Are You Ready? Relevant Trends in Healthcare Reform

The Affordable Care Act (aka Obamacare) is here. The biggest pieces of the Affordable Care Act go into effect now. With the latest report, the federal enrollment website has enrolled 2.1 million people. The open enrollment period for 2014 ends on March 31, so there could be another wave of last-minute signups. While Federal Administration has been backing away from its early suggestions that 7 million people would be the goal for the exchanges, additional enrollees are likely.

While the drama surrounding the enrollment website debacle has taken the majority of the news headlines the past 3 months, the real attention must focus on a number of changes for all consumers of healthcare. There are a number of trends percolating that change the way average health care consumers will interact with health care providers.

Focus on Quality Outcomes
Hospitals, physicians, home care providers are all being held accountable to meet the outcomes set by Medicare and other payors. Only providers who demonstrate improved quality, reduced costs and positive patient service satisfaction will be financially rewarded. These programs involve various quality measures that reward high-performing health care providers with money taken from poor performers in the form of penalties. – See more at:

Evidence-based practice
Research results and practice that is based on solid evidence will be required as payers look for the best patient outcomes. Patients are expected to follow through on the recommendations once they are home. Patient Care Navigators employed by the hospitals and Medicare-certified Home Health Agencies will follow many people back home to help with the transition.

Transitions of care: Focus on Reducing Hospital Admissions
What may seem quite obvious to the healthcare team in the hospital is not for the patient upon arrival back home. Patients are still ill and not in the best frame of mind when transitioning from hospital to home to fully comprehend what is happening. They are overwhelmed.

The key pieces needed for a successful transition to home without a trip BACK to the hospital include a full understanding of the medical diagnosis and the health habits that need to be adopted, clear understanding of discharge instructions that were sent home with them, a complete understanding of what drugs they are to stop or continue that they previously took and filling the prescription and successfully adding the new prescribed medications to their medication routine. It is also imperative that all patients schedule and see their primary care doctor within the first 7 days that they are home. A car accident, heart attack, abdominal surgery, a knee replacement, and most other medical problems that cause a hospitalization are overwhelming to the average person and require more than family support in the transition home. The evidence proves that failure to follow through with one or more of the above will result in another hospital stay in less than 30 days.

When a patient leaves the hospital with a diagnosis that is identified to be at higher risk for readmission to the hospital, they can now expect a daily phone call to check in on them. The doctor’s office is required to call within two days of discharge, and many health systems are employing navigators in a large effort to reduce hospital readmissions and to track daily progress after discharge. Medicare-certified home health agencies provide visits two to three times a week until the patient is stable and able to fully implement their new plan of care on their own.

The Focus on Wellness Will Get Serious and Patients Will Be Held Accountable
Health care providers are holding patients accountable to make appropriate lifestyle changes and follow medical recommendations. There will be less opportunity for the individual to refuse to make unhealthy decisions. In fact, it’s likely that some patients may be forced to look for new health care providers. Several recent stories report patients being fired by their primary care provider for non-adherence to health recommendations.

Health care providers need to evaluate their own lifestyles as their words will fall on deaf ears with patients if professionals don’t practice what they preach. In fact, <a href=” Healthy Nurse Widget ” title=”The American Nurses Association (ANA) recognizes this issue”> to be so important that the ANA is providing a comprehensive health risk appraisal (HRA) with funding from Pfizer so nurses can set an example on how to BE healthy.

Lower Medicare and Other Insurance Reimbursements
More health care system consolidation, and refocused business strategy will take place. Hospital lay-offs are expected as more focus and efforts will occur to keep patients out of the hospital. Health care professionals will need to apply their skills to reengineered positions and settings.

Higher Employee Cost Share in Insurance Premiums
Employers have seen exponential premium increases over the past few years. Employers are passing on more of the costs to the employee but are providing more information about price and quality of the plans provided. High deductibles are here to stay. Labor negotiations are projected to result in a trade off of salary increases with creative health benefit plans.

Which of these trends have you experienced?

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