Regulatory Hurdles in U.S. Healthcare

This entry is part 1 of 2 in the series U.S. Healthcare Issues

New Regulatory Hurdles in U.S. Healthcare are evidently having a damaging effect on the quality and cost of day to day operations in a physician’s practice.

The Patient Protection and Affordable Care Act (ACA), or more commonly known as Obamacare, took effect in 2014. The law was designed to increase the quality of care and affordability of health insurance, all the while expanding insurance coverage and lowering health costs. The ACA was able to lead more than 20 million Americans, previously uninsured, to sign up for health insurance. Thus, the uninsured rate of non-elderly individuals had fallen to 10.5% – the lowest rate in decades.

However, when Congress implemented this national health law, it unleashed a swarm of newly insured patients. The American healthcare infrastructure already had a difficult time meeting patient demands and this law, in turn, put a strain on the delivery system. The training of new doctors, nurses, and other healthcare professionals’ takes years – often times, even decades. With a constant innovation occurring in the healthcare industry, not to mention implementation of new national health laws, this poses new challenges to healthcare providers, such as you.

Less amount of time spent with patients

ACA exchange plans have cut reimbursement by up to 40%. In turn, a decrease in reimbursement and non-clinical work has led many providers to see more patients in less amount of time. In fact, many providers are seeking assistance from nurse practitioners and assistants to help cover health care. However, they cannot replace the physician-patient relationship and this leads to loss of focus on the primary objective of care. If patients have access to a different physician every time they walk into your office, they might turn to a different provider in the long run.

An increase in paperwork

Fulfilling administrative and regulatory requirements takes a lot out of one’s time. Physicians are beginning to feel the strain of increasing electronic paperwork. After all, more patients lead to a need for more documentation. Rather than spending quality time with patients discussing and addressing any questions/concerns, physicians are now forced to enter patient information into a computer while talking with patients and their families. This work overload not only increases stress among the clinic staff, but patients also face an increase in wait times. For this reason, less quality time spent with each patient one on one can lead to decreased patient care and patient satisfaction.

Changes in reimbursement

The one universal rule about health care is that patients should have easy access to quality care and they should be able to choose the healthcare provider that they prefer. However, in several states, there are limited numbers of insurers and many institutions are not able to offer care to every insured individual due to terms of reimbursement. What this means is that if a patient’s health plan is no longer covered by a particular physician’s network, the patient may be forced to pay out of pocket in order to remain within the same care. If patients have to seek help from a different provider, it can take time to develop the doctor-patient relationship that is based on trust and understanding.

Continuous rise in health care costs

While the ACA prepared for health related costs, it underestimated the expenses associated with millions of newly insured Americans. This resulted in increased premiums for patients, anywhere from 5-45%. While many patients had insurance on paper, they could not afford to use their coverage due to high out of pocket costs. For providers, there was also the fear that many patients will stop paying premiums and the provider will be unable to recover their losses.

With a shift in a different payment model through Medicare and Medicaid, providers encouraged the adoption of value-based payment models over traditional fee-for-service models. Value-based takes into account the quality of care that patients are receiving, rather than the quantity of each individual service. Growing examples of reimbursement models include:

  • Bundled payment – a model that targets one payment price for multiple services (surgery, discharge, and rehabilitation services);
  • Shared savings – a payment strategy that rewards groups of physicians for their efforts and collaborations, thus distributing payment based on percentages of net savings and reducing overall health care spending;
  • Medical homes – a model of care that focuses on care coordination, patient engagement, health tracking, and population health management.

With the new initiative of Medicare and Medicaid services, another challenge is to replace outdated and difficult to use electronic health records (EHR) with greater automated solutions. The ultimate goal of this reform is not only to improve quality and efficiency but also to reduce costs and expand services in areas where they can help more and more patients.

The ACA is subject to change in the coming years and only time will tell how it will affect the changes in the U.S healthcare industry. For now, health care reform has and continues to have an impact on every aspect within society. To this day, doctors, patients, insurers, and more – each have their own tasks and priorities. However, in order to be successful in offering superior healthcare, reform must be centered around the patients – with a focus on delivering quality care and ensuring patient satisfaction.

If you want to overcome these hurdles so that your practice can continue to thrive, consider reading part 2 of this article: U.S. Healthcare: Practical Solutions. It illustrates what you can do to ensure your practice’s needs, offer quality care, and improve workflow.

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