Health Care Finance

 

1- As we have all heard and learned about how the ACA (Affordable Care Act) has changed the way that health care is both financed and delivered.  It continues to change the landscape not only of the health care industry but the overall US economy. Discuss one ACA provision and describe how it will impact healthcare finance.

After answering the discussion question in detail, please respond to at least two of your classmates.

Student 1:

The Affordable Care Act established the National Prevention, Health Promotion, and Public Health Council. The goal for this provision is to support preventive health care. There are seven areas that the National Prevention Strategy focuses on: tobacco-free living, preventing drug use and excessive alcohol abuse, healthy eating, active living, injury and violence-free living, reproductive and sexual health, and mental and emotional health. This provision has saved and will continue to save money on treatments (chemotherapy/radiation, rehabilitation, etc.) that could have been prevented if these people were living a healthy lifestyle. Making people aware of what they are putting into their body/doing to their body will educate them on what could happen to them if they continue to live the lifestyle they are living. Preventive care helps lower health care costs by preventing diseases before they require emergency room care.

Student 2:

The Patient Protection and Affordable Care Act, adopted in 2010, has the primary focus of helping all Americans obtain health insurance. This implementation initially increases the health care spending for the government, with the hopes that in the future it will decrease the overall spending on health care. One provision that came about with the ACA is the transition from fee-for-service payment to the bundled payment.

With the previous fee-for-service payment model, physicians and health care organizations would bill the consumer for each specific operation, procedure or visit using DRG and CPT codes. These codes gave a specific amount for each individual procedure, increasing the cost on the consumer and the health insurance companies. This model is thought to have been increasing the over all spending, with no solution. The ACA provision is helping transition to a bundled-payment method, which gives a set price physicians are reimbursed for each operation, procedure, visit, etc. If the physician spends more on a specific procedure than the reimbursement, the physician and health care organization eat that cost, not profiting.

This bundled payment model aims to decrease the health care governmental spending, while also increasing the quality of care for the consumer.