in the healthcare system or hospital operations in response to the Patient Protection and Affordable Care Act.

Discussion

The Patient Protection and Affordable Care Act (PPACA) has impact on various hospital programs or operations; there will be new insurance regulations and avenues for conveying essential medical services. The healthcare industry is poised to go through changes in the following (Moon, 2012);

Staffing or workforce development

Through the Affordable care act, about 30 million American people are expected to be able to access health insurance. Therefore, a sizable and healthy workforce will be required to meet the increasing demands. It will be essential to evaluate whether the current as well as the projected size of healthcare staff, that is specific types of clinicians and particular regions can be sufficient enough to meet this demand. In fact, the healthcare staff is now experiencing a severe loss of health specialists over the next years. The Obamacare analyses the promises of quality and access to care for every American out there by intensifying the shortage and escalating the stress and burden on a system that is presently fragile. The Affordable Care Act tries to report the scarcity are unverified and also scarce in scope, as well as the essential monetary investment will not yield any results for some time because of the training pipeline. Looking at Obamacare's projected one hundred and ninety million hours of paperwork in a year that is enacted on the healthcare industry, businesses, combined with scarcities of staff, patients are bound to face an increasing cry times. Additionally, the patients will have limited access to providers, decreased satisfaction and reduced time with caregivers. The healthcare staff is undergoing instability and stress as well as a critical reform of the workforce is required to extend care to many American people. Nonetheless, the government will make funds available for the states and additional entities to expand the healthcare staffing levels including forgiveness programs, student loan repayment, and scholarships for improved training programs for a selection of healthcare experts like nurses (Foster, 2010).

Health Insurance Oversight and Regulation

The Obamacare established some "early market reforms," options and additional requirements that added to the already existing regulations of the health insurances. The legislature requires a careful consideration of how its rules and statutes governing health insurers as well as health plans line up with the new federal regulations and standard sets of benefits that are about to be enjoyed by persons who are participating in the healthcare benefit exchange. The set Obamacare's care policies took effect within states. There was a change in the standard- price insurance coverage for people who already had pre-existing conditions. The act allowed coverage of young adults by the health insurance until they are 26 years of age. Also, there was an increase in a review of premium rates, reduced employer shares for those retired people between the age of 55 years and 64 years and patients' privileges to appeal were denied coverage. Dozens of permissible exceptions, features as well as free federal scholarships or grants have taken effect in response to the affordable care Act; preventive services as well as screenings to be done without any co-payments. Moreover, there is more uniform mandated essential benefits, options for out-of-state or multi-state health insurance buying and no annual or lifetime limits standard policies (Williams, 2011).

Additionally, the act contained Godfathered plans that ought to defend the ability of businesses and people to maintain their current program, despite the fact that they still are still providing significant consumer protections that allow people of America to control their health care. The Obamacare also had prevention regulations that required new health plans s as to cover some evidence-based preventive services hence eradicating the cost-sharing requirements for the offered services. Students were also included in the Obamacare act. Their insurance health plans are bought if a family coverage is not possible.

Before the amendment of the Affordable Care Act, non-governmental plans and self- funded were allowed to elect to exempt programs from specific provisions. However, the Affordable Care Act enabled a series of changes, i.e., self-funded or non-governmental plans can no longer opt out like before. Enforcement of market reforms in states which are not directly enforcing them or have not integrated a collaborative arrangement which is done through CMS is essential to ensure that consumers' protection is assured.

Competition

The Affordable care act possesses one of the most noticeable features which is promoting individual plans that are chosen by consumers at marketplaces. Well, these programs have become a subject to regulation. Also, they are they are paid through a risk-adjusted capitation as well as set policies identified as competition. According to the Obama administration, the majority of the people purchased their insurance through centralized marketplace had better, and more significant choices of health plans and premiums were fewer in counties where they were more insurers who were competing for business.

Basing on federal data, the primary insurer who was in possession of over half of single market enrollment in twenty-eight states plus the District of Columbia. On the other hand, in Rhode Island and Vermont, the primary insurer had more than 90%market shares.

Fig.1

Fig.2

In the year 2014, an estimated number of 6.7 million Americans joined in the coverage through the marketplaces. Therefore, the total enrollment that is on and off markets increased from 10.6 million to 15.6 million. Still, you find that states like New York City with a 141% grew more compared to other countries such Ohio which had a 14 %. Thus, it would be right to say that insurers in every state welcomed new members. Therefore, the market competition either decreased or increased under the Affordable Care Act (CCH Incorporated, 2010).

Changes in the competition were visible when the Herfindahl-Hirschman Index is compared to states' markets in the year 2013 and the year 2014. If the HHI is smaller, then there is more competition, and if the HHI is more substantial, there is more market concentration.

As from the year 2013 all the way to 20014, there was an increase in individual market competition 20 states. For instance, Wellmark is an insurer in Lowa which had a decreased HHI thus leading to loss of market share.

Mergers

The hospice industry is faced with significant systematic changes that are as a result of federal policies. Most of the hospitals see the expansion of scale as an opportunity for them to be able to do away with costs through mergers. The Obamacare Act has been helpful on this issue as its incentives have enabled these hospitals to cut costs, benefit their customers as well as improving quality. As hospitals evaluate the effect of mergers in an Affordable Care ACT environment, they have no illusions, and they know that the law intervenes to stop mergers that are only going to create market power as well as harm consumers. The Obamacare Act does not interfere with the Clayton Act of hospital merges. However, the act is independently taking hold in the marketplace with considerable effect on the realities of hospice competition and economics.

Healthcare reform and realignment in merging hospitals is significant because they explain as to why there are so many hospitals that are looking to consolidate with a more substantial system for reasons unrelated to competition for market power. The act leaves a room for the parties to explain how the merger will suffer if one or both of the two is not able to adapt to the directives of health reform because of faults in economies and capital and absence of competition. The health reform by the PPACA included new models of payment and decreased Medicare reimbursements.

Every employer has the notion that the Obamacare imposes health care insurance coverage regulations upon some employers who have some "full-time equivalent employees." So, if parties are involved I a merger then it is essential to consider if the parties are current subjects to the requests of the Obamacare (CCH Incorporated, 2010).

In any case, the sell or even the buyer of a hospital is a small business; it means that the hospital has "full-time equivalent employees" less than 50. Therefore, that kind of a hospital would not be considered a subject to the Affordable Care Act. In this case, a determination has to be made so as know if individuals who are perceived as independent contractors are for Obamacare Act or they are just deemed employees. The Obama administration has aggressively and uniquely interpreted the Affordable Care Act to attain such objectives.

Conclusion

The Affordable Care Act has helped the lives of many people especially the poor, disabled and others. In the hospice industry, different areas have been changed trying to conform to the Act. Well, it has changed positively and negatively.

References

Buntin, B. M., Jain, H. S., & Blumenthal, D. (2010). Patient Protection and Affordable Care Act:

Laying the infrastructure for national health reform. Health Reforms, 29 (6), 1214-1219

CCH Incorporated & Kluwer, W. (2010). Law, explanation and analysis of the Patient

Protection and Affordable Care Act: Including Reconciliation Act impact, Volume 1.

Chicago, IL: CCH Incorporated

Foster, S. R. (2010). Estimated financial effects of the Patient Protection and Affordable Care

Act, as Amended. DIANE Publishing

Moon, M. (2012). Medicare and the affordable care act. Journal of aging & social policy, 24(2),

233-247.

Williams, A. R. (2011). Healthcare disparities at the crossroads with healthcare reform. New

York, NY: Springer