Healthcare Legislation and Medicare Reimbursement

The health care legislation Patient Protection and Affordable Care Act known as Obamacare has resulted in various organizations analyzing the state of their organization and the ability of the organization to adapt to the changes that will need to occur with the advent of Obamacare policies. As the act requires agencies to adopt new mandates and practices it has created uncertainty within these agencies as they try to determine how the changes will be made. Concern over the state of the economy has also resulted in increased anxiety. Although the current economic state has vastly improved since the recession economists are hesitant to state that the economy has fully recovered. Unemployment has reduced, home prices have begun to climb and the country is no longer in a recession. However these gains can be reversed if the country was to find itself in another recession. Organizations must prepare themselves for this occurring however health care legislation has made it so these organizations have to make changes to adapt to the legislation.

Obamacare serves to ensure that every individual has health care coverage and that the costs associated with health care are significantly reduced. It does this through ensuring that insurance companies offer the same rates to all individuals regardless of pre-existing conditions. The health care reform legislation also increased the number of individuals who would be able to qualify for Medicare. This change means that health care agencies will see more individuals who need services. “There will be more individuals presenting themselves to physicians and hospitals, and there should be more funding to provide for the increased care burdens” (Souter, 54). Within the setting of an acute care facility which already sees a large number of patients on a daily basis the health care legislation will result in an even increased amount of individuals who are provided services. The fact that these individuals will be receiving medicare also complicates the issues as these agencies will have to wait for medicare reimbursement. Unlike with regular insurance, medicare may not reimburse the facility if certain problems arise during the patients care. These problems could include skin breakdowns, pressure sores, hospital-acquired infections or certain readmits. This means that services providers within the facility have to deal with increased patients but also must ensure that that these patients receive optimal care to ensure that they receive reimbursement for the services provided.

The acute care facility must take these considerations into account when planning their budget. The fact that the economy may be at risk for another recession means that the facility will need to have money set aside for emergencies. The changing legislation which results in increased patients means that the facility must hire new staff and ensure that they have enough resources to work with all of these patients. The budget must also account for the fact that Medicare may not reimburse certain services. This could be accounted for by having funds available in case medicare does not provide reimbursement. The budget could also allocate money towards increased training to ensure that the staff provides the best services possible.

While these changes are anxiety-provoking for the administration who must implement these changes, it can also be troublesome for employees who are uncertain about what will occur. Good leaders must be able to lead a discussion with the employees regarding the changes that will be occurring. A leader must be honest and straightforward with the employees to ensure that their worries are put to ease. A leader must also make himself available to his employees at all times to ensure that they can ask any questions. The leader will play a crucial role within the organization to ensure that the new policies are implemented and also that the staff is able to adjust to the changes. The leaders will play a vital role in the implementation of new healthcare legislation.

References

Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §2702, 124 Stat. 119, 318-319. (2010).

Souter, P. D., & Gurevitz, J. (2012). Health and Taxes: What Obamacare Now Means for Employers. Financial Executive, 28(7), 54-57.

Van Tassel, K. (2012). Harmonizing the Affordable Care Act (Obama Care) with the Three Main Systems for Healthcare Quality Improvement: The Tort, Licensure and Hospital Peer Review Systems.